Holiday Vacation

The holiday floor strewn with gifts both adult and child reminded me of days with less stress and responsibility. This year we were fortunate enough to have three such weeks between semesters.

Prescribed Relaxation

Using vacation to get away seemed like such a good thought at first and it did the job to some extent. With upcoming board examinations, there is a lot of preparation that merits some planning. Whether finding the right question bank, registering for appropriate exam dates or making the perfect study plan I cannot let all of the vacation slip away to misdirected productivity.

In the meantime, vacation is here, classes are just around the corner and boards will be here in no time. If you happen to have a well organized study plan for boards and don't mind sharing please let me know.

Board Prep Question of the Week

A 32-year-old woman with no significant medical history presents to the clinic with visual complaints. On a recent trip to Arizona, she suffered an acute episode of visual impairment. She experienced blurred and double vision, which made it difficult for her to drive. On visual examination, her vision is 20/20 in both eyes. When she is asked to look to the right, her left eye only reaches midline while her right eye shows a beating nystagmus. Testing for visual convergence is intact. Based on the clinical history and physical examination, what is the most likely cause of her complaints?

A. Amaurosis fugax
B. Cataract
C. Multiple sclerosis
D. Optic neuritis
E. Panophthalmitis

Answer & Explanation

Objective Structured Clinical Exam

Despite the likelihood that I am actually making a fool of myself rather than providing a form of enlightenment, I have posted my personal OSCE experience for your viewing pleasure.

Medical Training

In preparing for the exam, I searched the internet for similar scenarios and was surprised that there are no amateur versions around. Perhaps that makes this the first student version available to be mocked, ridiculed and berated. It is in no way flawless, especially since it was our first OSCE experience. Nonetheless, I rather enjoyed the opportunity to "act" the part and play diagnostic detective if only for a few minutes.

For this exam, the patient was assigned to have strep throat, so it makes me chuckle in embarrassment that I submitted him to the Romberg test. In my defense, I was trying to stall with the last couple minutes to make sure there were no other exams I wanted to perform. Once we leave the room, early or not, we are not permitted to return. Fortunately, my assessment and plan were on target with the premeditated ailment.

Anxiety driven exams certainly test us under pressure, and we tend to make irrational decisions as a result. I did not have enough time to test for somatic dysfunctions as I ran out of time. If I was better prepared, I could have finished the physical early with a few less tests in order to leave time for the SOAP note. Not realizing how long the written portion would take, I learned the hard way that 9 minutes is not much time at all.

In time I have learned to hone in on the critical findings and tests to maximize the use of my time. The SOAP note information rolls out of my pen with greater fluidity and I now have a little more confidence than is portrayed above. At least this was an educational and preparatory experience, the real thing this early in the game could have been much worse.

Board Prep Question of the Week

A 48 year-old female presents with progressive shortness of breath and anxiety. She has no notable prior medical history, and on physical exam, auscultation reveals an opening snap over the cardiac apex followed by a mid-diastolic rumble. The most common cause of her disease process is which of the following?

A. chronic hypertension causing dilatation of the left ventricle
B. repeated attacks of Streptococci causing valvular lesions
C. primary pulmonary hypertension causing atrial dilatation
D. a congenital atrial-septal defect causing chronic hypoxemia
E. a congenital bicuspid valve causing increased afterload of the left ventricle

Answer & Explanation

Health Care Training

And it's over. All week long I thought for sure I would be looking for a new career path as the exams seemed to get tougher and tougher. One thing is for sure, your doctor has gone through a lot of tedious training to get where they are, more than likely they have some idea of what they are doing.

Allied Health Programs

When researching schools, I was happy to learn that Touro University Nevada supports a variety of health care professions such as nurses, physical therapists, physician assistants, and occupational therapists with the intention to expand into other fields of similar interest.

If you are considering health care careers there are many to choose from that may fit your personal interests. Whether you want to learn a new skill or need a complete career makeover, it can be done. A number of health care programs, online training, and trade development courses can be found with the click of a button.

The growing demand for health care professionals has shown a dramatic increase in nursing schools, radiography training, and various other allied health certification opportunities. Although there may be a shortage of physicians now and in the future, without the support staff, there is no way a physician could safely manage a patient's care.

Nonetheless, I am happy to say that when I reviewed my grades this time around, I was very pleased with the outcome. Despite contemplating other professions in case the exams had a poor outcome, physician is still at the top of my differential for future careers.

Board Prep Question of the Week

A 25-year-old professional cyclist is diagnosed with testicular cancer and undergoes chemotherapy. One month after beginning treatment, the patient complains of difficulty hearing. Which of the following chemotherapeutic agents is most likely responsible for this side effect?

A. Bleomycin
B. Busulfan
C. Cisplatin
D. Cytarabine
E. Doxorubicin

Answer & Explanation

Second Exam Week Three

There is really no need to say it, but the general consensus is that we are ready for the winter break to be here. The endless hours of review and study are starting to take a toll, unfortunately we still have five more days of exams to push through. This napping station sure looks enticing...

Endurance

Despite my best efforts to study into the next calendar day, I have found that I just cannot do it on my own. Taking time to break away from the books for a short period to shoot hoops, eat a meal or just squeeze in a short nap has fortunately lengthened my capacity to sit for longer periods. On the flip side, I have yet to determine the educational and graded benefits of this approach.

A fellow blogger and former medical student currently in his residency suggested an intriguing method for maximizing his time and efficiency. He calls it the Caffeine Power Nap as it combines the effects of sleep and drink to fuel ones durable energy. From personal observation I don't think my adenosine receptors are as responsive to the methylxanthine as others self-report, but the placebo effect seems to work for now. Ask me how I am holding up by the end of the week, that's the real test.

Board Prep Question of the Week

A 78 year old obese female with a history of bilateral knee arthritis and asthma presents to your office with symptoms consistent with stable angina. You choose to further evaluate her with a cardiac stress echo. For this patient, what agent is the most appropriate method to induce myocardial stress?

A. Adenosine
B. Dipyridamole
C. Dobutamine
D. Metoprolol
E. Treadmill Exercise

Answer & Explanation

Watch Medicine

In lieu of the holiday season and the thought of possibly having a little time to kill while on vacation I have sought out forms of digital entertainment that are sure to keep you amused while feeding the inner medical monster.


