There quite a few things I’ve learned in my first year of medical school–most of them have been the second half of the year as I implemented those things which actually worked. The first semester was more finding out what I was doing wrong and although I did well grade-wise, it was WAY too costly in terms of time and energy in how I went about it. I know I have some pre-med readers, and this is focused especially to them, perhaps too to those already in med school who might benefit a trifle from all the wisdom I’ve gained so far. (pause for raucous laughter)
If I can sum up my study philosophy in a pithy saying, it’s this: study from general to specific. This, on the surface, sounds obvious as who in their right mind would study something in detail for which they don’t know the general, but you’d be surprised how many textbooks and lectures go about it exactly this way. My favorite example of this is gross anatomy. One studies the upper limbs for example, and the textbook will start with bony structures where applicable and go into all those details, then go to muscles and go into exhaustive detail, then go to vasculature in exhaustive detail, then to innervation, joints/ligaments, etc. Each mini-section is complete with its own table of nerves, vessels, muscle origin/insertions, etc. down to the last named nerve/artery/whatever. This is ridiculous. I can’t imagine the brain of a person who will know every last named arterial branches of a part of the body and when asked about nerves, say, “I don’t know–I haven’t gotten there yet.” By the time you’re “done” to put it all together, you’re overwhelmed and are forgetting very basic information.
Take something big and obvious: vasculature of the abdomen. The descending aorta gives rise to the celiac trunk which will provide blood to the stomach, spleen, liver, etc. This is where you should pause. Learn just enough branches to figure out a topology of the major vessels which feed the main organs then move on, in this case, to the superior mesenteric artery. Learn what it supplies in a macro sense, then move on. When you’re no longer in the abdomen (R/L ilac aa.), stop, then go back and learn a few branches deeper at each level. The mistake is to try to learn what’s on the page in Netter with 25+ labels facing you with no clue of a logical progression of bloodflow.
I used anatomy as my primary example because being visual, it’s a clear case of what I’m getting at. In a class like immunology, a subject I discussed the other day, this is a bit trickier since it’s much more at the cellular and molecular level. In spite of cross-over from general pathology, I bet good money that more than half my classmates can not answer the simple question, “How does the uncomfortable symptoms we associate with [normal] inflammation help the body?” This is a question that could be asked of a high school student when being told that inflammation is part of the immune response, and someone who really knows what they’re talking about can answer the question without using words like “interleukin,” “chemotaxis” or “degranulation.” It is the simplest questions which are often hardest to answer, and that leads me to tenet #2: never lose sight of the big picture. Ask imaginary questions your parents/spouse/patients(!!) would hypothetically ask and prepare mental answers in laymen’s terms. The famous Einstein quote, “You do not really understand something unless you can explain it to your grandmother,” applies here. The same students I refer to above that couldn’t answer the inflammation question could probably tell me IL-8 is an interleukin that’s chemotactic for neutrophils because it was a fact to memorize on a table (one of probably 25), but could not explain why it’s useful.
Lastly, I wanted to say that you have to study from primary sources–textbooks, good notes from professors, or the like. Reading the BRS, “High Yield” series, or hand-me-down Kaplan USMLE review books is not fully learning the material, it’s learning facts to regurgitate. Unfortunately, a good chunk of the first two years is doing exactly that, but you are setting the stage for serious pain when, in your clinical years, you have to synthesize that information into a logical whole in real-time and you don’t have any depth to draw from, just topical factoids with no sense of belonging. Don’t even get me started on studying from old tests…we all do it when we get our hands on them because as long as we are graded, we want to do as well as we can, but that should be last after you’ve put in your real time studying. It shouldn’t act as a checklist by which you go about learning something de novo. Just because it’s not asked doesn’t mean you don’t need to know it (and conversely, just because a professor has a pet topic doesn’t mean it needs to be memorized beyond the scope of the class). How does one know? Ah, that’s the rub… that’s part of the anxiety that drives us to keep learning when our own motivation wanes.
Well, that’s most of what I have to say about studying and learning. I hope this doesn’t come across as paternal or arrogant, but I’ve learned many of these things recently after hitting many a solid wall. I was a horrible, horrible undergraduate student, discipline-wise, and by the time I was taking graduate courses, I was burned out and still making it on raw aptitude. It wasn’t until I worked in the “real world” for a while and went back to school did I truly appreciate how much more I could have done with myself academically had I applied myself from day #1. Even straight-A students in college (way unlike myself) get a rude wake-up call in med school because this is an environment where you have to learn for yourself what’s important and what’s not–that reading 300 pages from Robbin’s Pathology and learning everything in a few days is impossible, but learning the important things are absolutely expected. Again, it’s about figuring out what exactly is important, and that’s a personal quest, but the common wisdom is this: never lose the big picture, never stop asking the reason “why”, and look up what you don’t know to answer those hypothetical questions. I promise you’ll be as good as you can be–as a med student, as a physician, and most importantly, as a well-rounded individual.
Perdóname, por favor! 
Humor, Medical and Health | enrico | 
June 27, 2006 9:30 pm | 
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