So you want to go to med school, huh?

Well, to survive the first two years, all you need to do is memorize this information in 74 weeks:


5 wood and manatee for comparison. Manatee may or may not be to scale. Tape measure reads just over 4 feet tall (1.21 meters) tall.

Done with second year. Wooo.

Breathe... and stretch.

So I have my final exam of second year on Thursday. While there is a certain degree of surreality to typing that (part of my brain still feels like its 2008... or 2007 for that matter), I am definitely looking forward to leaving the brain-desiccating monotony of the pre-clinical years behind. If finally hit me as I was sitting down to study today after lecture how close I am to being done with second year. And my brain thought: cool.

A couple posts ago, I talked about my plans for studying for Step 1 up until the end of class and my intensive 3 week period (namely: not studying, but simply "pre"-studying). Well, that was going well, until chatter around the lecture hall started slowly switching to boards, then becoming predominantly about boards, eventually becoming the all encompassing obsessive fixation of the class. The lecture hall soon became riddled with micro note cards, flow charts of the nephron, acid-base tables, and clotting cascades. And frankly, I am not a strong man. I hate feeling like I'm not doing something I should be (one of the many reasons I do not study in the school library). So I've acquiesced and started doing more QBank questions to at least give myself the illusion that I am trying harder. The results have looked something like this:

... I think if you ran a linear regression on that it'd have a negative slope. But the main thing that is so maddening is the up-and-down nature of it all. One night I'm feeling like the work is starting to pay off. The next... certain doom. I took a second NBME and I'm up 15 points from my previous score. Yeah! Still 40 points from my goal. Crap. It's finally starting to sink in what a bear of an exam Step 1 is going to be. Sure, everyone "knows" that but there's a difference between watching Twister on your DVD player and standing in the middle of a field as a F5 tornado descends on you.

So that's is where I am at. Less than 48 hours away from having to regurgitate my last syllabus. Either destined to pass or fail Step 1. Can MedZag make the final push and make up those 40 points to preserve his future career? Or is he just a cocky jackass for thinking he could accomplish so much in such little time, destined to practice primary care in Disappointment, KY? Stay tuned.

An Apple A Day Keeps The Doctor Away

Back when I was younger, I used to hold a certain level of disdain for people who owned Apple electronics. Too trendy for me. Not enough functionality for the price.

Fast forward 5 years. I'm in a Starbucks, doing QBank questions on my MacBook Pro, listening to Explosions In The Sky on my iPod, my gym equipment with my iPod Nano in my car. I get a text message and respond... on my iPhone.

My how the mighty have fallen.

A fairwell to Scrubs.

A couple years ago, when I was recovering from a shoulder surgery, I watched every single episode of Scrubs in chronological order. Yes, I'm that big of a Scrubs geek.

So it was sad to see the show end last night after 8 seasons on the air. I always insisted it was the most accurate medical show on TV, and people often stared at me with crazy eyes for suggesting a slapstick comedy show could do such a thing. But I still feel like no other show really got at the deeper drama and emotional aspect of a hospital than Scrubs did. And its medical terminology was always spot on.

So farewell, Scrubs. And thanks-for-everything-five.


And yes, I can finally tell after all these years that the xray is backwards. Either that or the joke is on us and we're looking at a perfect example of situs inversus.

MedZag studies for the boards.

So I've been hesitant to really talk about board prep here for a number of reasons. Medical students are an odd sort with all sorts of unwritten social rules and idiosyncrasies, and there's a narrow line to be tread between being known as a "nice guy who works hard" and a "gunner." Frankly I think everyone in medical school studies more than they let on, but never honestly discusses it, for fear of being labeled the frightful "g word", except for the select few who are so neurotic that despite their best efforts its simply painfully obvious.

But I know several MS1s at my med school read this, as well as assorted students elsewhere in this wild world (Hi Malaysia! Say hi to Indonesia for me). And I think both board experiences and board advice on the internet tends to be skewed to come from the neurotic minority versus the gross majority of students. I've seen and heard enough through the med student grapevine to know I'm (probably) not in that neurotic minority so I thought I'd give my personal plan.