Medical Media

Fortunately, I do not own a television. Despite the shock this might cause, it is really a blessing considering how much homework I have. Every now and then, however, I just need a respite from the books and take advantage of the offerings provided by the World Wide Web. Below are links to free medical television shows, movies and procedures for your downtime enjoyment (if you have other suggestions, please leave them in the comments):

Medical TV

• House - An arrogant physician and great diagnostician takes on intricate cases
  
• Grey's Anatomy - Resident and veteran doctors dramatize their medical lives
• Mercy - Television drama at Mercy Hospital
• Private Practice - A drama about a neonatal surgeon practicing in California
• Trauma - Paramedics from San Francisco race to save lives
• Scrubs - A comical show about healthcare providers at Sacred Heart Hospital
  
• Emergency! - Los Angeles paramedics respond to emergencies in this older series
• St. Elsewhere - An 80's look at health providers in a Boston hospital
  
• Nip/Tuck - The dramatized life of plastic surgeons
• ReGenesis - Episodes about a team of anti-bioterrorists
• Chicago Hope - A healthcare team provides treatment to those who have lost hope
• Doogie Howser, M.D. - A young physician's approach to healthcare
  

Medical Movies

• Lorenzo's Oil - A moving story about parents who race to save their dying child
• Patch Adams - A comical view of humor in medicine
• Sicko - Comparison documentary between socialized medicine and American medicine
• Awakenings - New treatment permits catatonic patients to return to society
  

Medical Procedures

• ORLive - Watch recorded or live surgical procedures
• MedlinePlus - Various surgical videos available online

Board Prep Question of the Week

A patient presents to your clinic with a complaint of visual difficulties. On physical exam, you notice that when the patient looks to the left, only his right eye moves. The rest of the exam was within normal limits. The nerve responsible for this patient's problem travels through which of the following structures?

A. Internal auditory meatus
B. Foramen ovale
C. Foramen rotundum
D. Optic canal
E. Superior orbital fissure

Answer & Explanation

Giving Thanks

In this season of thanksgiving, I reflect on that for which I am grateful. My supportive family and friends are at the top of my list along with endless opportunities to serve my community. I am usually not grateful for the ability to grow so much hair on my lip, but this month is a little different.

Local Volunteer Opportunities

With the little time we have outside of classes, it is refreshing to give back to the community on occasion. Since we are in medical school, it commonly comes in the form of optimizing health through sports physicals or public screenings. Recently, I joined my peers in a 5k walk for chronic hypoinsulinemia on behalf of the Juvenile Diabetes Research Foundation (JDRF). In addition to raising money for a good cause, we caught a little fresh air and exercise at the same time.

In an ongoing effort to address prostate cancer awareness, men all over the world are "changing the face of men's health" by growing a mustache for Movember. I joined my classmates as Student Physicians for Fuzzy Philtrums, with the goal of contributing our follicular skills to this beneficial cause. If you have a prostate or love someone who does, please contribute to this noteworthy cause by sponsoring my fuzzy philtrum with a small donation. All proceeds go to the Prostate Research Foundation in cooperation with the Lance Armstrong Foundation. (After clicking the above link, you will be able to provide your contribution information online, if you have questions, please leave a comment.) Your generosity is greatly appreciated.

Board Prep Question of the Week

A 29 year old female with type 1 diabetes goes on a trip to the Caribbean and loses her insulin on the way. Three days after her last insulin dose she goes to the hospital. Lab work shows hyperglycemia and increased anion gap metabolic acidosis. Which of the following pathways is mainly responsible for providing the substrate of her acid-base disorder?

A. B-oxidation of fatty acids
B. Catabolism of branched chain amino acids
C. Citric acid cycle
D. Gluconeogenesis
E. Glycogenolysis

Answer & Explanation

Not On My Watch

Iatrogenic (caused be medical personnel) and nosocomial (obtained in the hospital) infections are unfortunately a sad reality in healthcare. When we visit the doctor, the last thing we want is to become more ill than our initial visit from an avoidable cause.

Healthcare Associated Infections

Hospitals are rightfully expected to get you better but that's not always the case. Sometimes people are picking up infections, from pneumonia to antibiotic-resistant staphylococcus (MRSA), while under treatment for other health problems, or even while just in the hospital having a baby. That's a situation that could, and should, be completely avoidable.

The fast pace medical environments such as clinics and hospitals make it easy to understand how healthcare professionals can facilitate the spread of infectious diseases from one patient to another. As simple as it is, hand washing is still one of the most effective means of reducing the spread of infection. Research has shown that alcohol based lotions equally accomplish the task in less time, hence the common practice of their use in medical facilities.

Healthcare associated infections not only have a significant financial impact on the medical system, but they are detrimental to the health of patients everywhere. The global campaign, "Not On My Watch" aims to educate healthcare providers how they can participate in reducing the spread of infection. If we all do our part, we can play an important role in the health of others and our own.

Board Prep Question of the Week

Five days after a mitral valve replacement, a 63 year old woman becomes hypotensive, tachycardic, and febrile. She is rushed to the CCU where an emergent transesophogeal echocardiogram shows multiple vegetations on the new mitral valve. Blood cultures are taken the patient is started on vancomycin and gentamycin. The initial Gram stain shows gram positive cocci. What additional bacterial characteristics are likely to be found?

A. Catalase negative with no hemolysis
B. Catalase negative with partial hemolysis and a positive quellung test
C. Catalase negative with partial hemolysis and no capsule
D. Catalase positive, coagulase negative
E. Catalase positive, coagulase positive

Answer & Explanation

Fertility Institute

With the new block comes new material. In anticipation of next semester's "project prepare," we have started our training of the genitourinary and reproductive systems. In terms of productiveness, we are gaining a fertile education.

Avoiding Educational Infertility

Although fascinating to learn about, the hormones involved in the endocrine system can be quite difficult with the first few passes. In working order, they control normal reproductive functioning and health. When the hormones are imbalanced, disease can easily take over resulting in various health complications.

It extends beyond the hormones into the histology, anatomy, physiology and biochemistry. The more we learn the "cooler" it gets as medicine incorporates so many fields into one.

As medical students we simply try to pack in as much of the information now, let it ruminate and make the clinical connections when the appropriate time comes. A significant part of our education is based off of getting the knowledge now so that we understand the clinical importance later. It may be wishful thinking, but I hope that the clinical experience really solidifies the chaotic sea of information that is floating around in my head. Books, flashcards and lectures can only go so far.

