Pre-Clerkship Advice Series: Academics

"Be careful whose advice you buy, but, be patient with those who supply it.
Advice is a form of nostalgia; dispensing it is a way of fishing the past from the disposal, wiping it off, painting over the ugly parts, and recycling it for more than it's worth."

8000.  That's my estimate of the number of hours I've spent in the last 2 years devoted to medicine.  Along the way, I've learned a trick or two that I wish I'd known back in September of year 1.  So for all the incoming medical students, I humbly present to you my first blog series:

Red Frisbee's Guide to Surviving BEING AWESOME! in Pre-Clerkship:

ACADEMICS
Medical school is a full-time job (sometimes it feels more like 2). 

A lot of my peers started medical school fresh from an undergrad degree.  In fact, one of the girls I'd pseudo-dated, like many of the other young'uns in my class, hadn't even finished her bachelor degree yet (she was legal...I'm pretty sure).  I, on the other hand, had spent my a couple of years prior to med school being the opposite of studious - being a hobo, working for "the man", and living a nomadic backpacker life. 

Although those years away from school effortlessly stripped away many of the tactics I'd learn in my undergrad years, I'm not sure I was necessarily at a "study skills" disadvantage.  Med school, after all, proved to be a different ballgame for everyone.  There were so many times where it felt like I was trying to drink from a firehose. 

After serving my first 2 years in medical jail school, studying effectively has become easier.  My best suggestion is do what works for you, but here are my study tips to doing well and getting through to the next semester.

1. Hit the ground running
It's still surprising that I managed to survive 1st year considering I crammed like nobody's business.  I did fine on the exams, but retained far less that I should have.

In 2nd year, everyone that I have talked to said year 2 was far more difficult (likely dependent on which school you're at).  I did far better and found it much more manageable because I actually kept on top of things right from the start line.  Still, I've had countless moments of "why don't I even remotely remember this topic?" everytime I looked back at what was taught a month ago.  Unless you're blessed with one of those "hear it once, know if forever" memories like some of the folks in my class, give yourself plenty of time to learn it several times through the block/semester.  Cramming in med school and keeping your sanity are mutually exclusive.  Start reviewing right from week 1.

2. At the end of the day, if you try to know it all, you will kill yourself
Nobody can know it all.  You won't.  The keener at the front won't.  Your doctor won't. 

There have been few exams where I don't recall people at the "high end of the spectrum" in my class feeling like they are going to fail an exam.  Yes, you absolutely need to know the details but it's pointless to stress over not knowing all of them. 

I learned to keep calm by appreciating that the feeling of "not doing great" is inevitable.   Never forget that at the end of the day, your chances of failing (even if you absolutely believe it) are very low.  And even if you do, it's not the end of the world (no one in my class has "failed" out of med school - they get kicked out for far dumber reasons like being cracked out while on duty).



3. Learning Resources
Accept that you will have to build a library
Here's a moment of extreme nerdiness.  I discovered this year that I have a huge crush on books (or if you prefer a "book boner").  I think I purchased 4 or 5 textbooks max in my undergrad years.  Unfortunately, medicine has SO much crap that you absolutely cannot get away without having an effective collection of resources.  Your classroom powerpoints will not cover everything you need to know.  Google and wikipedia will not cut it.  Neither will MD Consult/Access Medicine.  Nor Uptodate.com (these are all great resource by the way). 

Be selective when you do
My personal library is still scant compared to my friends' collections, but that's because I'm selective.  It's easy to become over-resourced once you hear Joe Blow describe how good a book is, or how Susie McSmartass gleams over her new set of antibiotic flashcards.  Over-resourced = overwhelmed = not effective studying.  Take a good look at what you think IS useful and buy those, especially if you can use it throughout the years.  I suggest just start with a good anatomy book and atlas, Toronto's Notes (so concise!), and a clinical skills book (Bates!).  If you have those 4 essential things, you've got a solid foundation and you can add to those PRN.

Pick books that are clear-cut (usually you can get recommendations from friends).  And get PDF's of those that you won't use much.  An Uptodate.com subscription is great but is more useful for the clerkship years.


4. Class
To go or not to go - that is the question
"Wow, I gained absolutely nothing by coming to class today.  I'll still have to go home and spend another 2 hours going through each lecture I sat through."  That's the thought I had in 90% of my days in year 1.  By year two, I smartened up and quit going to class.  That doesn't mean I was sleeping in or out playin' hookey Ok, I went snowboarding more than I should have.  But, nearly every class I wasn't in, I was in the library or at my desk learning the material being taught to my sucker classmates at that very moment .

I was able to go through new material, make my own notes, and most importantly - understand it!  Lecturers zoom through lectures super fast and my feeble brain ain't capable of keeping up.  I ended up saving a lot of time by skipping lectures and knew the material far better by the end of each week.  If you have a small group (see point 5) to chat about the material with, that's even better.  Provided you haven't tried to sabotage your classmates, they'll let you know when is something important mentioned in class you missed (which is about 0.1% of the time).


5. Study group
"I'd love to play poker tonight guys, but I'm meeting with my study buddies tonight." *Snorts and pushes nerd glasses up*
Maybe a study group was your saving grace during undergrad.  Maybe you were the Abercrombie douchebag who laughed at the thought of it.  I was never a firm believer of these until med school, but they definitely saved my ass more than once.  Set a designated time and day of each week to go through what was covered during the week.  Once routine kicks in, they aren't a drag.  It's amazing how different 4 or 5 brains can come up with far more perverted mnemonics than just 1.  And it's comforting knowing that others are going through the exact same excruciating pain as you.  Throw in a beer at the end of the session and life is suddenly a whole lot sweeter.

