Tag: KCU

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!

Premed Series: MD versus DO?

Hello hello!

Now, I wasn’t sure what ya’ll really wanted to know from this. By the time you are applying to medical school you likely have a good grasp on the differences between MD and DO. It will be a bit more DO heavy, and will obviously be based on how I’ve experienced this at KCU. But just in case you are still deciding and this is the beginning of your journey, OR you want some more clarification, keep reading!

What does MD and DO stand for?

Ah, I’m so glad you asked.

MD stands for Medicinae doctor, which is a fancy way of saying Doctor of Medicine. It is the allopathic branch of medicine here in the United States. It is one of the main forms of Western medicine that we recognize today. According to thenewmedicine.org, allopathic medicine became more official after creating the American Medical Association in 1848.

DO came around much later than MD, so we aren’t as fancy in the Latin naming department. But DO stands for Doctor of Osteopathic medicine. I can give you way more information about DO simply because I’m studying it. But long story short, a guy in Missouri by the name of A.T. Still created this branch of medicine in 1874. Better yet, he is quoted stating “On June 22nd 1874,  I flung to the breeze the banner of Osteopathy“. I have a whole blog post on Osteopathy here. 

What differentiates them now?

So, because osteopathy turned osteopathic medicine was seen as voodoo and witchcraft if you will for awhile by allopathic doctors, there was a period of time where they offered DO’s to get their MD license for a certain fee. I don’t remember the year. It’s somewhere in my notes and I’m too lazy to go hunt for it. Just take my word.

However, the DO’s fought strongly if you will, and eventually became accepted (to a degree). There is still some backlash by certain MD’s, particularly of the almost retired age. But, we literally do the same things MD’s do in every aspect except we use OMT (osteopathic manipulative medicine). In layman’s terms it means that “bone popping” stuff, but we do so much more than that. Popping, or as we call it HVLA (high velocity low amplitude) is a very small portion of OMT. And in all reality, just because you want something popped doesn’t mean you need it.

So, if you decide to pursue the osteopathic route, you do a bit extra. We call it “an extra tool in our toolbox” to treat patients. Not all DO’s once they graduate incorporate it as not every specialty may call for it.  On the flip side, many DO’s still incorporate some techniques into their practices.

What does this mean as a DO student?

When you first start out in your first 2 years (or didactics), you learn your coursework for your systems, you start learning how to be a doctor such as physical exam skills, learning to interview, and using that shiny new stethoscope. You also start learning how to do OMT! At the very beginning of learning OMT, you have absolutely no idea what you are doing. To be frank, there are somethings I’m really good at and others I absolutely suck at. Sometimes you just can’t feel it.

So you start learning how to try to “train” your hands and you start learning a bunch of ways to diagnose someone along with a bunch of techniques. You get tested both on written exams on these principles and how to do these techniques. You will also be tested on if your hands can produce the diagnosis and treatment as well. Our school calls them CPA’s, and they are a big chunk of our grade. The downside to when you first start is on one task, they ask you to diagnose your patient. But on the second task, they ask for a completely different treatment (unrelated to your diagnosis) to show them. This plainly is because you haven’t learned enough and they want to make sure you know how to do the treatments that they have been teaching you.

The further in you get, you will be asked to diagnose and then treat either the problem you found with a treatment of your choice OR they will give you a modality to use, and it is up to you to use it correctly for the problem at hand.

What are these treatment modalities you keep throwing around?

Basically, they are the different ways I can treat you for the problem that I find. Sometimes, depending on if you’ve injured yourself, you are sick, or your body just doesn’t like certain treatments, we may pick an indirect technique. Usually more healthy patients can tolerate direct techniques. But every patient and body is different. I won’t necessarily delve too much into this. That’s what going to osteopathic medical school is for!

