I wrote this up after noticing that critical thinking, which is pretty much all you do in grad school (and sometimes do in medical school) pretty much ruins your ability to take any arguments from laypeople seriously. Our culture has a thinking problem. More specifically, our culture has a lack-of-thinking problem. The scientific thought process, which will become your life in the grad years, makes you painfully aware of this.

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I want to briefly ramble about a bane of the first two years of medical school which, as I have emerged from my cocoon of WUSM II, I have also noticed a great deal in popular media:

The scourge of plausibility

In med school (especially 2^nd year), you go through some pretty specific and complex physiology and pathophysiology. You often find yourself trying to reason through complicated questions imposed by other students trying to figure things out, especially in topics like cardiology, nephrology, and neurology. Instead of wading through pages of text, you might find yourself coming up with an answer and justifying it with a plausible mechanism that you derive from other knowledge that serves as “common sense.” One example I remember is as follows (skip if you don’t care):

A friend and I knew from lecture that acidemia causes hyperkalemia, but we didn’t understand why. We thought that the increased acid secretion by the kidney would go hand in hand with potassium secretion… but this wasn’t the case. So, we tried to back-reason mechanisms for this apparent paradox. Here’s the scourge:

We had some pretty interesting solutions, all sounding “plausible” with our medical knowledge at the time, and all totally wrong. Once we got it straightened out, I felt a little silly. This happened other times with problems that were much more difficult to resolve.

Here’s a real world example: I am going to make a pair of contradictory statements, and back them up using stereotypes that you probably have. If you read only the first or only the second, you might believe either.

1. Heavy online video game players (think World of Warcraft addicts) are generally overweight. Their constant grazing on high calorie foods and soft drinks, in addition to their sedentary lifestyle, shifts their average BMI well into the overweight range.

2. Heavy online video game players (think World of Warcraft addicts) are generally underweight. Their constant inactivity, nutrient-poor diet, and low sun-induced vitamin D synthesis leads to muscle and skeletal atrophy and shifts their average BMI well into the underweight range.

These statements might invoke images from your memory (http://tinyurl.com/cjjeoz from South Park http://tinyurl.com/n6fznk, the mac guy/ hacker from Live Free or Die Hard), enforcing your belief in the “truth” of each statement. But which is right? I don't know, but a really fast pubmed search found this http://tinyurl.com/mkaerc which seems to suggest that neither is (clinically) true.

The popular media, I’ve been noticing, is HORRIBLE with this. Anything sounding plausible is reported as fact, especially under the pretense of stereotypes/generalizations. It’s gotten to the point where I just stopped believing anything vaguely “scientific” that I haven't read in a true scientific publication*. This is especially true when it comes to health, psych, or behavioral research. If you hear anything, and I mean ANYTHING, in the health/news/tech newsmedia, don’t believe it. Don’t even regurgitate in bar chatter with friends unless you’ve looked into it further.

If you want to know if it’s true or not:

- go to the article/news story

- find the researcher mentioned or interviewed

- go to their lab page or do a lit search

- find their most recent article pertaining to that topic

- skim the abstract and conclusions or, better yet, read the whole thing

If you don’t care enough to at least glance at it like this, it isn't interesting enough for conversation fodder anyway.

And I swear, the next person that says something like “I heard about a neurological study that shows that facebook and myspace are actually making kids stupid” is going to get chewed out.

*: Journal, review, textbook, book, or (with caution) science reporting outlet.

USMLE advice you won’t get anywhere else

Once I started studying for the boards, I found that most of the advice I had heard was crap. Not that it was bad advice in its own character, really; it just didn’t apply to me at all. I just don’t think I learn the same way the average med student does. Maybe this is why I went MSTP instead of MD. Anyway, here’s my list of unorthodox strategies that I found helpful while studying for the USMLE.