Board Prep Question of the Week

An 18-year-old female presents with abdominal pain determined to be related to ovulation. In reviewing the hormones of the menstrual cycle, you correctly remember that which of the following is responsible for ovulation? (Hint: Shown in the image above)

A. Estrogen
B. Follicle stimulating hormone
C. Luteinizing hormone
D. Progesterone
E. Prolactin

Answer & Explanation

Board Review

As we move forward into our last block of the semester, we often consider the inevitable board exam following our second year of medical school. For those of us who have not already started preparing, there are some very useful tools and programs available to make the most of time and resources.

Step 1 Board Exam Preparation

Whether you prefer reading from a book, listening to a lecturer, or answering thousands of practice questions, this is one test you have to prepare for well in advance. Some of the representatives of the programs have visited our school to share information, but it is important to know what fits you.

Below I have compiled a list of recommended review materials (and pricing when available) from those who have been through the process. As is often the case, the sales happen early, so do not wait too long to make your purchase. If you have suggestions, please leave a comment for others to read.

Books

• First Aid for the COMLEX - ($38) Geared towards the OMM and COMLEX style questioning
• First Aid for the USMLE Step 1 - ($40) Outlines the high yield information for USMLE
• Board Review Series - (avg $30) Various books detailing the important points of each subject (Physiology and Pathology are recommended).

Review Courses

• Doctors In Training - ($700) They are inexpensive, send bi-weekly emails with topics and have a three week online review. The price is lower because they do not include a question bank and use the First Aid book as their text.
• Kaplan - The old standard that provides excessive information at a high price. They offer practice exams, a question bank, and review sessions.
• Northwestern - ($400-$1500) Their emphasis is on COMLEX preparation, but they offer USMLE options. Pricing varies on supplies and package purchased. They offer a range of high yield courses or extended two week sessions.

Question Banks (Discounted prices are often available if purchased early)

• COMQUEST - ($75-$350) COMLEX oriented with 30-365 day subscriptions
• Combank - ($89-$389) COMLEX oriented with 30-360 day subscriptions
• USMLE World - ($99-$399) USMLE format with 30-360 day subscriptions; 2,000+ questions
• USMLE Rx - ($99-$199) USMLE style from the authors of First Aid offering 1 and 3 month subscriptions or until you pass; 3,000+ questions
• Kaplan - COMLEX and USMLE questions
• Northwestern - ($75-$145) COMLEX and USMLE questions with 1-6 month subscriptions

Board Prep Question of the Week

A 58 year old man presents with a past medical history of hypertension presents with a cough. The medical team suspects that the cough is due to one of his antihypertensive medications. Which of the following is a characteristic of the best alternative drug for this patient?

A. Interference with binding of angiotensin I
B. Interference with binding of angiotensin II
C. Reduction of serum angiotensin II levels
D. Decreased production of a key enzyme produced in the lungs
E. None of the above

Answer & Explanation

Second Exam Week Two

Other than missing out on the Black Eyed Peas and U2 concert up the street, studying for our exams this time around has been similar to those in the past. Thank goodness, it is starting to become a familiar process that has an end in sight.

Medical Knowledge

Knowing that after the last exams I realized a need to change the way I approach my studies, I am hoping that the change for the better has occurred. In the last few weeks we have had enough quizzes in class to "force" the information in our heads early. For better or worse, it leaves us with a simple review of the concepts at this stage, thus allowing more time for novel material and difficult concepts.

After talking with a few of my colleagues, we were happily surprised by how far we have come. One year ago we would not have been able to carry on a conversation concerning our current material with an understanding of the terminology or concepts. During this second year of medical school there has been a significant increase in vocabulary and conceptual development that builds a stable foundation for medical comprehension. We are only beginning the year, so I imagine there is a lot more to learn, but for the time being we enjoy knowing that all this studying is paying off.

Board Prep Question of the Week

A 44 year-old obese woman who has been recovering from a knee sprain develops sudden shortness of breath and left-sided chest pain with inspiration. On exam, HR is 110, RR is 24, Temp is 37 C, the pulmonic portion of the second heart sound is accentuated, 3 cm of JVD is appreciated, and the right leg is slightly swollen and tender. Trachea is midline and lung sounds are equal bilaterally without wheezes, rales, or rhonchi. The remainder of physical exam is unremarkable. If pathological examination was performed, what would be seen in the affected lung tissue?

A. Caseating necrosis with acid-fast bacilli
B. Exudative consolidation with numerous Gram-positive cocci
C. Hemorrhagic wedge-shaped infarct
D. Loss of alveolar septa
E. Pale infarct at the periphery of the lung parenchyma

Answer & Explanation

Medical School Training

Fortunately, medical school is not solely based on bookwork. Labs are intended to solidify the knowledge we get in class and clinical experience are used to tie everything together. This last week we had our first patient encounter.

Objective Structured Clinical Examination

Also known as OSCE, this course provides patient encounters by local actors who give us an opportunity to experience patient clinical interaction. The session can be monitored and recorded by faculty to help the medical student hone in on the challenging aspects of their experience. The exam rooms are equipped with everything we would need to perform a basic exam and we are timed to simulate the practical exam two years from now.

I enjoyed my first OSCE experience as it took me back to my days as an EMT gathering a medical history and executing a physical exam. For the purposes of OSCE, we performed a brief history and physical in 12 minutes to be followed up with a 10 minute SOAP note documentation of the encounter. Overall, time went much faster than I expected, hence the reasoning behind preparing us well in advance for this important exam.

This unique part of the curriculum is used to help us develop an understanding of patient communication, the importance of a complete history, and proper clinical examination. All these points are reinforced by the documentation of our impressions and plan. It is essentially an "ice breaker" into the rest of our career. For now, I think I am still afloat.

Board Prep Question of the Week

A 72 year old woman presents to her physician with the complaint of loss of vision. Visual field examination reveals anopia of her right upper quadrant visual fields bilaterally. What is the most likely location of the lesion responsible for this defect?

A. Left optic nerve
B. Left parietal lobe
C. Left temporal lobe
D. Right optic tract
E. Right parietal lobe

Answer & Explanation

A Breath of Fresh Air

I wonder if doctors have the privilege of prescribing vacations among other things. As a medical student, feeding the urge to enjoy oneself is often confronted with a looming need to study, thus rendering vacation a physical attribute that is rarely shared mentally.

Psychiatric Relief

With the extra day off last week and an opportunity to get out of town, I was sure not to pass up a potential vacation. Nonetheless I still have a quiz upon my return Monday. With some study behind me, the hours of travel time to come, and the mountain pass closed ahead there is a little time before I can consider myself fully prepared for the upcoming knowledge assessment.

