Rejuvenated

Ahh, I just returned from a 2 week vacation to Jamaica, and I had an absolutely amazing time. First let me back up a bit; the last few weeks of this past semester was absolutely mind numbing for me. It seemed like I had no time for me, and exercise, relaxation, downtime- those concepts completely went out the window. By the time the semester was over, I felt completely drained and in dire need of a vacation. Thankfully, I had planned this trip to Jamaica since this summer. I packed swim suits and party clothes and completely put the thought of studying out of my mind. The idea was to get my mind completely refreshed, since I won't have another vacation before Step 1. The only book I packed with me was Ben Carson's Gifted Hands, and honestly I didn't open it once the entire time I was there (although I will say it was highly recommended to me so I do plan on reading it).
So what did I do on my vacation? I went to a bunch of live outdoor concerts, relaxed on the beach (in Negril there are over 7 miles of white sand beaches with crystalline blue water...pure heaven), climbed Dunn's River Falls, explored Green Grotto Caves, spent a day at Hedonism II Resort (I won't tell you what makes that interesting, but you can google it ;), went to Rick's Cafe and watched the cliff jumpers, and much more. I feel so rejuvenated and ready to plunge into Step I studying. Incidentally, I got my First Aid 2011 from Amazon in the mail today (I had pre-ordered it) .
Will post vacation pics and study schedule soon!
xoxo,
HOGO
   

Delinquent

I know, I know; you're probably thinking why start a blog if you don't have the time to maintain it. The truth is, I am thinking the same thing, but I really really want to post more often than I currently do. However, classes this fall pretty much ran me over like a steam roller. Like other med student's out there (if you're a med student and reading this, you know what I'm talking about), I have been so busy I barely have time to breathe. However, enough of that, I am writing now and would much rather write about fun stuff more so than how busy med school is.
Well, if you read my earlier blog, I was in the process of pre-reading for my Renal block. That paid off nicely, I aced the exam :) Gastrointestinal didn't go as well, and I still feel as though I don't have a good grasp on that stuff.  I will have to teach it to myself since we have a cumulative exam coming up soon.
With regards to the USMLE, I have been trying to do a little bit of prep here and there. I bought the Kaplan Qbank, and have done 300 questions so far, with 55%. That sounds pretty bad, but I am not too worried about it at this point since I haven't reviewed the material as yet. Also, I found this website that has this score-relator, and it shows that if I complete the bank with this percentage I would be in the 218 or so range. Since I have a lot of review to do, that's fine for now. I am basically using the questions as a way to familiarize myself with the material so that when I get my dedicated study time none of the material is new.
I have decided to change my class strategy; instead of reading the class syllabus, I am going to rely on Robbins and Costanzo. That way I will be preparing for the boards while studying for classes. I go to class and review the powerpoints, so I feel like I will still be able to pick up any little specific details the professors want us to know. I also have BRS Physiology and Robbins and Cotran Review of Pathology which are great question books (I actually have an older edition of  Robbins Qbook and I think it works just fine, if you're trying to save some money).
Anyway, it's Saturday and I'm going to get some R&R. Will try to update more frequently in the future, and please please post a comment and let me know your thoughts, or if there's anything you'd like me to comment on! I would also love to hear your study strategies and tips :)

   

The value of time

Eek! Classes start next week! Somehow that just crept up on me, I had it in my head that I had two weeks before school starts. Anyway, that means I'll spend the next couple of days frantically trying to tie up the loose ends of summer so that I can get my head back in school mode. That means finishing up things with my summer job, cleaning my apartment thoroughly, including straightening up my bookshelf and tidying up my desk, getting parking permits for school, etc. Ahhh, so much to do, so little time.

On the good side, I am still reading the renal chapter in Robbins, and it's making a lot of sense. I also bought the corresponding flashcards and going through them, I really like them. So just to tell you a side story, I am a flashcard junkie so I have all these flashcards...Microcards, Lange Pharmacology, Robbins Pathology Flashcards, Pharmnemonics, and my favorite so far...Netter's Anatomy. During first year, I used Netter's A LOT; I would take them to the gym and do them on the elliptical, between classes, etc. The great thing about these cards is that they are sturdy, and they have a hole punched in them so you can put them on a binder ring (which it actually came with, and for US med students, if you joing the national AMA you get these cards for free). The binder ring keeps them in order and prevents you from losing them, so they are super versatile. So back to my original story, I noticed I wasn't really utilizing my gazillion flashcards, and realized it was because they were so cumbersome to take around (can you imagine taking that two pound box of Robbins Pathology to the gym?) Anyway, I got this bright idea to hole punch them all. Of course, this is not a job I would tackle myself, this is one for the pros! I took them to FedEx, and when the guy saw how much flashcards I had I swear his eyes popped out of his head. Anyway, he looked at the cards and pronounced it would be quite difficult to punch them without punching through the text. Then he started whistling and got out his ruler and started measuring, you would think it was the highlight of his day to figure out how to punch holes in the cards. Anyway, he said he could do it and I could come pick them up later in the afternoon. Now, this is over 500 individual cards we're talking about, so I was like how much is this going to cost. He said don't worry about it, it won't be much. Anyway, I went back that evening, and all my cards were perfectly punched. Guess how much it cost? Zero dollars! The guy happily proclaimed it was "a labor of love" and handed me my cards. I didn't question it, just gladly thanked him, took my cards and lit outta there. Now, my Robbins card are much more manageable and I'm about halfway through the renal stack. Man, am I ever grateful for little treats that life hands out!