1. Learn excel. Learn it really, really well.
Let’s say (in theory) you somehow got your hands on an electronic copy of First Aid or some other boards review book and you really want to make some flashcards. If you know excel really well, you can just highlight the columns of the table in Acrobat, paste into Word, run your cleaning macros (Oh, BTW, learn Word programming really well, too), and paste into excel. Repeat this with all of the columns from the First Aid table and you have reproduced it. Then just write some formula like:
=C38&IF(D38<>"","<><>"&D38,"")
Or
=IF(C139<>"",$C$113&C139&$I$113,"")&IF(D139<>"",$D$113&D139&$I$113,"")&IF(E139<>"",$E$113&E139&$I$113,"")&IF(F139<>"",$F$113&F139&$I$113,"")
Fill down, copy all the results, paste into Flashcardexchange.com with “<>” as the line break indicator, and you’re done. Seems like a lot of work, huh? Well it isn’t; you just made 100+ flashcards in under 10 minutes. All you need to do this is really solid knowledge of excel functions and how to link them together. I’d go into this more, but it’d be really boring pretty much everyone but me.

2. Get flashcards on your iphone/ipod touch.
I used Mental case despite not having a Mac. I bought the premium version, too. Worked great with all those flashcardexchange.com sets. Now you’re studying while in line at the grocery store or bank. Awesome.

3. If you’re not one to burn out, don’t think you’re going to burn out.
Everyone I talked to from the class above said things like “after 2 weeks, I couldn’t read any more” or “anything after 3 weeks is useless as you’re going to burn out anyway.” I never thought I was a burning-out kind of guy, but I believed them. Well, turns out I don’t burn out. I got a little wobbly a few days before exam, but that was due to the number of days remaining opposed to the number of days behind me. Not everyone burns out, so just go with what you know about your work ethic.

4. You don’t NEED to take a break first.
Everyone and their mother seems to believe that in order to survive the USMLE, you MUST take at least a few days, and as much as a week off between 2nd year finals and studying for the boards. Nope. I suspected that I’d rather start right away and get more days off at the end. I was spot on. Turns out that advice was crap.

5. Nearly everything anyone tells you about the boards is anecdote, not fact.
Duh, right? This should be obvious, but soooo many people spout advice and stories like it’s all absolute Truth. “The test doesn’t really mention X or Y” “You need to study by doing Z” etc., etc. Well, their words apply to them and maybe a subset of everyone else, but you can’t be sure it works for you.

#5 is the most important one here. It tells you that #s 1-4 of my post are complete crap. They are! Those things applied to ME, and I am an outlier (and that is an understatement). I would be shocked if any of it proved useful to more than 1 or 2 people. If you seek advice from SDN forum members or classmates already done with the USMLE, take it all lightly; you are a different person. It’s like a vacation: if someone you know has been to Venice and tells you about it, you wouldn’t assume that their Venetian vacation is the only right Venetian vacation, right? It’s just like that, only the vacation sucks.

Update

I am in the throes of the USMLE right now. I have oodles to spew forth on the interwebs once I have the time, but for now I need to keep at this. For the record: my last post (where I said I was studying for the USMLE already in December) makes me laugh. I did that for, like, 3 days. Some good that did.

Topics to come:
- buying a home as an MSTP (with your own money!)
- USMLE advice you won't get anywhere else (alternatively titled: Why >80% of the USMLE advice I received did not apply to me at all)
- USMLE advice you likely will get somewhere else
- MSTP0 - MSTP2: how it changed what I thought about science/medicine/intellectualism
- Rants! I have 1 or 2 things I just need to rip to shreds.

I'm sure I will come up with more as I go. I promise, before I hit "publish", I will make sure I keep the wishy-washy nonsense to a minimum and keep things as short as possible.

Until then
R

Yes, I am alive.

So, it's been forever and a half, since I last posted, and for those of you out there that were worried I am still alive (which I'm sure weren't many of you....except maybe my mom, but since a) I talk to her everyday and b) she doesn't know what a blog is, I don't think she was concerned). Anyway, I thought it was time for a post.

Lots and lots has happened. 2nd year is hard as everyone said it would be, but it is also interested. The sheer amount of information is definitely overwhelming at times, but a long time ago I accepted that perfection was unattainable and I feel OK even if I don't know every detail and minutiae. I think that has been harder for some of my other classmates. I also have been trying really hard neither to beat myself up over unproductive times nor to become overwhelmed by the amount of work that still needs to be done. Although I have had my moments of freaking out (no one's perfect...see above).