From the beginning, the idea of boards has haunted me as the ultimate test of knowledge. In the interim, there is always something that needs to be studied. This unending progression of curriculum makes weekends and vacations difficult to enjoy completely. Although, I must say, studying for my quiz at a mountainside resort was not the worst experience ever, despite the urge to enjoy local amenities. My kind wife made an attempt at helping, but when it came time for the “anti-pyretics” and I had to point out they have little do with “pirates,” I finished the investigation on my own.

If for nothing else, this weekend getaway provided a mental respite from the monotonous page turning that fills most weekends. I would definitely suggest taking the time, however minimal, to regroup and stay at the peak of your game. Do yourself a favor, consider your mental health too and maintain your sanity once in a while.

Board Prep Question of the Week

A 43-year-old woman presents with bone pain, joint pain, and fatigue. Further history reveals blood in her urine and difficulty moving her bowels. She denies recent weight loss, poor appetite, and night sweats. She has no chronic medical conditions and does not take any medications or use drugs. Her family history is negative for malignancy. Physical examination is negative for lymphadenopathy or hepatosplenomegaly. Laboratory values include serum calcium 11.2 mg/dL, serum phosphorous 2.0 mg/dL, urine calcium 410 mg, and increased levels serum 1,25-hydroxy Vitamin D, and parathyroid hormone. Which of the following medications would most likely help in treating this patient?

A. 1,25-hydroxy Vitamin D
B. Calcium gluconate
C. Furosemide
D. Hydrochlorothiazide
E. Magnesium sulfate

Answer & Explanation

Organization Learning

Once again the Jewish holidays Yom Kippur and Sukkot have come around offering a respite in our studies. The extra time off has made life a little more bearable.

Time Management Strategy

When the school year started, I had no idea how much more difficult this year would be in relation to first year. I spend a great deal of my time at school late into the night preparing for exams, quizzes or simply studying recent material. The environment provided there helps to maintain focus, where the home environment can easily become distracted...especially if the refrigerator has been recently stocked.

I have found that spending a little time organizing oneself for a few minutes makes a significant difference when it comes to accomplishing the necessary tasks. It may be a simple check list or a detailed breakdown of how each hour is going to be spent. In any case, time management is critical to our success as medical students. Unfortunately, we sometimes forget to plan in the important things such as family, sleep and exercise. They all have their place and need to be considered into the equation. Thus when the days off come around, there is much rejoicing.

It is important to find what works for you. I break down my material into subject matter and then what I feel can be accomplished with the time I have. Commonly, it is by deadline prioritization - if the due date is coming, it gets top priority. Occasionally, I will complete a task simply because it can be done quickly, thus leaving one less thing on my list to worry about. Whether you make a spreadsheet with all your tasks, create an online task list that can be accessed anywhere or just write it down on an index card, being organized from the start will maximize your time and lower your stress.

Board Prep Question of the Week

An otherwise healthy 10-year-old boy develops blotchy areas of erythema that are pruritic over the skin of his arms, legs, and trunk within an hour every time he eats seafood, followed by diarrhea. These problems abate within a few hours, and physical examination reveals no abnormal findings. Which of the following immunologic abnormalities is he most likely to have?

A. Cell mediated hypersensitivity.
B. Hypergammaglobulinemia
C. Immune complex deposition
D. Localized anaphylaxis
E. Release of complements

Answer & Explanation

Medical Training

We are slowly making progress through the body systems and their related pathologies. Fortunately, the curriculum is set up to permit a significant overlap in material so that most courses are reinforcing concepts of an important nature. This repetitive exposure has been helpful to build working knowledge of how differing subjects can contribute to a comprehensive understanding.

Medical Program

All of our courses, during the second year, relate in some way to the health of the human organism. The learning process at Touro Nevada has been made simpler by combining topics from the multiple courses to coincide with one another to some degree. For example, this week in Pharmacology we covered Non-steroidal anti-inflammatory drugs (NSAIDs). At the same time in the Clinical Systems course we learned about various rheumatologic diseases that employ the use of NSAIDs to treat symptoms. Additionally, the Osteopathic Manipulative Medicine staff presented lymphatic treatments that could be used to aid in the recovery process.

The combined efforts of each course is to develop a well-rounded understanding of the approach to various body systems. So while studying for one class, I am equally reviewing material for another. The pieces of this "human puzzle" come together quite nicely to paint the whole picture.

Board Prep Question of the Week

A 40 year old female presents to her physician for worsening joint pain. She has had joint pain for many years in both wrists, MCP joints, and PIP joints. Her DIPs are spared. Her pain is always worse in the morning and improves as the day goes on. Lately she realizes both knees also hurt her and she is more tired than usual. Examination reveals her painful joints to be mildly warm and her PIPs are flexed, while her DIPs are extended. Laboratory testing reveals high titers of rheumatoid factor (RF), an elevated ESR and C-reactive protein, and a normocytic normochromatic anemia. Examination of the synovial fluid at the involved joints would most likely reveal which of the following?

A. Clear fluid; 125 WBC/mm3; 20% PMNs
B. Clear-yellow fluid; 1,800 WBC/mm3; 20% PMNs
C. Cloudy-yellow fluid; 6,000 WBC/mm3; 60% PMNs
D. Turbid, purulent fluid; 50,000 WBC/mm3; 80% PMNs
E. Reddish fluid; 1,500 WBC/mm3; 20% PMNs

Answer & Explanation

Wireless Mobile Phones

As technology advances, similar improvements can be seen in the medical field. The possibility of having communication devices at our fingertips has changed our approach to simple tasks. With smartphones now available in all shapes and sizes, technology continues to maintain its "coolness" with the added bonus of simplified communication.

Smartphones

Knowing full well that in less than a year I will be working in the clinics and hospitals among physicians and patients, I wanted to ensure that I had one of the most helpful tools in my pocket. Where a Personal Digital Assistant or book may have useful applications they still lacks in communication. The smartphones, on the other hand, are all encompassing with everything from internet and wireless communication to user friendly applications that make life easier.

Within the last few years the smartphone market has become increasingly saturated with new brands and models to meet diverse personal needs. In my recent hunt for the right phone I was able to narrow my search with the help of Top Ten Reviews. With so many options, it was helpful to have one place with customer reviews and technological differences.

