June 29, 2008

Is there a best pre-med school?

HalfMD responds to a reader's question:
Is there a best pre-med school?

Abstract: No! Your academic dedication (GPA, Letters of Rec), your ability to perform (MCAT), your compassion (volunteering), and your familiarity with the health field (shadowing, personal statement) strengthen your application.

However, you might want to consider one of the "Big Five" if you need someone to hold your hand for the application process (the reader's parent submitted the question....)
  1. University of California at Los Angeles
  2. University of California at Berkeley
  3. University of Texas at Austin
  4. University of Michigan at Ann Arbor
  5. University of Florida

I mean no offense by that, by the way. I was completely clueless about what it took to apply for medical school and quite honestly, my first application was a complete BOMB even though I had enough of the right stuff. It would have been really nice to have a pre-med advisor. The closest thing we had was the Pre-Med Association... but really... would you expect your fellow classmates (i.e. your "competitors") to give you the best advice and review your application? That's why I'm really thankful that I had the support of a more objective and reliable group: the Medical Student Mentorship Program.

June 28, 2008

5 Tips for your Big Day

The First Aid team offers 5 tips for your "Judgment Day:"
  1. Double-check your paperwork.
  2. Leave your gizmos behind.
  3. Bundle up.
  4. Show up early.
  5. Chill out!

It's a great list... especially #1! You'll have so much on your mind that it would be a shame to push your test date back because you forgot a picture ID and your confirmation code.

June 24, 2008

Test taking strategies

There's a few basic strategies when approaching questions. This works for any sort of multiple choice examination, but your results will vary. I suggest swiftly adopting one that works for you. If you run into a question where it doesn't work (and you will!) then slow down, reread the question and use a different strategy.

I've become fond of a few methods as I studied for the USMLE Step 1. I'd recommend using them in the following order:
  1. Stop. Think. Predict.
  2. Question-directed searching.
  3. Answer-directed searching.
Stop. Think. Predict. Start at the beginning and highlight the important clues/buzzwords. Blot out the negatives. Think about the diagnosis (and some of the evident treatments.) Predict what the question will be and what the answer is. If you anticipate the right answer and it's there, BOOM! You're done. You should still review the other answers just to make sure that there isn't anything better. I love this strategy because it MAKES YOU THINK. It's exactly what you'll be doing for the rest of your life as a doctor... might as well get used to it!

Question-directed searching. This strategy is the preferred method by Drs. Walker (Tips for Taking the USMLE) and Dimov (How to Do Well on Boards). Basically, read the question first and look for clues to help guide you. This spares you the frustration of a "bait and switch" question where you read a long stem only to discover that the question is asking you about a basic science topic that's minimally relevant to the stem. I've never ran into this particular scenario myself, so I prefer to read something the way I read a novel -- skipping to the end cheats you out of the pleasure of figuring things out.

Answer-directed searching. Sometimes, you have no idea what the question is asking. Sometimes you have no idea how to guess what the answer is. I've learned a little lesson from Sesame Street. It's called "One of these things is not like the others." :) This proves that ignorance is bliss. Sometimes you can get the right answer even if you totally ignore the question and just look at the answers, isolating the one answer that's different from the others! It might be a drug from a different class than the others or a diagnosis that accounts for that one weird physical finding noted in the stem.

If you've got any other ideas, let me know. I can't think of any other ways to read a question and answers other than top-> bottom, bottom->top->bottom or just bottom...

June 23, 2008

Cognition for the USMLE Step 1

I scribbled down a few notes when first thought of this blog entry. The thinking process for the USMLE Step 1 is interesting... and the more I realized what I was thinking about (meta-cognition), the more I learned from the process of learning. It was very strange. It's been about two months since I took the exam itself. My sharp dedication to this topic is rapidly fading since I started my third year orientation today. However, I also feel a sense of urgency to at least address this topic before I ponder my clinical years on this oft-ignored-blog-of-mine (but I'd like to do better!)

In regards to the USMLE Thinking Process, consider the 4 R's:
  1. Recognition/Resonance
  2. Recall
  3. Reword/Restate
  4. Reconnect
Recognition/Resonance refers to the first part of the question stem. When you're reading, a feeling will come up. Obvious clues related to risk factors (female, fat, forties, fertile for acute cholecystitis, for example) will act as triggers. However, you should watch out -- in real clinical practice, the heuristic of stereotyping may be misleading! Stereotyping in the USMLE is surprisingly effective... and amusing.

