Some Tips for Incoming MS1s

I am having a hard time understanding just how it can be that July 1st is today. This last summer is absolutely flying by, and in just a few weeks I will be helping out with orientation and getting the new MS1s settled in on campus. While I am excited for everything that is coming next year, I am totally enjoying not having to study all the time.

Now that I’ve had some time to relax and decompress from the past 10 months of non-stop med school craziness, I’ve compiled what I think is the best advice I could give any incoming MS1 on how to get the most out of the year and have everything go smoothly.

PRESTUDYING:
The first rule of Fight Club is… you don’t talk about Fight Club.”
The first rule of summer before MS1: DO NOT PRESTUDY. Go live your carefree life before you get lost in the black hole that is studying for med school. For the love of all that is holy, don’t ignore this advice from every single med student ever. Prestudying will get you nowhere because you won’t know what to study or how. Just don’t do it! I know you’re anxious. I know you think it’ll give you a head start to make the beginning easier. IT WON’T. Go have some fun and enjoy the best year of med school: the year you got in.

SCHOOL SUPPLIES:
There’s not really much that you need. At our school, there’s a new requirement to have an iPad for the MS1s. Some schools will “give” their students a laptop or tablet so that everyone has the same; other schools (like mine) will just make a recommendation and expect students to have a computer of some sort. As far as medical equipment goes, most exam rooms will have most of the equipment you’ll need, so there is no reason to spend an ungodly amount of cash on an ophthalmaloscope or otoscope. You will need a stethoscope. Last year, I went ahead and bought my stethoscope because I’d done extensive research on which one I wanted. You’ll hear people say to wait until the school sells them during orientation week, but I found that at multiple schools (DO and MD) they’ll still run around $200 at the “discounted student rate”. I have a Littmann Cardio III that I absolutely love, and I went through Steeles.com during last July when they were having their annual “back to school” sale. It came with a free “student kit” that included name plate, CD of heart sounds, lifetime warranty, extra ear buds, and a free penlight and reflex hammer for $130. The ones that bought their stethoscopes through school didn’t get the free student kit–so I thought I’d share that sooner rather than later so you’d get the best deal. I did buy a blood pressure cuff from the school for $20 so I could practice my clinical skills at home, especially since at the time I was planning on being somewhere remote during the summer on a missions trip. You’ll need a pair or two of scrubs for the anatomy lab, and my group each brought in a box of gloves. The bookstore sells scalpel blades for $0.40/each, which I thought was ridiculous, so I bought a box of 100 from Amazon for $10 and they came with free shipping (I have plenty left over that I plan on giving my mentee). The books I bought online through Amazon and I saved a ton of $$$ doing it that way–I also bought them in July before the “mad rush” to buy books, so they were pretty cheap. I think I got BRS Anatomy for $5.

So…. just a heads’ up. I figured any MS1 at just about any med school could use those tips.

BOOKS:
We don’t technically have a book list or a website that lists the books, because most people don’t use them. I’d imagine that most schools are like that, at least for the first year. Our profs’ notes are generally pretty good, so even though they may say that some books are “required” in the syllabi, it’s not necessary to have them to do well in the courses.

With that being said, there were several books that I used in this past year that I thought were really helpful.

Anatomy:
-Everyone will say to get a Netter’s Atlas. It’s pretty much the gold standard, but one of the authors is actually our main professor so if there’s something in Netter’s that you don’t understand, she’s an incredible resource.
-They recommend a Grant’s Dissector–don’t buy it. There will be a group copy in the anatomy lab, but it’s not especially helpful for studying in class, and I didn’t find it very useful for lab either, because your instructor for the day will tell you how to go about the dissection, which is usually a bit different from Grant’s.
-I cannot recommend Rohen’s Color Atlas of Anatomy enough. It’s a compilation of pictures from expert dissections so you can see the same structures from many perspectives. I hated staying long hours in the lab, so this source was invaluable.
BRS Anatomy was a great resource for practice questions; highly recommended.