In the end I chose to purchase Apple's iPhone for a number of reasons. A large portion of the purchase cost ($400 to be exact) is covered by AT&T making the initial out-of-pocket cost more affordable. To my surprise, the technology is rather easy to use and navigate, even for a beginner. With an expanding collection of applications, the iPhone has a versatile array of uses for many settings including the medical field, which was a critical deciding factor in my case. Although it may be a little more expensive than some of its counterparts, I felt the iPhone was the best fit for my particular medical student needs and will be an indispensable tool in my professional aspirations.

AT&T Gift Card

I have also recently learned that with a new AT&T account you can receive a $25 dollar gift card when referred by an existing user. That said, if you are planning to switch to AT&T or have recently joined AT&T, leave a comment on this post to that effect and I will provide you with the information needed to get your $25. Just be sure to leave your name and a means to contact you. Consider it your bonus for getting to the end of this post!

Decompressing

Block week certainly took its tole on me. Little sleep, difficult exams, and copious amounts of information culminated in a rather challenging week.


Overload

Coming into medical school, I knew the curriculum would be a feat to overcome. The change from undergraduate training to graduate level was no piece of pie, but I learned to cope and make the most of the situation rather quickly. The change from first to second year, however, was a curve ball I was not expecting. From the beginning of this year, we have been running at a sprint just to keep pace. Block week was no different.

I thought by studying in greater detail, for longer hours, from numerous sources that this year's courses would be surmountable. Unfortunately, there was little relationship between the amount of study and the resulting grades, which means I have to review the way I study. I felt that I already made a change for the better this time around, but it is apparent that I review my approach.

Needless to say, this weekend has been a much needed recovery. Catching up on sleep, missed errands and emails has been a great break in the action. It sure is a good thing I like the medicine.

Second Exam Week One

Let the fun begin. Although it seems like we've just begun the year, block weeks are here. That equates to a lot of late nights, little sleep, and excessive stress.

Student Syndrome

Fortunately, by this time we have been "around the block" a number of times and we are starting to feel comfortable with the flow. The sense of shock that was once there is more of a nagging feeling to get back in the books and make the most of our time. With one week to show what we have gained over the past month, why not drive hard?

Now the exams are not necessarily "old hat" just yet. In addition to revisiting the grueling routine again, we still have a lot of new subject material. Where there is one normal physiological function for everything, there are multiple pathological occurrences. That adds up really quick, leaving a substantial amount of material to cover.

The school has become my second home...for better or worse. The two most appreciated feelings are 1. Doing well on an exam and 2. Jumping into bed at the end of the night. Did I mention how much I love medical school?

Clinical Corner

Student Syndrome

This refers to the art, skill or habit of procrastination commonly employed by students to hold off their most important tasks to the last minute or wish there was more time to complete their work. Although I would like to say I do not actually have this syndrome, I am of the opinion that if you are a student, you likely exhibit it to some degree. Avoid cramming and use your time efficiently, even if it is at the last minute.

Pathology Education

The second year of medical school certainly has a lot of information compared to first year. Fortunately, it is focused on the pathological abnormalities, which make learning the material much more fascinating. [Image provided by the National Cancer Institute]

Pathology

This field of study often associated with autopsies and coroner's investigates both the abnormal macroscopic and microscopic findings in anatomical tissues. Learning a subject that takes years to master is quite a challenge for the novice pathologist.

It has been difficult to narrow my study of the subject as there are so many sources to pull from. The professor has his way of disseminating the information and pathology review books are quite different from that style. I have learned that with more exposure to the subject, the better it falls into place. As with anything, repetition is bound to make a connection sooner or later. Since there is a grade at the end of all this, in this case I am hoping for sooner.

We started the year with cellular pathologies and more specifically when cells get out of control. One of the leading concerns today is cancerous growth whether on the skin, in an organ or rampant throughout the body. Although I certainly do not have a cure for it, I am just starting to appreciate what causes cancer and how it is manifested. Often times it is the result of a genetic deviation from normal that no longer suppresses rapid cell growth. However, there are environmental factors that contribute to the development of cancer too.

Examples of carcinogens include UV light, occupational chemicals, and even hormones. We are exposed to them in various amounts depending on our habits, environments and genetic vulnerabilities. There is little that can replace healthy eating, regular exercise, and minimal carcinogenic exposure. So until next time, don't get too much sun and stay away from those asbestos infested workplaces; it could mean the difference between life and death.

Clinical Corner

Asbestos Exposure

Despite workplace safety measures, exposure to asbestos has been linked to mesothelioma, a malignant cancer affecting the lining of the lungs and/or abdomen. Where pleural mesothelioma can cause difficulty breathing due to fluid in the lungs, peritoneal mesothelioma affects the intestines causing weight loss, pain, and fluid accumulation in the abdomen. The latter is also associated with bowel obstructions, anemia, and fever.

It is most commonly seen in individuals who work closely with asbestos or their families, but may not be symptomatic for years. Mesothelioma is diagnosed by a pathologist who obtains a biopsy for histological examination. It is treated by surgical removal of the organ involved, radiation or chemotherapy. It is difficult to treat and therefore has a poor prognosis. For this reason there are clinical trials being performed in an effort to find better outcomes.

Neck Pain Treatment

One highlight for osteopathic medical students is obtaining hands-on training in Osteopathic Manipulative Medicine (OMM). Cervical spinal manipulations are among the most anticipated of techniques and thankfully have successful outcomes.

Neck Therapy

With the Hollywood stigma and the spine tingling sound of cracking, it is no wonder that we have had to wait this long to learn the mechanics associated with such treatments. As students we are just as nervous performing the technique as we are to be the patient on the table. The risk of severe damage is reported to be rather low, nevertheless, attention to properly performing these treatments is critical.

There are numerous resources available for learning the art of OMM and the American College of Osteopathic Family Physicians' website outlines a few of the more common treatments performed by osteopathic doctors. Although it is needless to say, there is more available than we students have time to consume. After learning it in the lab, we have to take it upon ourselves to make the time to practice our new skills.

In cases of somatic dysfunction, when a diagnosis is obtained, a trained DO can perform these treatments which relieve unnecessary pain and muscle imbalance. Because it is so sensitive, the neck can have a significant amount of dysfunction. Osteopathic cervical treatment is a quick way for the patient to find relief from their symptoms, and it is an enjoyably unique part of most osteopathic medical students' curriculum.

EKG Training

While working in the Emergency Department, I saw a lot of electrocardiograms (aka ECG or EKG) but did not have the training to read them correctly. Now in our second year of medical training, we are learning the basics of a somewhat complicated art.