I also found that going through our Clinical Skills weekly made me a superstar in the clinics as well.  I never took clinical skills seriously during my first year but lemme tell ya - OSCEs are a bitch if you don't practice regularly.  I'm writing this while I'm on a Family Practice rotation right now and my preceptors have been very happy with my patient examinations.  And, again, a glass of wine during clin skills practice sessions are nice too.



6. Get Your Money's Worth!
A lot of my peers were hesitant to get help from the profs and doctors.  I never understood this.  They are being paid by the public and my 20K tuition a year to do their job...teach!  Email them nicely with your questions and they are generally super friendly and willing to help you out.  If you're hesitant just remember...you paid for it - milk it for all it's worth!


7. Lather, Rinse, Repeat
Go through things again.  Then again.  Then again.  Most of clinical practice is common sense, but a lot of the science behind it is not.  Do whatever practice questions you can to help yourself.  Then go through things....again.

Good luck everyone.  Remember - the idiot that everyone knows about in the year above you made it through.  You will too.

Canadian Medical School Interview Questions

Big mean interviews. I'd always wanted to do a cross Canada trip. In 2009, in a way I did - only it involved many planes and me flying back and forth the nation every weekend for about a month - and even once while I was backpacking through Honduras (btw thanks, Toronto, for the short notice!).

In a few months, thousands of eager-eyed pre-meds will have been grilled by all sorts of medical "professionals" about their medical ambitions. Doesn't seem like it was so long ago that I was there myself. I still remember sitting in my living room with my wonderful roommate at the time practicing for medical school interviews.

I, of course, remember desperately googling tips and hints for schools. Wasn't easy, so here's my contribution back to the world of the pre-meds. Credentials? I did interviews at 4 Canadian schools (and even Australia as a backup) and was accepted into all but one school. So here goes:

Disclaimer: it's been several years and selection processes have surely been updated along the way.

University of Toronto:
Interview style: Panel (one 2nd year medical student, one doctor/health professional)

Unlike any of the other school I'd interviewed at, Toronto really knew my portfolio. They paired me a doctor who worked in my area of interest at the time (non-profit community health medicine). Their questions were fairly straight forward. Know your history well, strengths & weaknesses, learning experiences etc.


Other Schools: Here's a list of questions modeled after those that I actually had. No questions are actually from interviews, but they are very reflective of the ones I was asked.  Feel free to comment on how you'd answer.  I'll try to give some feedback.   

MMI Questions (good for University of Calgary, British Columbia, an Manitoba):

1. You and your best friend try out for the varsity track team. You just find out you got in, but your friend was rejected for the 3^rd time. Enter the room.

2. It has been argued that wait times for organ transplants can be significantly sped up through surgeries and donations from other countries. You are a physician working with a patient who you noticed had recently gone to the Mexico to receive a liver transplant. What are the ethical issues involved?

3. You are a third year medical student involved in the research of Dr. A, a senior physician. He is testing the efficacy of a new drug on lowering cholesterol. This drug is not yet known be more effective that existing drugs on the market. He insists that you recruit patients for trials even though the clinical risks of the research are still undefined. What are the issues involved for the patients? For yourself?

4. What is the biggest accomplishment of your life? What is the biggest disappointment?

5. As medicine advances with technology, what are the pros and cons? Discuss your experience with use of technology.

6. Dr. Who is a physician for Mr. Bean and his wife. Dr. Who discovers that Mr. Bean has an STI. Mr. Bean does not wish to tell his wife . What should Dr. Who do? Explore the ethics surrounding this scenario.

7. You are a resident working in a team of several others for on call shifts. You and your partner just had a new baby. Would you re-adjust the call schedule? How? What problems do you foresee and how would you approach the problems?

8. You are a young, single doctor working in a small town of 1500. You meet an attractive male/female at the bar that you are interested in. What problems do you foresee?

9. You are a GP working in a community where the majority of patients have very little education and many are refugees from other nations. What challenges do you foresee?

10. Describe your experiences with physicians. What traits would you and/or would you not emulate?

11. Data has shown that doctors who smoke are less likely to make good role models for patients. Should doctors be allowed to smoke? Do doctors need to be role models?

12. You are a first year medical student who is doing above average in some subjects, and below average on others. What would you do in this situation? What resources would you access?

13. You are working in a clinic for street youth. A 16 year old girl comes in seeking sleeping pills that you do not think is appropriate for her. She says she will see another doctor if you do not prescribe them. What would you do?

14. You are a physician who has finished his or her day and decide it's appropriate to leave on time for the first time in months. You have promised to meet your family for dinner. You suddenly receive a phone call from Mrs. Black, a 87 year old patient in a nursing home long time, who wishes that you attend to her long-standing condition. She has been patient of yours for 15 years and refuses to see another doctor. What issues are involved? How would you approach this situation?

General MMI tips:
- Come up with personal experiences that you can apply to each of these situations. This allows you to personalize your answers. You don't a long list since each MMI station will have a new interviewer and you can always repeat experiences in your answers.
- Smile! A classmate of mine was recognized by a faculty member after she got it: "you're that girl that smiled a lot!"
- Sum up what you said at the end if you have time.
- DON'T RAMBLE! Silence is ok.