Embryo:
I bought the High-Yield Embryo book and it was the only resource I needed besides the class notes.

Neuroanatomy:
-You’ll need a Sidman’s and Sidman’s at our school (one of our profs is also an author) which is a self-study workbook. Hold off on buying it though, since your MS2 mentor may give you theirs (I’m giving mine to my MS1).
-I used the High-Yield Neuroanatomy and that’s all I needed besides the notes.

ICM:
Dr. K suggests Bates’ Guide to Physical Examination, which I’ve heard that most schools suggest, but I don’t think anyone used it. I didn’t.

Histology:
-I don’t think many people bought/used an outside book, but I did. The one suggested by our profs was Ross and Pawlina’s Histology, and I thought it was really helpful. I did extremely well on the exams because I’d used more than just the slides provided in class, so I thought it was worth it. I only bought it in the beginning because I found it for dirt cheap on Amazon.

Biostats (Incorporated into ICM):
High Yield Biostats was definitely worth it since our biostats is a self-study model.

Biochem:
BRS Biochem for practice questions was helpful.

Physiology:
-Personally, this was the hardest class for me, so I felt like I needed a little extra help. I bought the Medical Physiology book they recommended and used it for practice questions and clarifying things I had a bit of trouble understanding.
BRS Physiology was also great for practice questions.
-PreTest Physiology was also great, but I borrowed a copy from the Student Affairs office.

I also had a copy of First Aid (came with my AMA membership for free) that I used to review before exams.

That is all that I can think of. Books aren’t really necessary (except for Anatomy), but I do think the books I used to supplement my lecture notes definitely helped me to succeed this year.

That being said, if other schools add in other courses during M1, I suggest going through First Aid’s appendix and get the books they highly recommend for USMLE Step 1 review to supplement the classes.

LEADERSHIP AND EXTRACURRICULARS:
A word on extracurriculars and leadership positions: In my class, there are 160 of us who are trying to make our residency application as impressive as possible. This means that on some level, we all need leadership and ECs, if only to put a check in that box. That being said, there can be a lot of competition for every leadership spot and even limits the number of slots for ECs, so my best advice would be to apply or volunteer for the things that you’re really interested in doing (since you never know unless you try), but don’t get too bummed if you don’t get everything that you want. Remember that classwork comes first. No one will be impressed if you have the most lines on your CV if you have to repeat the year from failing too many classes. Like everything else, prioritize.

FUN:
Make time for fun to destress. At the end of the semester, since our Physiology class was cumulative, I was spending every waking moment studying and doing old exam questions. When my professor asked me what I did for fun, I’m embarrassed to say that I totally blanked. I couldn’t think of one darn thing I did for fun. In my tunnel vision of doing well on the cumulative final, I had neglected something that I really needed to balance out my life. Learn from my mistakes and don’t do that!

HOW TO NOT SMELL LIKE THE ANATOMY LAB:
One of the things I worried about most before school started was the Gross Lab, and most importantly (at the time), how to not always smell like formaldehyde/formalin. The advice I was given: change every article of clothing so you don’t take the smell home with you (including socks and even hair ties), buy a few pairs of old scrubs to wear and throw away once they get too smelly, swimmer’s shampoo will help get the smell out of your hair; put a clean towel over your pillow at night so your bed doesn’t smell….
I tried to follow most of these, but as the year went on some things fell by the wayside. I did keep extra socks to change into–sometimes things drip into your shoes and you’ll want to change your socks. I kept a small bottle of perfume in my locker that I would spritz on before and after lab so the smell wasn’t so bad. I did keep extra hair ties in my locker. When my scrubs got too nasty, I threw them away and brought in new ones. My husband said he could never smell it on me, so I didn’t worry about it too much. The worst thing was, there was one time where on the drive home I could taste it… I couldn’t get to a drive-through for a drink quickly enough! There really is no way to fully prepare for the first dissection; dissection isn’t really something you know how to handle until you’ve done it, but you’ll get through it!