Electrocardiogram

An electrocardiogram is a medical tool that provides an electrical reading of the heart's activity. Once you get past placing the leads in all the right places, it is a matter of understanding what the data is trying to say. With lines, spikes, bumps, depressions and what seemingly looks like cat-scratch, they can appear quite daunting to the amateur like myself. Careful observation and study of the markings can reveal a lot of pertinent information about the patient's anatomy and cardiac condition.

EKG training has branched out from the classroom to include online resources and texts that provide a quick reference to normalcy and abnormalities. As both an educational tool and reference book, Dale Dubin has published an easy to read book, Rapid Interpretation of EKG's, which I would recommend to any student of the art. Once there is a foundation of the principles, it is useful to consider a number of unique readings to see how they actually look. Dr. Wes, an electrophysiologist and cardiologist, occasionally shares EKG's on his blog for reader interpretation before posting his diagnosis. In this way, readers are exposed to various rhythms that demonstrate critical findings.

Being competent enough to know what you are seeing is a significant task when reading an EKG. With time and practice, I could be well on my way to understanding it a little better than before. Pathological indications will be jumping off the screen giving vital hints as to what treatments are required, and it's my job to recognize them when I see them. Fortunately, they will not be on living patients for another year.

Bicycle Transportation

We've only had three days of class and I already feel behind in my work. Between previewing lecture notes, reviewing lecture notes and reading the texts, I seriously wonder if I will have enough time to do anything else. At least getting to and from school will now be beneficial in relieving some of that stress. Check out my new wheels!

Scheduling Overload

Somewhere between the end of first year and the start of second year I lost a lot of important information mentally. As we cover certain subjects again, I can feel that sense of lost recognition. The professors certainly did not wait to open the flood gates and started in full force. After pharmacology and pathology were introduced, I felt my time would be well occupied. But it didn't stop there, they tacked on behavioral medicine, medical microbiology/immunology, clinical systems, osteopathic manipulative medicine (OMM), and objective structured clinical exams (OSCE).

On top of all that, I plan to squeeze in time for work-study in the anatomy lab, tutoring, several interest groups of which I'm an officer for two, and act as a "big sib" to a couple of the first year students. I smell burnout in the near future.

Stress and Anxiety Relief

In an effort to reduce some stress and use my time efficiently, I purchased a great bike at a great price thanks to Craig's List. Last year, I was in the worst shape of my life due to classroom inactivity. I'm hoping this year will be different. Amid the busy schedule, I don't see a whole lot of time for exercise and plan to ride my new bike to school instead of taking the car. Surprisingly, it takes almost the same amount of time to travel due to an abundance of traffic lights. At least this way I will be getting some movement into my otherwise sweat-less chair routine and burning useless calories in the process.

Sports Physcial

Not only is school starting in a matter of days for Touro University students, but high school students too are getting ready for the coming year. In conjunction with a local sports medicine clinic a few of my classmates and I teamed up to provide pre-participation exams for students trying out for various high school sports.

First Patient

Although our cadavers may have been our "first patients" as medical students, they were not breathing. So my first patient would have to be among the students I examined this last week. Each of the medical students were assigned an exam room where we obtained vital signs, medical histories, and performed sports physical exams.

After talking with some of my colleagues, I don't know who was more nervous, the medical students or the highschoolers. During first year, we were never instructed how to perform genitourinary exams. Given this responsibility among other tasks, we were expected to be professional and lead the exams in a timely manner. Looking back on it, it really wasn't so difficult. I assume at this point in my education, there are going to be a lot of firsts. Fortunately, this one was a positive experience.

I can tell there is a lot to be learned as the flow seemed a little choppy. In all, it was great exposure to the physical exam, younger patients, and my weaknesses as a learning student. It gives me something to work towards the next time around.

Healthcare Reform

Political propaganda just keeps rearing its face in lieu of the healthcare debate. Making sense of it all is an entirely different story and I am no where near understanding.

Healthcare Debate

With the new president and political party, we are soon to be introduced to a new form of healthcare. As medical students we may not yet be intimately involved in the business aspects yet, but we certainly will be in the future. Medicine as we know it today will change to adapt to the new policies decided in Washington.

In March, the largest gathering of osteopathic students and professionals held a conference in Washington D.C. to share their voice with politicians concerning healthcare reform. Considering the task before them, politicians may take a while before coming to a consensus, but the August deadline remains.

It is exciting to imagine how things will change by the time I and my colleagues graduate. Nevertheless, the majority of physicians are not content with the way things are moving. Understandably, the idea of doctors doing more and getting paid less is not an appealing alternative to their current standing. Perhaps if doctors were to be sponsored like professional athletes, there would be no need to worry.

Online Preparation

As new books are coming in, old books are being sold. The cycle seems a little ridiculous when we have so much technology available. How long will it be before there is an online medical degree for physicians?

Online Medical School

Although it may not be too far into the future before medical degrees come via online schools, at least online resources are a great place to study for such degrees. Whether a student or simply intrigued you can get a feel for questions that are asked on board examinations at WikiTestPrep. It is a free question bank composed to help students prepare for Step 1 (after second year) and Step 2 (near fourth year) board exams.

It doesn't take much time to answer a couple questions making this a simple addition to board prep exercises. Detailed explanations help to give a better understanding of difficult concepts. Add this to your routine as early as possible and reap the benefits when boards come around. Question banks are useful but can have expensive subscription fees which is why the above link is provided. Below are a few qbank offerings:

• USMLE World - ($185, 3 months, 2000 ?s) Good reviews
  
• Kaplan - ($189, 3 months, 2400 ?s) Most popular
  
• Exam Master - ($99, one month, 7900 ?s) Commonly free through school libraries
  
• USMLERx - ($129, 3 months, 3000 ?s) Similar to the Kaplan service but with a free trial
  
• Score95 - ($59, 3600 ?s) Poor reviews
  
• Scrub Notes - Blog post with an insightful qbank opinion

There may be other question banks available, but these tend to be the standard. I have been using Exam Master through Touro's library in addition to the WikiTestPrep just to get started. Getting in the right mindset to approach the boards has been a challenge, and the little time spent using these programs has been helpful in exploring the process. It may not get me a degree, but the internet has been my online medical school this summer and definitely keeping me busy.

Early Board Review

More than halfway through summer vacation and I can't seem to stop thinking about preparing for board exams and the second year of medical school. Despite being a year away, they loom incessantly in the back of my mind. It's time to start warming up the memory centers I turned off a while back.