Modalities are as follows:

  • Soft tissue (ST) which is direct
  • Myofascial release (MFR) which is direct or indirect
  • Articulatory (ART) is direct
  • Facilitated positional release (FPR) which is indirect
  • Balanced ligamentous tension (BLT) is also indirect
  • Still’s (named after the original bone wizard A.T. Still!) can be either
  • Muscle energy (ME) is direct
  • High velocity low amplitude (HVLA) is direct
  • Counterstrain (CS) is indirect
  • Chapman’s points and Viscerosomatics typically fall under direct.
  • Craniosacral can be direct or indirect.

What is the difference in schooling?

Well, we mostly covered that above. DO students spend extra time learning OMT and there is a large focus on treating the patient as a whole, not just a specific problem. But other than that, we learn the same things.

However, different schools (even within MD and DO) go about teaching in different ways. This is why going to the school’s site you are interested in is important. The gist of your questions are the same no matter what type of school you are looking at though.

So what does that look like?

  • Does your school go by a traditional grading system (like KCU) or do they do a P/F system?
  • Do they go by systems or subject?
  • Are your courses longitudinal or block? Are they mixed? For example, KCU is taught by systems in a block schedule. So we do one main subject for x amount of weeks before we move onto the next one. Then we have a handful of longitudinal courses that go all year round. So, I may only have 3 or 4 classes total, with one main one. Another school may have 7 classes that go all year round.
  • Do you have cadavers or is it virtual? Personally, I really enjoyed having a cadaver. Made things more realistic. Turns out main structures can be tough to get too, yet oh so delicate at the same time.
  • What type of services do they offer students?
  • Is the campus more student friendly or more traditional in the sense that it is faculty based?
  • How much exposure and practice does the school integrate when it comes to practicing my exam and patient interviewing skills?
  • How does the school prepare you for boards? How well has the school ranked with board scores?
  • If you are interested in research, are there opportunities for this?

You get the idea. All of these things are important when looking at schools to apply at. Not only do you need to look at the specific schools website for some of this, but you may need to scour additional sites to get a better idea per the students.

Just remember, med students can get pretty salty so take it with a grain of salt. Ha, hahaha. 

What are the differences for getting into medical school?

Honestly, they are pretty much the same. You need to have the basic pre-med/science courses down. Each school may require slightly different “required” courses versus “recommended” courses. Check out my “Pre-Med Courses: What to Take Before Medical School” post for more information.

Before you get too far into undergrad, make sure you’ve looked at some medical school sites to see what those courses are. You want to have enough time to incorporate any additional courses that aren’t in your required major, but that schools you are interested in going to require/favor so you don’t have to spend money on postbac courses.

What you need for your application:

  • Required and recommended science courses (which do slightly vary from school to school).
  • A good GPA. High overall GPA is always good, but you need to make sure your science only GPA is also high.
  • MCAT. You aren’t really getting out of this unless you do one of those fancy programs from high school to medical school. Honestly, I think taking the MCAT (even if it is a beast) is a necessary step to growing as an individual. You need to learn failure and hardworking at some point in life. The current average MCAT score is 500. Most schools won’t look at you if you are below this unless you have a super compelling application outside of that. Some schools don’t give you the time of day unless you meet their average. Such as the top 10 schools, coastal schools, etc want a higher MCAT score.
  • Volunteering. You need a good mix of medical and what you are personally interested in. By the time you get to applying, they mostly look at what you did in undergrad. Unless you did something for all 4 years of high school, they likely won’t care. They want to know that you could balance extra things in undergrad while prepping for medical school. There is no set number, But the more you are able to incorporate with different experiences the better. And honestly, pick a few things or one thing that you are really passionate about outside of medicine. Passion shines brighter than mediocre requirements.
  • Shadowing. A must. You need to show you’ve seen what the field is like. For DO students/applicants, it is highly recommended that you’ve shadowed a DO. Find out with each specific schools if this is required or recommended. Why? No clue. They literally do the same things. But, that’s what DO schools like to see.
  • Even better than shadowing is patient care experience. Get in there and get your hands dirty! You are also more apt to get a good letter of rec this way.
  • Speaking of Letter of Rec’s, you need these. Usually 3 is good, sometimes up to 5 is fine. Anything else and they won’t look. Make sure they are strong though. Don’t just ask someone that doesn’t know you well. And for DO schools, you need at least 1 DO to write you a letter of rec. Again, most of the time DO schools prefer a letter of rec be from a DO, but it is not necessary for all DO schools. In general, make sure you are making strong connections so they have positive things to write about you. You usually need 1-2 science professors and a physician. Each school has separate requirements for this as well, so make sure to peruse the sites so you have what they want. Otherwise, they will just toss your application out.
  • Research. I honestly didn’t really do this, but for MD schools they look very favorably on this. But in general, the more you are able to immerse yourself into the science and medical fields before-hand, the better.
  • Have a list of meaningful experiences and why. These will be your highlighted achievements when filling out your application. They can be from the above categories, but you need to make sure you have a compelling reason as to why they were meaningful to you and how they will help you in medical school OR how they have helped you grow as a person, which makes you ready for medical school.
  • And lastly, that darn personal statement. I hated this. There is no great way for you to go about this. Just start writing why you want to go into medicine. Throw in some main meaningful experiences, or one main one that helped guide you to your choice of medicine. You are going to rewrite this thing a million times. And if you have to reapply for the following cycle, you will probably completely re-edit it. My advice? Make sure someone else reads it. Preferably someone in the field, but you need to make sure it is a strong piece of literature written about yourself that sells you well.