I had heard that CPR block was hard conceptually but GI block was hard because of the sheer amount of material, and I think that that was pretty much true. I had also heard that it was really hard to start GI block right after CPR block because you don't have a long weekend in between (as you do between the first 2 blocks). I think that this was true, but I don't think that the long weekend really would have made a difference. I was definitely just burned out after CPR block for about a week and I really never regained the same intensity during GI block I don't think, but it all seems to have worked out alright.

I really started focusing on Lecture Objectives as a way to study, and that seems to be working pretty well, so I've been sticking with it. I also have really liked small groups/labs as a way to go over things and hear them another time and in a different way. I definitely like repetition.

I had been studying at the carrels a lot more than I had first year, but I got really sick of it during CPR block, so I wasn't there as much for GI block. I also started just studying at home more, partially because it really started getting cold out (at least for my wimpy constitution), which makes me become somewhat of a hermit. The only problem with that is that I definitely felt a bit lonely and isolated, which is largely due to the fact that I live by myself (which I actually usually enjoy quite a bit). I don't know...I definitely need to work on some kind of balance. I think the other issue is that I've found it hard to hang out with a lot of my friends because we all have such limited non-studying time, and that time doesn't always coincide (i.e. you started studying earlier so you want to take a break earlier than your friends, or you were planning to take Saturday night off, but they weren't etc. etc.). It definitely takes some more planning.

In an effort to try and maintain some semblance of sanity and social interaction this block, many of the MSTP girls (and some of our med school friends) planned to get together once a week and watch the PBS version of Pride and Prejudice (featuring Colin Firth...insert swoon here). We weren't wholly successful (we only met twice), but it was really fun and I believe will be continued next year.

On a totally separate note, I've been helping to choreograph for the med school musical (yes, the med school puts on a musical every year, which at least last year was quite good. There is a surprising number of EXCEPTIONALLY talented people in med school). I have limited dancing experience and ZERO choreography experience, but it's been really fun.

We've also all been trying to figure out the whole USMLE process (for those of you as clueless as I was, USMLE are the licensing board exams that you have to take. There are 3 steps, which you take at various points during your medical career. Step 1 is taken after your 2nd year of med school). I have gotten registered and tentatively picked a date. I haven't done major studying at all, but I am doing a bit of review of Biochem over break, esp. since I took a grad school class (molecular cell biology) in lieu of med school biochem. However, since I haven't taken biochem since my junior year of college, I figured a little review and some focus on clinical biochemstry would be a good idea.

Ok, well I think I"ll leave it at that. Happy New Year to everyone!

GI block redux, USMLE for fun?

We got to learn a bit about the science advisory board in DC for the next four years. I am not going to write anything about it. I don’t feel like it.

GI block (gastrointestinal disease, endocrinology, and dermatology plus their respective pathology sections) was MUCH harder than CPR block. CPR, in hindsight, wasn’t that bad. More concepts, fewer factoids were to be had in CPR block. Be forewarned, incoming students.

Really, it took me until GI block (and halfway through, at that) to understand how I need to study. I tackled pharm block like a first year that worked a little harder (wrong idea). I took on CPR block like a study-shotgun being fired at a course-load wall (wrong idea). Halfway through GI block, I took a few hours and constructed an elaborate workbook that tracked, graphed, and summarized my study activities, confidence with various lecture subjects, pace vs. lecture schedule, and many other things. It updated automatically when I input various parameters and gave me a constant overview of where I was and where I needed to be. Anal-retentive organization, it turns out, was what I needed. Too bad this is completely against my nature and took me 3 months or so to learn…

On another note, I started studying for step 1. I am not crazy, I am not gunner, and I am not a perfectionist. The reason I started studying is because
- Reviewing medicine is actually interesting. Reading about science is a zen activity for me, and since I have no deadlines or pressure at the moment, it’s actually entertaining.
- It doesn’t stress me out right now (see above) and I figure more is always better if you can handle it.
I have also decided where I am going to study when it comes down to the 3 weeks pre-exam. I was thinking about coming to stay with my parents (up north) for free food/laundry service while I studied. I figured that I could study in peace.
When I took a diagnostic exam for shits the other night, I posted a note on the door of my study reading:
“Taking an exam until 7:00 or 7:30. Please do not interrupt me unless it is something REALLY important. Leave a note on the door and I will get it when I am done.”