Board Review Books

Since pathology is taught predominantly during the second year of medical school, it is wise to know the normal characteristics and actions of the physiological processes. Many students before me have suggested a self paced refresher course focused on physiology. For a relatively inexpensive price, I was able to procure the Board Review Series text. I figure with a couple hours every day I can at least review the important concepts so they are less foreign when we get into the material this coming year.

Many students have also recommended comprehensive books, such as First Aid for the COMLEX, First Aid for the USMLE, or question banks that will guide the study sessions towards board material. These are often used in conjunction with course materials throughout the year. In any case, there is more material available to prepare for boards than anyone has time to consume. As for enjoying summer to some extent, I think I have plenty of materials to work with and expect to see an improvement in information retention.

Clinical Corner

Home Medicine

Who isn't a fan of self-diagnosing? Admit it, you always try to guess what you have before asking the professional. I had an experience this past week where I was headed to the clinic and stopped at a book stand before arriving. To my surprise they had available a home edition of the Merck Manual. After a little thumbing, and I have to admit a selfish desire to have it on my shelf, I found a detailed description of the ailment, symptoms, treatment and more all in understandable English. For a quick reference, an abbreviated online Merck Manual is also available.

Matriculating Year Two

Hoping everyone had a great independence weekend, this blog comes to you while I'm actually out of town on vacation...enjoying every moment of it. Meanwhile back home, the school registrar is signing me up for the second year of medical school.

Registering

Registration has to be one of the simplest homework assignments I've had all year. With a quick signature, I was on my way to 45 more credits of graduate education. From what I have gathered, the first year of medical school is the most tedious as it concerns everything normal. Second year may have less credits, but a lot more material to cover in the way of pathological systems. Third and fourth years are just plain great due to the clinical experiences and freedom from the classroom.

Fortunately, some of the courses will be continued from last year so the terrain will not be foreign, but the rest will prove to keep me busy without a doubt. If Pharmacology and Pathology don't have me buried in a book all the time, I'm sure Clinical Systems will. (This comprehensive course, for example, touts a cumbersome set of notes and a lot to learn.) At least the information is becoming less dry and more interesting to learn as time goes on.

Assuming all goes well, I will be starting classes as planned in early August with adequate funds and supplies. In the meantime, I'll be enjoying vacation and honoring those who serve our country to protect our freedoms, thereby supporting my education.

Federal Student

Although I never really imagined having time to be employed anywhere as a medical student, I was happily surprised when the opportunity presented itself. This is the cadaver lab where we dissected cadavers and where I participate in the federal work-study program.

Federal Student Work

No longer a run-of-the-mill student, but a federally paid student, I reduce some of the hefty student loan I borrowed and learn at the same time. Nationally, students at more than 3,000 institutions are hired part-time to help in various operations and other positions. Almost two-thirds of the pay comes from federal funds geared towards students in financial need...for which most medical students qualify. The remaining third comes from the institution and all remuneration is tax free.

Once first year ended, I gained employment as a laboratory assistant in the bioskills and anatomy labs at Touro University-Nevada. Currently, the labs are home to 47 cadavers, the majority of which coworkers and I are preparing for the incoming DO class of 2013. Some are being prosected in preparation for allied health students within TUN's other colleges. I must admit that my job is probably one of the more unique federal student positions available.

In addition to earning a little extra among the cadavers, I will be able to brush up on anatomical landmarks and terms. This should bolster some of the already fading memories of structures once learned. Although impossible to work off my student loans in this position, if it helps when boards come around, I will be one step closer to graduating as a doctor. When that happens, no more federal student for me, instead my tax dollars will be feeding into the next generation of federally paid student employees.

Clinical Corner

Willed Body Program

The cadavers that are provided for students are obtained via willed body programs. A number of these programs exist around the country which are often associated with medical universities. An individual can specify that they would like their bodies to be used for the purpose of medical research by filing a donor form before dying. This gift to science has benefited the medical community in ways that the common public is not aware. In the university setting, these individuals are often considered a student's first patient.

Summer Exercise

We've already had a few days with temperatures above 100 degrees and Summer is officially here. It's time to enjoy this summer vacation before school starts again.

Mental Exercise

With some free time on my hands and in an effort to avert the quickly growing student loans I currently have, I tried out for the game show Wheel of Fortune. As exciting as it would have been to tell everyone I won thousands and a vacation getaway, my Wheel experience ended in the second round of auditions. Phrase, only vowels remain... B_TT_R L_CK N_XT T_M_. Left without much money and a stubby pencil as a souvenir, I am grateful for the mental workout.

Physical Exercise

High on my list of priorities for this summer has been eating nutritionally and getting in shape. Exercising right is time consuming and physically demanding. With the right tools and knowledge, workouts can be fun and rewarding.

In my search for exercise tools I have come across a fantastic website that crawls the web for the best deals in online stores. They provide definitions and guides in choosing the right product that meets your needs without the bias of commercialized businesses. With filters to narrow your search, it could not be simpler to shop the internet.

I have been looking for heart rate monitors for a while now, because meeting or exceeding 60-90% of your maximum heart rate is a significant part of an effective workout. Using a heart rate monitor will provide instant feedback that helps determine your level of exercise intensity, a major component in physical training.

When exercise intensity is not elevated, pedometers serve well to be riding your waist. They help track steps taken throughout the day which correlates with overall daily activity. Using a pedometer can help you reach the recommended amount of 10,000 steps per day by taking the guesswork out of counting the steps yourself.

What better way to model your new electronic wear than with a new pair of trail running shoes. Whether your in the gym or on a nature hike, your feet are often the most important part of your training. Recommendations are to replace your old shoes every 300-500 miles to avoid injuries from lost shock absorption and uneven tread wear.

With luck and a lot of effort, by the time second year comes around I'll be a little healthier and more prepared to take on the new year as long as I keep moving.

Discount Medical Books

It's time again to purchase the next series of textbooks and supplies. Those that cannot be found at Google Books may just have to be purchased at a reasonable price elsewhere.

Book Discounts

Fortunately, some professors reuse texts from the first year cutting down on book costs significantly. If this is not the case, here are a few learned ideas that may come in handy:

• Upperclassmen are often willing to sell used school books which would cut out the problem and expense of shipping and handling
• The school library will usually have course texts available for loan at no expense to you
• Deal Oz - Scouring more than 200 online stores, they find the best prices on the net, coupons and discounts apply to both new and used products...use it
  

Selling Used Books

If you are like most medical students, you are always looking for a little spending money, even if that means you just need to make up the difference in the cost for discounted books. It might be time for you to sell used textbooks. Honestly, most of them you will never use again and others will be outdated in no time. Rid your shelves of those that are taking up space while people still want them.