My Advice For Before You Begin Board Review:
-Do not start studying for the boards before you get into medical school. Do not start studying for the boards during MS1. If you're so distraught over an exam that is over a year away and simply, absolutely, must do something, buy First Aid for the USMLE Step 1 and read through relevant sections as you progress through the subject in your classes. I bought FA last year with the intention of doing something like this, but ended up not even touching it and don't feel like it was any loss.
-Likewise, do not study for the boards the summer after MS1. Anything you DO learn will be long dispersed and displaced by second year classes and its essentially lost work. Besides, the gross majority of Step 1 is based the pathophysiology you learn as a MS2. If you haven't learned it yet, board review books will be pretty much useless to you.
-I'd recommend to "start" doing something the early spring of your second year. For me, this was as simple as getting a study plan together and making sure I had all the relevant materials on hand or ordered. I also 3-hole-punched my First Aid. That was a big accomplishment.
-Everyone studies differently. Everyone learns/reads/memorizes/poops at different speeds. Get a good sense of how you study and how fast you study compared to your peers so when you're creating a plan of attack you know how to tweak your schedule (which will most likely be based on someone else's schedule you run across) to fit you as a person.
-Medical students stress out wayyyyyyyyyyyyy too much about this test. I am as guilty of this as anyone else. Acknowledge you're stressed out, and wrangle your Type A personality down a bit. Stress is useless. And counterproductive.
-If you put in the work like everyone else, you'll pass. Step 1 is not an IQ test, and except for the exceptional few amongst the exceptional few, your success is largely dependent on the time you put in. I say this not to make you exclaim "OMG! THAT MEANS I HAVE TO STUDY FOR 6 MONTHS TO GET A 290 AND MATCH INTO DERMATOLOGIC RADIATION PLASTIC NEUROSURGERY!" but to make you realize that if you study as much as everyone else, you'll pass. If you are really shooting for a killer score, you're going to have to put in more work, but you are not stupid and you don't need 10 weeks to pass.

What I've Done/Am In The Process of Doing:
I've allotted 3 weeks to study for Step 1. Until then, I'm trying to muster up some R&R so my motivation tank is full going into that 3 week period. That being said, I am a medical student. I have a festering Type A personality. So I've assembled a few things to accomplish prior to that period to make me feel like I'm doing something and keep the stress level down. Note that the things I am doing now are not directly studying for the test per-se, but rather making sure I got concepts solidified, sources consolidated, and am becoming familiar with material so that I will have an easier time studying during that 3 week period.
-Read through Goljan's Rapid Review of Pathology while listening to his audio lecture (Do not ask me how to get them. Ask Frankie over there. Yeah, the guy sitting at the bar with the mean dragon tattoo on his arm) and annotating things into the book.
-Do the questions in the Robbin's Review of Pathology question book. For questions I miss, I make sure the key concept I was wrong on is in my First Aid. If it isn't, I write it in. 1 sentence max per concept.
-Read through BRS Physiology and do the questions in the book to make sure I gots my key physiology concepts dowwwwnnn. Extrapolate on concepts in First Aid that are vague.
-Review my biochemistry /immunology/cell biology/genetics. You know, all the nitty gritty stuff you're in all-too-much of a hurry to forget when you learn it.
-Skim through Clinical Microbiology Made Ridiculously Simple to jog my memory of some of the more useful mnemonics in it.
-In the couple weeks just before I really have to buck up, plan to start doing some questions on USMLEWorld/QBank to get myself more experience with the question format and system. No more than 48 questions at a time. Missed questions go into First Aid like above.

I started doing these things about 3 months before I take my Step 1 (~2 months before I really buckle down and study). But I must point out that I have done them in order to de-stress, not add stress. So I've been doing a couple, and only a couple, hours a week at maximum.

These are also what I am doing. I know people who have been doing QBank for months. Others have had their First Aid open next to them all year in class. Others have done flash cards for pharm and micro. And still others plan to do nothing until its time for them to really bite the bullet. All of these strategies have worked for others in the past. The key is finding a level of effort anywhere between 0 and 100 that you feel like is helping you.

My final schedule for the 3 weeks+ to come soon.

Want some cheese with that swine?

So yeah, pigs are taking over the world. Or at least the news feeds and the stock options for Prestige Ameritech and their surgical masks. Everyone's heard about this swine flu deal which frankly strikes me as a cross between Y2K and the bird flu scare. But science will not be deterred! Science will overcome! Science will... uhmmm... compose?