Once you've read through the stem, you ought to Recall some basic facts about the problem at hand. This is a great exercise during your tutorial sessions as you go through questions in USMLE World... it will eat up too much of your time if you systematically quiz yourself during a timed exam. Here are some example questions: What are some causes of acute cholecystitis? (Blocked duct by a stone, either pigment or cholesterol.) Why are pregnant women more likely to develop cholesterol stones? (Answer: estrogen increases the cholesterol in the gallbladder-->hypersaturation and progesterone decreases GI motility-->stasis in gallbladder)

Next, read the question. Sometimes, it won't make sense. Restate the question, in the context of the clues given in the stem. A lot of times, certain words will be disguised and you'll have to take the extra mental effort of rephrasing them so you'll readily recognize them. Example: During the physical examination, tenderness is elicited in the upper right hand quadrant of the abdomen. Convert this long sentence to the eponym "Murphy's sign" and voila! You've created a mental shortcut.

Restating the question and the stem in your own words often helps you Reconnect with the question-writer's intent, if you didn't recognize it right away. Sometimes questions will give you a "Bait-and-Switch" and ask you about something slightly different. Sometimes it will be so painfully obvious what the answer really is that you'll wonder 'is it really this easy?!?' I felt that way on the NBME and the USMLE enough times that I felt comfortable responding with a 'Yep!' Rarely, the USMLE will disguise the question and the answer choices to such an extent that you have to rephrase everything. However, USMLE World does an excellent job disguising questions that they are all imbued with high-yield topics. They are worthwhile branches to consider even if the answer is obvious.

Take the time to figure out why every other answer is WRONG! That's more important than knowing the right answer as you study. That's not my second opinion!

June 10, 2008

Top Ten Tips for Step 1

I've been busy having a lot of fun this summer break (i.e. going scuba diving, getting a girlfriend and suffering the repercussions) so I'm sorry to all my readers out there. In lieu of a more original post, here's the list of tips I sent out to my friends when I was asked for advice about Step 1.... most of it I've said before.

1) Use USMLE World and mark the challenging questions.
2) Go through other question banks Kaplan, USMLE Rx, etc.
3) Revisit the questions you got wrong in World in random blocks and keep at it! Themes for your weaknesses start to emerge, so rehearse this material in the way that suits you best -- for me, it was silly drawings and mnemonics that I scribbled into First Aid.
4) Make First Aid your bedtime reading material. Imagine the question stems related to each subject and some of the tricky answers that typically throw you off.
5) Three weeks before, go to Prometric and take the practice. These questions are representative of Step 1 (albeit 150 questions shorter than the real thing.)
6) Two weeks before, take another self-assessment. I used USMLE World's Self-Assessment ($25, 200Qs) because it gives you the World-class explanations.
7) A week before, take NBME self-assessments to your heart's content. I'd highly recommend doing 350 questions in a day at least once.... I didn't and I found myself wishing I had more "test-stamina" as I had a series of mini absence-seizures by block 6.
8) Keep reviewing your weaker subjects in First Aid!
9) Relax the day before your exam. No matter what you think, you won't learn anything new the day before.
10) I did a quick 25 random Q block before I biked to Prometric on my final day. This warmed up my brain before the grueling 350 question exam.
11) Write down the number of blocks you have (7) on the corner of your blue laminated sheet from Prometric and knock it off as it passes. I lost track and I convinced myself that block 6 was my last one so I missed out on some vital break time.

Sorry, that list turned out longer than I expected.

Some observations I had on the real thing -- there were less calculations and more behavioral sci scenarios than I expected. Common subjects tend to cluster by block (I had literally half a dozen questions on hepatic encephalopathy in block 6 and 7!) The micro was easier than Kaplan's. Review a lot of CTs for your anatomy points. I'd estimate that the questions are 70% like NBME, 30% like USMLE World (in the thinking sense, not the obscurity sense.) Hm... there's a lot more, but the information is draining out of my head as we speak (or more accurately, as I write.)

June 04, 2008

JABSOM is not Pharm-Free

AMSA PharmFree Scorecard 2008 ranks 150 medical schools on their pharmaceutical rep policies. Only 7 schools received an A while 60 received a failing grade.

JABSOM was the first F.... shame on you, JABSOM! We failed to provide any policy whatsoever on this matter. Comments below:

University of Hawai’i John A Burns School of Medicine has implied that it is not a clinical facility and therefore it is not necessary to create policies in many of the domains on which it was assessed. It should be noted that other schools and colleges of medicine, which are not clinical facilities themselves, have created policies on conflicts of interest that apply to many of the domains assessed.