About 1 hour, 10 mins into my test, I get a knock on the door.
“Dinner’s ready.”


That settles it. I am staying in St. Louis.

Daring proposition for US medicine

President elect Obama released this video last week about jobs and the economy. The part that relates to this blog comes in right after 3:50 or so: electronically linking all of our health care. The task is massive and I am skeptical (skepticism has its place in politics as well as science) but it could change the way we do medicine. I don't see it happening before I get my PhD, maybe even my MD, but here's to hope.

Look, this blog isn't about politics. It's about science. Any soundbite by any candidate that so blatantly trivializes a key part of scientific research deserves attention by the scientific community.

BTW: if you want to be involved in science and politics,
http://sefora.org/

2nd year represented in 1 image

I took a quick break from studying to take and stitch together this shoddy panorama of our study carrel. The desks here mostly belong to MSTPs, some of whom use this space as mere storage and others who use it for daily studying. Note the piles of study materials and beverage containers. We have 2 minifridges stocked with food, juices, and beer, about a dozen different dry teas, a microwave, water boiler, rice cooker, food cabinets, etc. It's pretty much a home away from home, and many of us spend 12+ hours a day in this little room.

(We got really unlucky in the lottery for carrel space. Most carrels are much larger and have windows. We live in a closet. Although this sucks during sunny days, it does help you forget that it's 11 PM and you are still studying. A mixed blessing, for sure.)

Back to pathology...

CPR block'd!

This blog has been on my mind more than the [lack of] updates suggest. A few reasons:

I keep thinking “I should really do an entry about 2^nd year” and the madness that is CPR block

I think I want to change the kind of content that is here (more about this below)

I notice that we (or, since I am the only one that really writes here, I) get more traffic these days.

Why haven’t I updated? Mostly because I am a 2^nd year med student and my life has little time for blog updates. Sorry, that’s how it goes in CPR block. After this exam block, I will see if I can bang out an entry or two about 2^nd year. Until then, I have some thoughts about content that I would like to spew forth to see if any readers will react. Positive or negative comments are welcome.

About what am I writing? Well, I read many other med/MSTP blogs. One blog in particular irks me. Now, maybe it’s because I have a personal bias against the school/author(s) for admittedly shallow reasons… or maybe it’s because the content sucks and it comes across as pretentious, boasting, and other adjectives that convey the same point. I dunno.

At any rate, I don’t want to write about my MSTP life like the other blogger(s) go(es) on about this other school’s program(s)*. I realize that some of my previous entries, especially those written when I was still in awe that I actually made it this far, sound almost exactly like this other school’s blogger(s). This irritates me.

So, readers (that I know are out there!), what do you want me to cover here? I can bitch about the daily strife of the MSTP life, I can wax philosophical about the state of science and medicine today, or I can just answer questions about the school and programs. My goal is to be as palatable and useful as possible without having to censor myself, sound like a PR firm, or end up reading like that other blog. If you don’t give input, I will just write whatever I feel like writing. This blog might thus end up as something like a verbal colostomy bag. That’s something nobody wants.

OK, readers, what would you like this blog to become?

*To avoid digging myself into a hole, I have to be annoyingly cryptic about my trivial dislike for this other party. To the other bloggers out there that I know read this at every update- I read lots of blogs so the chances that I am bashing you are pretty slim. Most of you write well and provide a great service to those interested in your institutions. Even if I am referring to your school, my opinion means nothing; what do I know, anyway?

class show tidbits

If you want to see what antics our crazy class our class is getting into these days, check out these youtube videos. If you know the MSTs (through interviews or second looks) you will notice that we were pretty omnipresent in the class show. There are some more vids on the WUMS2011 youtube account if you care to see some more.

Oh yeah, and we got the final roster of the incoming MSTP class. I look forward to meeting the ones I haven’t yet. Alright, I gotta study for Neuroscience; final’s next week.