So back to the topic of this post...time. I came across this great quote on usml-forums.com, posted by someone who saw it on another site, so who knows who originally wrote it. Anyway, I think it's great so I'd like to share it with you.

Imagine there is a bank that credits your account each morning with $86,400. It carries over no balance from day to day. Every evening it deletes whatever part of the balance you failed to use during the day.
What would you do? Draw out every cent, of course!!!!!! Each of us has such a bank. Its name is TIME. Every morning, it credits you with 86,400 seconds. Every night it writes off, as lost, whatever of this you have failed to invest to good purpose. It carries over no balance. It allows no overdraft.
Each day it opens a new account for you. Each night it burns the remains of the day. If you fail to use the day's deposits, the loss is yours. There is no going back. There is no drawing against the "tomorrow".
You must live in the present on today's deposits. Invest it so as to get from it the utmost in health, happiness, and success !!!

To realize the value of ONE YEAR, ask a student who failed a grade.
To realize the value of ONE MONTH, ask a mother who gave birth to a premature baby.
To realize the value of ONE WEEK, ask the editor of a weekly newspaper.
To realize the value of ONE HOUR, ask the lovers who are waiting to meet.
To realize the value of ONE MINUTE, ask a person who missed the train.
To realize the value of ONE SECOND, ask a person who just avoided an accident.
To realize the value of ONE MILLISECOND, ask the person who won a silver medal in the Olympics.
Treasure every moment that you have! And treasure it more because you shared it with someone special, special enough to spend your time.
Remember that time waits for no one.
 
So, let's you and me both make the best use of our time, and make every millisecond count.
 
xoxo,
HOGO
 
 

Summer's end draws nigh...

First let me say I had a wonderful summer. I went on a cell phone- free, email -free vacation for a week, and it was pure heaven. I also did research with a neurosurgeon, and fingers crossed I may get a publication out of it (if not, I still had a great experience and made some wonderful contacts). So all in all, I had a productive summer. This week was my last week as a full time researcher, so it was quite hectic as I scrambled to wrap up everything. I still have stuff to do, so I'll be putting in a few hours per week over the next few weeks to finish up.
This summer I also tried to figure out the best way to approach studying for the boards. I came across all sorts of stuff (most on SDN); one was the infamous Taus method ( http://forums.studentdoctor.net/showthread.php?t=756311 ) that I never heard of until this summer. It seems pretty sound and something I'll likely use, although I'll modify it to suit  my study style. The other is Gunner training https://www.gunnertraining.com/free_trial_offer  I mention it because they are offering a free trial so it's definitely worth it to check it out to see if it fits your study style. (Thanks for the heads up Jessica!). I haven't gone through it fully as yet, so I can't comment on it. WikiTestPrep http://www.wikitestprep.org/ also looks like a site I'll visit frequently; they have a bunch of questions that can be organized by systems. On a lighter note, I also discovered this super funny blog, I swear this post is one of the funniest things I've seen in a while, and so true!  http://doccartoon.blogspot.com/p/anatomy-lab-groups.html
So my other goal for the summer was to pre-read for Renal. I started off reading the text for the class (Renal Pathophysiology); about a third of the way in I realized I wasn't retaining anything and needed to do something else. I am happy to say I read the renal chapter in Costanzo Physiology, annotated most of the chapter in FA, and am now reading the renal chapter in Robbins. I must say, Path is so much more fun to read than Physiology; that one chapter of Costanzo took me so long to get through. Of course, I am also a slow reader and get easily distracted, so that may have been part of the problem. Costanzo Physiology is a great book, well written and very straightforward. By the time I got to the end of the chapter I realize some things were repeated multiple times, so they actually stuck. I also have Costanzo BRS Phys which everyone swears by for the boards. However, I don't do well with bullet points, I need to have stuff explained. So for classes I'll use the text, then when I get ready for serious boards I'll use BRS. I'll also do the end of chapter questions in BRS within the next few days also.
I haven't had a chance to review any of the material from first year, but I will try and do even a little bit before classes start. In particular, I would like to annotate the Cardio, Respiratory, and Biochem chapter in FA. I'm not sure how manageable that is is the amount of time I have, but I'll try.
Anyway, off to troll on SDN and read Robbins...
xoxo,
HOGO

  

The "B" Word...how do you plan to prepare?