What are the differences in boards?

Same thing as previous honestly. The COMLEX which is what DO’s take has OMM (osteopathic manipulative medicine) woven in. MD’s take USMLE. Everyone takes a step 1, step 2, and step 3. You don’t get out of it either way. DO’s can take both the COMLEX and USMLE, however MD’s can only take the USMLE.

You will mostly use the same resources to study for both. First Aid is still the biggest tool, along with U world questions and pathoma. Other favorites include things like Sketchy, Boards and Beyond, Doctors In training, Kaplan, and other question banks.

When taking the exam, the style is a little different. However they just revamped the test in early 2019, as the amount of answer options varied between the two exams. I will let you know more about them once I take them this summer!

What are the differences in residencies between the two?

Previously, the match for residencies was separate. So if you wanted to go to a more MD focused residency as a DO, you’d have a harder time getting in. Vice versa for MD students. They did take students with outstanding applications though (or so I’ve heard).

In 2020, the residencies for both MD and DO will merge as one. So technically, each site should take either COMLEX or USMLE and they are supposed to be seen as equal. However, there are still some MD specific places that are not as friendly towards DO applicants and do not see the COMLEX as equal as the USMLE. I’m assuming the same if it is vice versa with some DO residencies and MD applicants.

If you are interested in a more MD oriented-type of residency in the future, you will be looking to see how many DO’s they tend to take. Most DO residencies don’t restrict on MD students unless they are very focused on integrating OMM. The hope with the merger is that they are seen as equals (because they literally are outside of OMM?) and to incorporate a more diverse set of doctors.

Hopefully with the merger in years to come, there won’t be a difference in the types of residencies.

I have also learned that regardless of those “average” board scores that you see in some of those charts *cough cough*, the main takeaway is you need to interview at a certain number of residencies to get placed. A lot of times, if you interview at enough places, your board scores and that fact that you are a DO who didn’t take USMLE doesn’t really matter.

However, if you wish to go to a more academic institution for residency REGARDLESS of what degree you have or residency you are looking for, you do need to have research on your CV. They don’t tend to take students who haven’t done research. They also tend to have you do research while in your residency as well. And if you are considering a surgical specialty, it is always a better plus that you have some research on your CV as surgical specialties tend to do more research as well.

Do MD’s and DO’s practice differently?

Not really, no. Again, some DO’s don’t use OMT at all while some do. Medical procedures and the art of taking a history, doing a physical exam, and treating patients is exactly the same. However, if a DO does use OMT, they can bill it as a procedure. Just like if you were to get a knee injection, or get your dislocated shoulder back into place, or get an IUD placed. Other than that, they practice in the same capacity.

I hope this was helpful! Let me know if there are other aspects of MD vs DO that you would like me to talk about. Cheers!