Other advice:
-Try to get into some sort of schedule or routine. Remember to eat, exercise, and get some sleep.
-Figure out what works best for you. Your study habits will not be your friends’ study habits. Don’t worry too much about what everyone else is doing. Take care of yourself, and you’ll do just fine.
-Don’t get bogged down too much in the first week. For our first week, after about two hours of lecture, my brain felt like it was going to implode, and I got a bit overwhelmed. We even had a Histology review on the Saturday of the first week, and I felt like we were thrown into something that would completely and utterly consume my life. I adjusted. It did get better, and was even enjoyable.
-When classes first started, I tried a bit of everything. I read the notes before class, attended lecture, rewatched the Tegrities, reviewed the notes, made flashcards, studied in groups… everything I could think of. I kept what worked and trashed what didn’t. Sometimes my study habits needed adjustment between classes or even between blocks of the same class. Find what works and if it doesn’t anymore, adjust.

That should be a good start. As always, if there are any questions, just let me know! I’m happy to help. Congrats to all the incoming MS1s!

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Changing Definition of Excellence

Today makes our third (I think) snow day of the semester (and one canceled volunteer event on a Saturday). Although it’s beautiful out my window, I’m getting a bit sick of snow days. Don’t get me wrong, I love snow… around Christmas and New Year’s, not so much when it interferes with work/school and makes things more complicated. Sure, I enjoy being able to stay home today since I’m paranoid about falling while carrying this kiddo, but there are no such things as free days in med school.

There is also a forecast for an appreciable amount of ice the night before I’m due to take my CSE-1 Exam, where we perform a head-to-toe physical exam with one of the SPs. I really, really do not want to have to reschedule this exam, so I’m hoping this is the only snow day we get this week.

So, this brings me to my original idea for this post. Friday at lunch, we had a short seminar about career planning and things we need to be doing (or at least, thinking about) during first year, especially since we are now well past the halfway point of MS1. I did an extensive amount of research over the summer before school started and assembled a binder full of information about how to make myself a great candidate for any residency program of my choosing, so I felt pretty prepared for the seminar, but it was still informative and useful.

This seminar made me think about how my definition of excellence has changed since school started. If I had gotten into medical school the first time I applied, it was my goal to eat, sleep, and breathe med school in order to be the best physician I can be, because I thought that was the most important thing I could do. Thankfully, I am no longer 22 and so near-sighted. Sure, it would be wonderful to be first in the class, AOA, and the like, but those things are no longer my top priorities. I’ve learned so far that being all-consumed with schoolwork leads to burnout and is inconducive to how I learn. This doesn’t mean that I’m not committed to my education or that I’ll be a subpar physician-in-training. However, this doesn’t mean that I don’t feel subpar these days. High school, college, and even graduate school were so much different than this type of educational program. I worked hard, things came to me fairly easily most of the time, but hard work usually paid off in excellence. I’m still struggling with giving my schoolwork my all and still feeling mediocre or falling short of my overall goals, even though I’m doing well. Friday’s seminar only reminded me that there are other things outside the classroom that also need to be done–in this ample free time that I have–to be considered competitive for our future first jobs as physicians-in-training. Just thinking about it is exhausting sometimes. (But, have you ever looked up a physician to see his or her background? Usually there are a lot of “and”s… “Chair of ___ and Chair of ___ and Dean of ___ …” And I used to think I was the Queen of And. *Sigh*)

I’ve made my personal philosophy (Always have at least one Ace up your sleeve at all times) known to a friend and fellow classmate, and then got accused to cheating due to stealing the Ace’s in the (hypothetical) deck. (/total sarcasm there– med students need a laugh every now and then too.) Medicine is one field where there has to be constant consideration of what’s to come… it’s not just about studying, Boards are looming a mere year now from now; after that, performing well in clerkships and then taking another Step of Boards; then applying for residency spots. What score do I need on Step 1 to boost my odds of landing interviews in 4th year? (This was mentioned in the seminar.) I fully understand the importance of being well-prepared for such things, but geez, right now I just want to focus on biochem and physio for awhile.

