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!

What I’ve Learned (So Far) About Navigating MS1

Now that I’ve had some time to recuperate, I’m in a bit of a reflective mood. (That, and I cannot sleep tonight.) First semester was rough at times, but it wasn’t that bad overall. As the saying goes, I’m 1/8th of an MD already! Here’s just a few things I’ve learned so far:

1) Volume

One of my biggest questions before starting school was about the volume of material. Everyone likes to throw out the “it’s like drinking from a firehose” analogy, but what does that even mean? So what was undergrad, a drip? A trickle? A water fountain? When I would ask someone what the volume looked like, visually, all I got was blank stares. What I meant was, please put it in terms I can understand. I felt that if I had a visual of what exactly this “firehose” was, I could at least be mentally prepared.

So this is how I would explain it anyone who asked me that question: In college, sure, I would study. I’d review. I’d do the homework. But I only really studied when it came down to finals. The all-day, leave-me-alone, I’ll-see-you-after-finals, do-nothing-else-but-study type of studying so I could be prepared for finals. For me, med school is that type of studying every single day. Printed notes for two weeks’ worth of material more than filled a 2.5 inch binder. It is so easy to get bogged down or to get behind. Because test questions are not as simple as they were in undergrad, which was basically a regurgitation of facts. It’s a new way of thinking that not only requires understanding what the notes say, but being able to apply it in a given situation. I feel for the first time that this is what I’ve been looking for in an education since I started high school: challenge me. It’s incredibly rewarding, but a total time sink.

School started out seeming like it was going to be impossible to stay afloat, but after a few weeks you do, somehow, get used to the volume and processing it. If this endeavor were impossible, we wouldn’t have physicians… so if we have as many physicians as we do, it can’t be as daunting as it seems in the beginning.

2) Time

I still don’t feel like I have my routine down to an art yet. How I study has completely changed since I started getting sick every day. I started the school year by reading the notes before lecture, attending lecture, and reviewing material during lunch or at home at night. Effective studying, but I was burning out quickly. At the time, I wasn’t taking any time out for myself during the week. While it is easy to fall behind or get bogged down, it is equally important to work in some down time. There are days when I come home and thought I just don’t want to do this anymore! (“Do this” = studying the same thing again.)

3) Sleep

I have yet to compromise my sleeping habits. I don’t really see the point in making myself miserable. There comes a time at night where I mentally shut down, and I know that nothing I’m reading or reviewing is sinking in. At that point, continuing is only wasting time. I’m not 21 anymore, and I’m not a gunner. Sleep is a precious commodity.

4) Books, Notes, and Lecture Slides, Oh My!

We have at our disposal so many different resources, it’s a bit ridiculous. There is no way that having a dozen resources for every class is efficient. My classmates are excellent about making review sheets, powerpoints, and other study aids that are fantastic… but they only exacerbate the problem, so I have to carefully pick & choose which ones are worth my time.

For instance, Gross Anatomy. The books that are generally required are Netter’s Atlas, Grant’s Dissector, Moore’s Clinically Oriented Anatomy, BRS (Board Review Series) Gross Anatomy… the list goes on (and on and on). Then there’s the Visual Body 3D program, a plethora of apps, Netter’s/Gray’s/Kaplan flash cards, etc. And let’s not forget the lecture notes, recorded lectures, and countless hours of lab time (with 24/7 access to the cadaver lab). Keep in mind that this is only one of the classes we’re taking, and the others are similar in resources required/recommended. It’s a bit ridiculous. Of course I want to be successful, so I’m going to want to be efficient. There is no way that I can thoroughly use each and every one of these resources without wasting a ton of time because I’m trying to do too much.

My suggestions, at least for Anatomy:
Netter’s: This is the holy grail of anatomy texts, but I don’t really like it all that much. Dr. Frank Netter was very gifted with his renditions of the human body, and they’re helpful when you’re first learning the names/layers/functions of structures, but that’s about it. Arteries aren’t bright red, veins aren’t blue in comparison (well… some were, but not most), the lymphatic system is not green, nerves are not yellow in a real body. In a real body, it can be hard to distinguish between a nerve and an artery. On our cadaver, muscles in the back were bright red, where in the abdomen and lower extremity they were more like a pinkish color, where in the face they were white. Netter’s also doesn’t do the best job in really showing the relationships between structures, such as what muscles cross other muscles, and where vessels weave in and around them. As the semester progressed, I got more and more frustrated with Netter’s and my flashcards, so I eventually quit relying on them.

Moore’s: Meh. I didn’t find this book helpful at all, minus several of the “blue boxes” with clinically-relevant information. Didn’t waste much time on it.