Some dude, Stephan Zielinski (I knew a Stephan and a Zielinski in high school, wonder if they married) transcribed the amino acid sequence for hemagglutinin 1 (aka the "H1" of H1N1 influenza) into a music sequence. In his own words:

"Each beat corresponds to one amino acid, and the piece is in 3/4 time, so each six measures would correspond to five turns around the alpha structure. (I’m weaseling because I haven’t the foggiest idea how the protein actually gets folded.) Amino acids with side chains that are neither aromatic not aliphatic control the piano and organ: the nine non-hydrophobics the piano, and the four hydrophobics the organ. The three amino acids with aliphatic side chains control the low synthesizer, while the four with aromatics control the percussion."

LISTEN TO IT HERE

It's strangely beautiful, in a child-with-Lennox-Gastaut-playing-your-keyboard-from-the-early-90's sort of way.

MedZag fails at the internets.

I've come to find that blogging (wow, its hurts me to type that) about medical school during the first two years eventually loses its momentum and eventually reaches this steady state. In the beginning, everything is cool and interesting "WOW! MED SCHOOL TESTS! WOW! ANATOMY! WOW! DONE WITH FIRST YEAR! Hahaha I'm a quarter of a doctor! If you have 4 of us stand together we make a whole doctor! Hahaha!" But really, the life of a medical student during the pre-clinical years is about as interesting as stale bread. After the excitement wears off, you realize that even though the subjects change, your life stays pretty much the same, and after a while you run out of things to say about it, because at its core its a perverse form of Groundhog day (minus anything nearly as humorous as a young Bill Murray). And frankly, that's definitely had an impact in my absence from posting these past 54 (wow) days. Neuroscience was a bear of a class, spring break was an opportunity to recover, and I finally decided since I have this "little" test called Step 1 coming up in 7 weeks that I should probably start doing some review for, so facetious things like blogging have unfortunately fallen by the wayside, especially when I don't feel like I have anything interesting to say. Do interesting things still happen? Probably. But you tend to notice them less because you have an exam coming up on Wednesday or you've had a swamped week and have been ignoring your significant other or the weather is nice outside and you just want to go catch some rays.

A couple of highlights of the past 2 months:
-I learned some stuff.
-I did my first pelvic exam, and successfully found the cervix on the first try. It's the little victories that get you through the day.
-The "Prostate exams performed" ticker has quietly climbed up to 1.
-I have amassed 1472.8 miles driving to and from my preceptorship this year, and have only 56 miles to go until I never return to that far away land.

Currently I am suffering from a bad case of what has affectionately been termed "2nd yearitis" (inflammation of the 2nd year?), otherwise known as a completely and utter apathy towards everything involving the pre-clinical years of medical school. We're currently slogging through our "Human Growth and Development" class which is roughly the equivalent of "Gynecology Gynecology and Gynecology," and 4 more exams, a book report (yes, a book report), and an OSCE separate me from being blissfully done with the monotony of the first two years of medical school. And frankly, I cannot wait for it to be over.

At the beginning of medical school, the clinical aspect of things can often be trepidating. And the lecture hall is a refuge of sorts, where you engage in an activity you've been doing for pretty much all of your life... that your long-term memory tells you anyways. Namely: class, note-taking, studying, ad nauseum. Regurgitate, rinse, and repeat. Sure the material is at an enormous volume, but studying is studying and its not really any different in med school, so its a comforting activity compared to trying to do a history and physical on another human being when you can barely tell a uvula from a vuvla. But along the way of the first two years, it's been my experience that something switches. You start to gain a certain level of competency in the clinical setting and start to find the intellectual engagement from patient problems instead of focusing on not f*cking up enough to let the patient and your superiors know what an idiot you are. And once that happens, its all over, because the lecture hall becomes a place where you're forced to sit, absorb, and later upchuck banal facts and minutiae that have often have no context or application to your actual fund of medical knowledge. And the clinical side becomes the place where the really interesting things happen.

It's in a way analogous to the "senioritis" of high school, when you feel like the trivial things that high school involves are behind you, and you can't wait to get to college and start the next stage of your life, but you're forced to gut out another few months or weeks of the same old crap just to graduate. Likewise, I've been slogging through the staging of prostatic cancer and whether a mature Graffian follicle has a single or multilaminar layer to its antral chamber. I could care less about this stuff, but am forced to go through it for the sake of crossing the finish line. Even though all the while my eyes are set on June, when I'm out of the classroom and into the real action. Sure, third year and beyond involves its own set of aggravations and monotonous activities, but they're different aggravations and monotonous activities.

And there's sure to be more interesting stories for a medical student blog than "woke up, went to class, ate lunch, studied, ran, studied some more, made dinner, watched True Life: My Life Is Boring, went to bed."