In speaking of Aces, in recent developments, the Distinction in Global Health track that I applied for is officially “on hold” due to unforeseen circumstances that happened after all of the applicants had interviewed. I’ve made some good contacts and had a few conversations, but until some things are straightened out, the DIGH track is indefinitely on hold. I cannot even describe my disappointment, as I had ideas for three projects, but I’m hopeful that the issues will be resolved before MS2 begins. We’ll see, I suppose.

The seminar also focused on summer plans. I am still brokenhearted that I will not be venturing to Ecuador, Kenya, Thailand, or Brazil this summer with my classmates to work in clinics where people need help. My summer plans are still unconfirmed, as I’m still waiting to hear back from several possibilities, and the earliest I’ll know anything will be March. Sometimes I think I should change the title of this blog to “Major Change in Plans”… but I guess that is to be expected. It seems as though my interests in global health will go unfulfilled for awhile; luckily, the programs that I’ve been investigating for residency all have global health programs, certificates, and rotations. Someday, that dream will be realized, just not when I want it to be, apparently.

My plans for today are to go over the material we would have had in class today, prepare some more for my CSE-1 Exam (and praying the weather holds out so I can take it at my scheduled day/time), work on my part of our first Biochem TBL (Team-Based Learning) session on Thursday, and work on my Aces. So far, I’ve accomplished several items on my To Do List already, but it’s time I quit procrastinating and get back to it.

Have I mentioned lately that I’m living the dream?

“Cast your net wide, and you just might catch a fish or two.” ~Me

Another One Bites the Dust

Three weeks down (already!) and we are DONE with Neuro!

This was the reprieve I’ve been wanting. New year, new start in new classes.

This was just not my favorite class, and I think the arrangement of the schedule was one of the reasons why I was a bit disappointed in it. We spent a whole self-study week on just the anatomy of the brain, and I think this is where I got a bit complacent with the class; we definitely didn’t need that long just to finish Sidman’s Neuroanatomy. But that also coincided with my first full-blown week of morning sickness (which lasted all day every day), so I was grateful to be able to stay home and away from people.

This week has been rough. The night before the final, I couldn’t sleep. Then I forgot my badge on the way to campus so I had to go back to get it. On campus, I got a migraine. I thought the exam and the end of the day would never come. I was so happy to be done with that final!

Biochem and Physio definitely interest me more, so I am actually excited to get started with those next week. I’m also excited (because I am a total nerd) to start going to lectures full time again, now that I am finally starting to feel like myself again. There’s also a lot of things coming up this semester that I’m excited for. I just applied for the Global Health Distinction Track at school, and I have submitted a few pieces for publication. It is so nice to not be sick every day anymore, I’m finally getting things done!

My Shift in the ED

For ICM (Intro to Clinical Medicine), everyone is assigned a required 8-hr shift in the Emergency Department (ED) either this semester or next. Mine just so happened to be on a Sunday, midnight to 8am. (Note: EM is what they practice, ED is where they are, ER is the TV show.)

I was hoping the ED would be busy that night, since I’m not used to being awake & fully functional in that time frame.

We were extremely busy that night. Multiple MVAs (car wrecks), car v. pedestrian, gun shot wounds, very deep lacerations, stat flights, necrotizing fasciitis, and lots of drunken stupidity. Thank goodness I have a strong stomach. Seeing someone with a deep wound, dripping blood everywhere, deep enough to count the severed muscle layers, and I was fine; but the really difficult parts to watch were the strong, grown men that were reduced to shivering and whimpering in pain. That was the hardest part to me, to just observe all that pain and not be able to do anything about it. I did get to follow around not just the attendings and residents, but also a visiting 4th year student who actually took his time to explain things to me and answer my multitude of questions, not just about procedures but also general student stuff. At one point I actually got to recall my upper extremity anatomy to help figure out what muscles and nerves were severed in a deep laceration. Overall, a very productive night!

Emergency Medicine is still one of the specialties I’m considering (as a backup), but as cool as it was for even just one shift, I’m still leaning 100% pediatrics.