Since day one of med school, everyone has been talking about the Boards. 

"Oh, make sure you start studying now." 

"Be sure to get this, that and the other book to study for the Boards." 

"If you want to match in a competitive residency, you need to get such and such score on the Boards." 

I was on SDN recently and there is a thread on when and how MS II students are planning to start studying. Needless to say, with all this talk going around the "B" has been on my mind A LOT, and I am starting to get a bit anxious. I didn't ace the MCAT; in fact, I took it twice. I'm not saying this to imply I'm not good at taking standardized tests; I simply did not prepare well enough. Looking back at that time in my life, I can clearly recognize some of the mistakes I made. I will most definitely not repeat those with Step 1.

These are the two of the biggest things I need to work on:

1) Minimize distractions, i.e. focus on studying when I need to and not be doing a million and one other things. I am very involved with volunteering and professional organizations at school, and sometimes tend to get carried away and end up devoting too much of my time to extracurricular activities. This coming school year, I have attempted to limit the number of these activities I am involved with, and I'll have to learn how to delegate and say "no" more often. I am also really close to my family, which is great, but too often I let their personal issues overwhelm me and interfere with my ability to focus on school. This is something I've struggled with for a long time and know I need to work on. 

2) Make sure I have a plan that ensures I cover all the material THOROUGHLY. 

After talking with my advisor and some senior students at my school, it seems  that the best way to prepare for the boards is to do well in classes. This totally makes sense since this is the exact material that will be tested. However, I'm not entirely comfortable with this plan. For one, first year is already gone and there are some classes that I didn't exactly "do well" in, such as Biochemistry. Genetics wasn't very well taught, so I'll practically have to teach myself that. Developmental Biology was very well taught, but we didn't cover most of the Embryology that's tested on the boards. The point is that there's a lot of stuff from first year I need to cover while learning the material from second year. Thus, I need to come up with a plan that will facilitate that.

From everyone I've spoken to, the general consensus is that First Aid for the USMLE Step 1, 2010 (First Aid USMLE) is golden (i.e. a MUST HAVE). Thus, this will be my primary study guide. I have the 2009 version, so for each system I cover this school year, I will go through and annotate the crap out of it. I also have First Aid Q&A for the USMLE Step 1, Second Edition (First Aid USMLE); it's a question book and is great because it follows the organization of FA  text, so after each system I'll do the questions to help prepare for tests and also test my understanding of the material in FA. I recently ordered Robbins and Cotran Review of Pathology (Robbins Pathology) which is another purely question book; I haven't gotten it as yet but I love the Robbins text book Robbins & Cotran Pathologic Basis of Disease: With STUDENT CONSULT Online Access (Robbins Pathology)so I think having the question book will be a great complement. Goljan Rapid Review Pathology: With STUDENT CONSULT Online Access also gets mad props from virtually everyone; I like it because it has great path pictures and is pretty concise. The thing is, it is truly a review book and is organized in bullet point manner so it sometimes doesn't really cover things I need to know for class. For this reason, I imagine I will use Robbins during the school year, then use Goljan when I really settle in Boards prep.

Realistically, I don't think I'll have much free time during the school year to go back and review first year stuff. I'll be an Anatomy TA this fall, so this will of course be a great source of review. I have a few weeks of spare time before school  starts; my plan is to read up on Renal during this time since that's our first system for fall. If I have enough time during those few weeks,  I'll try to do some microbiology and cardiopulmonary stuff from first year. I'll also use Thanksgiving and Christmas break to review first year stuff and organize my study material.

In January, I'll get a three month subscription to a Qbank, probably USMLE World, and start working on that. From what I've heard, you should go through your Qbank at least twice. We get 6 weeks in March-April to study, so at this time I'll buy FA 2011 (I think it comes out in January?) and go through it with a fine tooth comb.

Of course, none of this is set in stone, so as time goes on and I figure things out, I'll modify/ refine this study plan. I'll keep you in the loop, and if you have any suggestions, I'd love to hear them (particularly if you're in the same situation as I am, or if you've already taken the boards). Till next time,

xoxo

HOGO

   

Clearance = UV/P...Lightbulb!