I've done s presentation about drug reps with my classmates and one of the lecturers in our EBM course expounded on the influence of drug companies in academic medicine. These are just small measures on the part of individuals though and easily tuned out as "just another boring lecture" by students.

AAMC and AMSA are pressuring schools to become more proactive in reducing financial conflicts of interest and lead by example for future doctors. This means banning all gifts and free drug lunches at University events. It means refusing industry support for CME. It means keeping our hands clean and doing our business.

There are some doctors who think that this is impractical. They think that they are immune to influence by pretty women with convincing papers on their latest drug. They think that CME will die without hefty financial support by pharmaceutical companies.

I'm not that naive.
  • I know I'm easily impressionable... that's why I do my best to surround myself with good examples.
  • In the long run, free samples aren't cheaper if the fancy new designer drug is 10x as expensive and just as effective as a generic drug.
  • I don't fret about CME... just checking my blogroll every day is a hefty dose of up-to-date medical education.

June 03, 2008

"Bodies" exhibition in Hawaii

It's a little strange, but "Bodies... the exhibition" will be at Ala Moana Shopping Center come June 14th. A mall? Really? I guess it's a more accessible venue than a museum. I didn't get the chance to go when it was in Philly a few years ago, so I'm excited!

I'm planning on going. Feel free to come with! Cameras aren't allowed, so no pics. sorry :(

Of note: the Bodies website has a distressing disclaimer.
-This exhibit displays full body cadavers as well as human body parts, organs, fetuses and embryos that come from cadavers of Chinese citizens or residents... Premier relies solely on the representations of its Chinese partners and cannot independently verify that they do not belong to persons executed while incarcerated in Chinese prisons.

Put your cell phone on the dash

Last night, I called my dad to make plans for tomorrow evening. As I chatted with him, some construction workers on the side of the road shouted at me. I didn't realize why until I had finished my call and pulled up behind another vehicle.

Crap. My headlights were off!

Recent studies found that drivers (such as myself) are distracted when they are on the phone while driving. This level of distraction can be equivalent to drunk driving! There's MADD... pretty soon there'll be MACC (Mothers Against Cell Calls.)

Yet, people consider it an "efficient" use of their time when they multitask while driving.

So what can be done to ameliorate this situation?

Devoting 100% of your attention to your road is the best way, of course.

Barring that, NY Times has this tip by Amit Almor, an associate professor of psychology at University of South Carolina:

The volunteers did much better on their visual tasks when they were just
listening, as opposed to preparing to speak or speaking. When they were
listening, if the demands on their brains became too much, they could just tune
out what they were hearing.
It may be, the study said, that when people talk to someone
who is not present, the visual-processing parts of their brain create a mental
representation of where the other person might be. This suggests, Dr. Almor
said, that using cellphones may be safer if the sound comes from the front.

June 01, 2008

A spoonful of Obecalp

At first, it started off as a joke. I mean, it's easy to ask the question. In a clinical trial, if a placebo actually improves a patient's health almost as much as a regular drug, shouldn't we be selling placebo pills? It's certainly a funnier (and more marketable) idea than ditching the drug undergoing clinical trials... especially after the drug company forked over $100 million for research and development up until that point.

Graham at OverMyMedBody! brought the idea of Obecalp to the blogging scene earlier this year.

45% of doctors who responded to a survey said they’ve given placebos to
. That number certainly seems high, but sometimes patients don’t
want to hear what you’re saying–namely, that no drug will help them. ...
I’ve certainly wanted to write for “Obecalp 1 tab PO BID” (’placebo’
backwards) but I find it totally unethical and undermining of the doctor-patient trusting relationship. (emphasis mine.)

So now what?

According to the NY Times, Obecalp will now be for sale as a dietary supplement. The example cited? A child with "a nagging case of hypochondria." I'm not sure how I feel about this.

Would you have to deceive Obecalp recipients in order for it to be "effectual?" I mean, I up my Vitamin C content and drink chicken long rice soup (with lots of ginger) whenever I get sick... that's placebo and I know it! Regardless, I feel better knowing that I did something.
Why limit the marketing to harried adults with whiny kids? This drug will fit in perfectly alongside Airborne and herbal remedies. In many ways, I'd prefer something that tells you up front: "I'm completely useless!"

via The Happy Hospitalist: Ma! Ma! I Need Another Fix
image by Djenan (creative commons license)