Saturday, July 31, 2010

The "B" 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,



Wednesday, July 28, 2010

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:


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.   


Monday, July 26, 2010


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!


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.