What It’s Really Like

I’ve already been asked a hundred times, “What’s it like?”, and even once (as a joke), “Is it like Grey’s Anatomy?”

I’ve probably made it sound like it’s not too bad so far. (Really, it isn’t THAT bad.) However, it is really, really hard. Not because it is that much more difficult than other undergrad classes, but there is just so much of it. I get excited about all the stuff we learn in lecture… for the first two hours or so. Then I just get overwhelmed, and I just want to go home, crawl under my rock, and study. It comes at us so fast that there really isn’t any time to enjoy what we’re learning (because what we’re learning is SO COOL! And AWESOME! And all that jazz…) because there is just so MUCH.

My least favorite thing is dissecting. I really and truly thought I would love it before we started. I was looking forward to it. But now, after having done it for a few weeks, I can’t say that it is really something that I enjoy. It just feels so wrong. And there have been a handful of times that I’ve nearly been sick, but I have yet to have to leave the lab. However, there is a tremendous amount of responsibility to take on, and learning this way is amazing. My mouth drops open in astonishment multiple times a day. One way I rationalize is it, no matter what we may do to a patient in our future careers, there is no way we will ever do something like this to a patient ever again. Personally, I think we’d be better served studying prosections instead of spending so much time doing a novice job at dissecting, because we’ve already destroyed several structures we were supposed to preserve. I don’t think I will ever get used to the smell of the lab, or knowing what my hands have done to a person. I will not be donating my body to science.

I miss the simple things of pre-med-school life. I just want a haircut. Is that really too much to ask? I’m lucky if I remember what’s going on this week and the next, so obviously there’s not enough time to get a hard-and-fast appointment with my stylist. I’m debating just shaving my head to save the hassle. I really need another home pedicure–mine looks lazy and sloppy. Most days I just don’t feel like myself, I feel like a completely and utterly exhausted version of myself. Apparently when I come home, I have lost my ability to park the stupid car. I’m just not paying attention. I still feel like I haven’t actually moved into the new place yet, it’s still a mess and I do not know where anything is, but hey, my histo final was one week and my two anatomy exams and embryo exam was the next week, so I needed to study and other things fell by the wayside. Somehow, somehow I am still sleeping well but I’m not sure how. If David didn’t do the laundry, I’m not sure it would get done. I do manage to fill the dishwasher from time to time. It’s sad. Some days I forget my lunch. My To Do list never gets any shorter, it just rearranges itself. I have forgotten how to cook. I think. My fried rice, chili, and broccoli soups do not taste right anymore, but I wonder if that could be attributed to the formaldehyde in lab.

In my spare time, I’m a volunteer research assistant and I volunteer with the SMILE program (Students Making Illness a Little Easier), playing with the kids at the children’s hospital. It doesn’t feel like an “extra” though, it just feels like an another requirement for school, and I’m still learning. But, it means more time away from home and less time to just be myself. I totally feel like I’m leading two separate lives, one at home and one at school.

There are some day where I just want to sleep. Or I just want to spend a night hanging out with my husband. But it usually has to wait until I get some free time, post-exams. I spent my birthday in the cadaver lab studying for the next two days’ exams, so it wasn’t the best birthday I’ve ever had. Luckily though, we were able to get our families together last weekend to celebrate, so I did get a bit of a reprieve from school to celebrate.

Every day is different. Some days we start at 8am, other days we don’t get started until 11am. Or we might even have the entire day off (like this Friday!). We might have Anatomy two days a week, or maybe four. We might have several online modules of lectures to finish on our own, outside of the regularly-scheduled lectures. We might have “fresh tissue lab” in the afternoon (don’t ask). We might have several sessions of ICM in the simulated clinic. One week I had to change in and out of clothes for either clinic or anatomy 12 times. That part does get old. It’s not the most glamorous life, and some days it’s not much to talk about. But there has been a lot of new material for creative writing, if I ever have time to sit down and write it out.

I know this just sounds like a lot of complaining. There are some fun things though, and it’s not all bad. I just feel like I could sleep for a week, as I’m constantly exhausted.