Visual Body 3D: Downloaded, did not use. Didn’t seem to be worth my time.

Grant’s Dissector: This book was okay. Some of the diagrams were extremely helpful for filling in gaps left by Netter’s. Overall though, I didn’t use it much after the first two weeks of dissection because our instructors usually told us the way they wanted us to proceed that deviated so much from Grant’s that it was a waste of time to read it beforehand.

A book that no one mentioned that wasn’t even required or recommended, but suggested to me by a friend who went to med school a few years back, was Rohen’s Color Atlas of Anatomy. This book saved my grade in the lab. It’s no secret that dissection was my least favorite part of the first semester; I made a great effort to spend as little time in the lab as possible because dissecting a body bothered me so much. It helped if I went into lab considering it as a job: all I had to do was finish my structures and then I could go home. Task, time, done. If I went into the lab with that robotic workaholic attitude, I could manage the urge to retch. (It did help that my dissection team had a sense of humor and we had things to talk about to pass the time.)

Lab can be frustrating because structures are hard to find, or can be destroyed, or one perfect example can be destroyed by the next day’s lab and then you have nothing left to study. Rohen’s is not a traditional textbook, but rather a large collection of color photographs of cadaveric dissections in expert examples. I would highly recommend this book to any incoming student, it made my gross anatomy life so much easier.

4) Fun

There is still plenty of time for fun in medical school. In fact, I can’t study in the unit labs because we have too much fun in there. It’s also pretty easy to get involved with a group (or two or ten) on campus. I’ve had a blast so far working with the kids in the oncology ward, helping them to SMILE. Shadowing and being a part of a research group has been a lot of fun too, and I’ve met some pretty cool people. But if that sounds like too much school-disguised-as-fun nonsense, there’s also group trips some clubs take–like the Wilderness Medicine Club–that have taken trips skiing and whitewater rafting. (Personally, I’d like to see more outings planned that significant others can also attend.)

5) The Importance of Being Friendly and Polite

Sometimes, you’ve just got to be in the right place at the right time. Not always easy to do, of course, but my momma always told me that “Someone is always watching,” which is absolutely true. I just so happened to be in the right place at the right time when I met a Program Director who shared his career advice for me. Out of the blue, I had an hour conversation with this person I’d never met before, and I really felt like I learned a lot from his advice. I ran into him a few weeks later (he’d even remembered me), and he told me about his disappointment with a few other MS1s he’d also tried to help. It always, always pays to be friendly and polite, especially in the medical field where networking can go a long way.

6) Being Married in School

I’ve hosted a few interviewees over the semester and given tours, and the question I am most commonly asked is how I handle balancing schoolwork with being married. The first semester wasn’t that bad. With David also being a student and working, he had plenty to keep him busy while I was studying. We had originally hoped to keep Friday nights as Date Nights, but with our busy schedules, that didn’t work so well. We’re hoping that with the second semester (and him “just” working instead of also tacking on school) we’ll be able to stick to it. I also tried to get all my studying done through the week so we had our weekends free. This didn’t always work, and if I had a test on Monday my weekend was booked solid for studying. But I did learn that if you prioritize your schedule, it is possible to make time for things that are important to you, be it a relationship, a hobby, or something else.

7) The Smell of Anatomy Lab

Gross Anatomy pretty much ruled my first semester. It was arguably the most challenging and required the most time. As an incoming student, I’d done a lot of research on how to avoid the smell of the lab, since that’s what all of the medical students I’d talked to had mentioned to me. There’s a ton of tricks for how to avoid the smell: put Vick’s Vapor Rub under your nose, always change clothes before lab (everything, including shoes, socks and hair ties), keeping perfume in your locker, double-gloving, washing your hair with swimmer’s shampoo… and the list goes on. At first, I did all of the above. It was a real hassle, but as the semester went on I started slacking. I quit using Vicks, and I wasn’t concerned too much about the socks and hair ties part anymore. I did throw out one set of scrubs after the second exam and brought in a new set. I can’t say that I ever really got used to the smell, but you learn to just work through it. The worst part was when I’d be driving home after lab and I could still taste the formaldehyde. That part was pretty gross. No one ever told me that they could smell it on me after lab, though, so in that respect I had an easier time of it than some of the upperclassmen I’d talked to before school began. Overall though, I’m just thankful that my school completed the entire course in one semester instead of dragging it out for the whole year.

I am so thankful that medical school is going well so far. It turns out that the words my mentor gave me long ago still ring true: “You CAN do everything… Just not all at once.” I have no doubt that this will continue to be true, especially now that we’re expecting to add to our family.

And again, if I can do all of this with being nauseated every single day, and wanting to die when I got the stomach flu… it can’t be that bad.