A couple months ago I completed the cardiopulmonary block at school. Basically, our curriculum is organized by systems, and within each system we cover physiology, pathology and pharmacology (of course nothing is ever that neat and tidy so sometimes things are randomly strewn in, but for the most part that's how it is). Anyway, while reviewing past exams for our cumulative final exam (the teachers make these readily available to us since the questions vary somewhat each year), I came across a problem that stumped me. It read something like this:

What is the clearance of a drug X?

a) Clearance = UV/ Pt

b) Clearance = V/UP

c) Clearance = UV/P

d) Clearance = U/PV

Straightforward problem, right? After all, we had learned the concept of clearance (CL) probably in our first pharmacology class. Basically, within the context of pharmacokinetics the clearance of a drug is the volume of plasma from which the drug is completely removed or eliminated per unit time, and the equation is

CL = Rate of elimination/Plasma concentration (unit is volume/time)

You can also relate it to volume of distribution (Vd, which is the total amount of drug in the body relative to the plasma concentration):

CL = Vd x Ke , where Ke is the elimination constant

You can even relate the clearance to the half life:

CL = 0.7 Vd/ (t1/2) where t1/2 is the half life

Since I understood all this, I should have known the answer to the question, right? Maybe, except that I had no clue what any of the variables in the equation in question referred to. Since I didn't recall anything like this being taught, I promptly dismissed this question. Except that as I continued reviewing, I noticed that the same problem had showed up on the 2009, 2008, and 2007 exams. By the time I realized this, I was sort of at my studied out phase (i.e. the phase where I'm like I don't care anymore, just give me the damn test already) so I put it out of my mind. Surprise surprise, guess what showed up on test day? Yep, you guessed right. Afterwards I was discussing it with some classmates to try to figure out the answer; pretty much everyone though it was a) because it had the time variable in it. When we got our scores back, I noticed that almost everyone in the class had a) which was of course wrong.

Fast forward to today. Next quarter, we start off with Renal block. The recommended text is Renal Pathophysiology: The Essentials, and our teachers were nice enough to lend us copies to read over the summer. So anyway, I just read the part on glomerular filtration rate (GFR, which is the volume of fluid filtered from the glomerulus per unit time) ; the equation is:

GFR = UV/P

where U is the urine concentration

V is the urine flow rate (in mL/min or L/day)

P is plasma concentration.

So does this look familiar? It turns out that it's the same equation for clearance!

Clearance = UV/P

Note that there is no "t" in this equation because since V is a rate, time if already factored in. The mnemonic to remember this is to think of UV light shining on pee.

So there you have it; months later, I finally understand that question. Yes I got it wrong on my cardiopulmonary test, but USMLE, I dare you to challenge me with that one!

Note: Things in red are must know stuff according to First Aid for the USMLE Step 1, 2010 (First Aid USMLE), so I just thought I'd highlight them.   


      

Welcome!

The heights of great ones*
Reached and kept
Were not attained by sudden flight
But they while their companions slept
Were toiling upwards through the night
- Henry Wadsworth Longfellow

It's finally here! I have been thinking about starting a blog for the longest time, but as the saying goes nothing happens before its time. This is the time! I will use this first post to tell you a bit about myself and why I wanted to start this blog.

I am currently a medical student (class of 2013) at an amazing US medical school. Getting to this point in my life and my career is a long story; maybe someday I'll go into more details about that. For now, suffice it to say I feel like the Universe has been smiling with me, most of the time at least. I love writing, but over the years I have found myself writing less and less, so hopefully this will help me rekindle that passion. I hope to use this space to talk about my experiences in med school, life in general as a med student, and as a journal to catalog my preparation for the USMLE Boards exams.

In order for you to understand why I love the above quote and used it as the inspiration for the title of this blog, I will have to share a bit of my background with you. I grew up in a tiny rural district (not in the US) and attended public schools where students were given government issued reading books. These reading books basically had little fictional stories that we would read together as a class at school. There was one particular story that resounded with me, and I'll share it with you. Basically there were these kids attending two schools that were competing with each other in track and field. At one school, the kids had all the resources they needed to train; at the other school the kids had little or no resources. For many years, the kids with all the resources would win in these competitions. Then one year, the kids without resources got a coach who believed in them, and told them they could win. This quote by Longfellow became their motto. They would train after school everyday, and do their homework by candle light at nights. Long story short, the kids with no resources won the competition that year.

I love this story and have used it to motivate me through life. I really do believe hard work pays off, and am looking forward to many more late nights as I embark on this journey of medical school and beyond. Thanks for checking out my blog, and I hope you'll continue on this ride with me!

xoxo,
HOGO

Ps. Please feel free to leave a comment, and let me know if you have any questions or suggestions for me!

* I changed the "men" in the original quote to "ones" to make it more inclusive.