Uncertainty

Today was our second histology exam.

For some reason, they’ve taken it relatively easy on us before this exam. I had, more or less, 5 days to study for this exam with minimal class or extracurricular commitments. I was going to rock this exam!

But… there have been some issues. Non-school-related issues, that have kept my mind preoccupied for most of those days, and I found myself with just yesterday to devote to studying. My mind has not been in any way, shape or form ready to sit down and concentrate. I couldn’t even focus on the one day–the one FULL day!–that I had nothing to do but study.

And this is the awful little side effect of such things: I feel like I can’t do this. That I’m going to fail. That my school made a mistake by offering me a seat in the class when I can’t even be a good student and study. Even the fear of failing and being dismissed (which I don’t think they’d do over one exam anyway, but, irrational fears come from stress, right?) was not enough to motivate me. I just could… not… study.

Until this morning. I got more studying done in 5 hours this morning than I did in all of the other 5 days I had to study. And I still thoroughly smashed the exam, and left school doing my happy dance.

I can do this. I CAN do this.

And the side effect of this is that now, I feel like I can do anything. That I can be a badass in my own way. That these plans and these hopes and these dreams may be just within my reach after all.

One day at a time. Which means that now, after having a reprieve from the exam, I can now work on my presentation (that I give tomorrow) and catch up in anatomy and embryology. Just keep swimming.

Under a Rock

So here I am, at the end of week 2. I feel like it’s gone pretty well so far, but as far as the rate we’re getting new information while still reviewing the old, we’re reaching exponential growth. The stress is almost palpable.

I am very happy to announce that, as of right now, I am “honoring” anatomy! I did well on the one small quiz we’ve had so far, which I was very nervous about even though it wasn’t worth many points toward our final grade. I only announce this because there is a very real possibility that this will be the only time in my medical school career that I can actually say it. My school has a Pass/Fail grading system, so we don’t really get the traditional ABCDF grades that everyone is used to. We just need to pass, >70%. Anything at a 90% or above is an “honors” grade (so basically an A) while passing is anything greater than 70%. Below a 70% is a fail–and we all want to avoid this like the plague. As the saying goes, “P = MD”, although P =/= Neurosurgeon. I’ve probably mentioned that before, but that’s generally why you’ll hear medical students say that. We just need to survive. (This is why I say to strive for excellence, not perfection!)

Next week, things get a lot more stressful. We have our first embryology practice quiz/exam, histology lab & quiz, ICC small group meeting, my vitals clinical with small groups, and a big embryo/anatomy combined quiz. So yes, things are picking up rather rapidly. The information really isn’t that much harder than it was in undergrad, there’s just so much more of it. And there is never, ever going to be a break. The whole drinking-from-a-waterhose analogy is dead-on. Each week, our notes for just that week have filled an entire binder. I’ve used up at least two highlighters that were brand-new. And I totally have had that feeling of, I-just-want-to-live-under-a-rock-and-study several times this week.

Which brings me to today. A Saturday, and I am fresh out of the cadaver lab from two ours of a teaching/studying session that we’re using as review. It was totally worth it to see the other bodies in the lab–we get to busy during our dissection time that I never have enough time to go around and see the other bodies. So I feel like a learned a lot even in just such a short amount of time already today, but I still have a lot more to do this weekend just to prep for next week. So far, I’ve been on campus every single day since August 5th. Maybe I’ll take tomorrow off and just study at home.

While it’s just so much information, I’m still sleeping at night and I’m not feeling completely inundated or overwhelmed. Still no nightmares about cadaver lab (yet). From what I’ve seen so far, none of us look too stressed yet. The majority of the girls in my class still fix their hair and wear makeup every day, so that’s got to be a good sign. When I do feel a bit inundated, I just think to myself, “This is what you wanted.” Overall though, I’m still not feeling like it’s too bad (yet).

So there’s the update for Week 2. It’s a beautiful and cool day, so I’m going to get back to studying outside at school.