Despite the large variety of small textbook businesses, it may be wise to stick with the more common vendors; half, ebay, and amazon. If you would rather see your used textbooks go to good use, consider the incoming class, they will be looking for your great offers.

Physician Continuing Medical Education

Just when I thought my shadowing experiences had finished I was given the opportunity to explore medicine in a very different way through the Medical Education and Research Institute of Nevada.

Surgical Training

Currently, MERIN is the largest bio-skills lab in the Western United States and boasts their unique second floor observation area. Major medical companies converge on this site to host physicians from around the world for seminars and research on the latest in surgical techniques and procedures.

This well developed facility is housed under the Touro University Nevada roof, yet remains independent of the school. Willing medical students can spend a day rubbing shoulders with physicians as they learn or relearn critical medical treatments. With cadavers as patients, radiographic imaging when necessary, and the semblance of a sterile environment, the experience is the next best thing to performing the actual procedure on living subjects.

Their most recent clinic focused on pain management devices with guest lecturer Dr. James Chao from UCSD. (The subject matter was rather fitting as I recently finished shadowing a local anesthesiologist/pain management physician.) MERIN clinics host knee, shoulder, and hip surgical training to name a few. The two students in attendance moved among the stations with the doctors, networking and learning along with everyone else.

It is one of the few times, recently, that suggests the educational loans we students incur are going to be worth the pain. Although pain management may not be my specialty of choice, this experience certainly opened my eyes to the ongoing effort by physicians to maintain optimal performance and patient care through physician continuing medical education.

Shadowing

Now that school is out for the summer, we have taken to the clinics to see the local professionals in action. Job shadowing with a doctor permits medical students to learn by observation.

Job Shadowing

As I stood in the exam room, listening to the physician taking a history and performing a physical, I was impressed at how much I had learned from my first year of medical school. The terminology was not completely foreign and the medical principles behind diseases were still in my retrievable memory.

TUN students are responsible for shadowing two physicians for a period of 24 hours each. In an effort to cut down on wasted rotations, I chose to observe a gastroenterologist and an anesthesiologist. Despite some interest in their professions, I do not currently expect to choose either specialty, yet I continue to have an open mind towards both.

Thus far the experience has taken me to both clinic and operating room where I observe the doctor's responsibilities and techniques. Occasionally, the physician would surprise me with questions (known in medicine as "pimping") which often catch me off guard. If I can pull the answer out in a split second I feel pretty good, if not, they usually answer the question for me. That said, I find myself studying at home in between visits to prepare for my next pimping session.

Clinical Corner

Shadowing

My clinical preceptors have been fantastic, offering opportunities to educate and learn, they offer more to learn about their fields of practice than a book possibly could. To gain the most out of this experience, I would have appreciated a little more advice from our faculty. For what it is worth, I am listing some job shadowing tips. As usual if you have additional thoughts, please share.

• Set Appointments Early - Contact your preceptor early to set up shadow experiences (especially if it is a class assignment), there is greater flexibility and secretaries have little empathy for those who wait until the last minute
  
• Dress Professionally - This is a "no-brainer" but unfortunately there are some who do not
• Arrive Early - Plan to show up at least 15-30 minutes early, in the event a preceptor starts early or has time to talk it will be to your advantage
• Research the Position - Know a little about what your preceptor does and the educational ladder to get there before shadowing
  
• Questions - Do not overburden the preceptor with questions and carry a card to write on when they are busy performing their responsibilities so you can ask questions at more opportune times...nevertheless, ASK QUESTIONS, you are there to learn
• Shadow - Unless they ask you not to follow or copy them (hand washing etc.) you are there to experience it, do it too
  
• Study - If you have multiple days to follow a preceptor, take the time at home to study relevant terms, cases, diseases or ideas that you observed in preparation for the next visit
• Be respectful - Be nice to the other staff in the office and the patients or clients you work with, you never know when you will see them again
• Show Gratitude - Everyone deserves your appreciation for the opportunity, share it verbally and send a simple note of gratitude once you have completed your experience
  

Things I Wish I knew - First Year

After becoming a second year medical student two days ago, I looked back at the last year and gave each week a point value between 0 and 10 signifying my interpretation of medical school intensity where 10 is the greatest. Low points were often vacations (with the next few weeks prorated) and tallest peaks represent block weeks. Call me a geek if you will, but I think it's pretty cool to see the year in graph format.

Things I Wish I Knew

This last week of exams was not difficult academically, but was more so in anticipation of summer break. With one year behind me I have come up with a list of things I wish I knew before my first year of medical school.

1. Not all the textbooks were necessary - In addition to presentations and notes, the textbooks added a valuable resource, but there was simply not enough time to read every assignment. Occasionally, books were not even used. Contact current students and find out what they recommend. If possible, get used or discounted books. Often times they will already have markings of the material that is important and you save a little money too.
2. Much of the day is spent sitting - Time management is crucial to success. With excessive amounts of lecture and self study, there is little time to exercise. Elbows become sore and dry from hours at the desk, the back sore from pore posture, and the neck aching from constantly looking down. Exercise can be difficult to fit into the rigorous schedule, and it will make a great difference if included on a regular basis.
3. Organizing study habits takes time - It seems like a moot point because most people who get into medical school have some experience in studying. As one who has never used a laptop during class in undergrad, it took some time to learn how to organize my notes. When I realized that wasn't for me, I had to move back to paper. Transitioning between school and home is a challenge that requires attention. Having specific times dedicated to studying and following them will help significantly. Do what you are comfortable with, and most importantly how you learn best.
4. Associations are everywhere - At first it seems like you are struggling to get the fire-hose out of your mouth as far as information goes. Whether it is anatomical structures, terminology, or concepts it can quickly become overwhelming. For example, if you have experience with a condition you are studying (clinical, family or friends), it makes it a lot easier to remember and understand. Making associations to things you are familiar with personalizes the same message in a way you can comprehend.
   
5. Get involved - At first it was hard to imagine that there would be time to do anything but read. Initially, I was going to avoid the groups and activities until I could handle more which was not wrong thinking, and permitted proper time to habituate. Study groups are vital to bounce ideas and thoughts around. Student organizations are a great way to participate in community events and gain more experience. There is no better time to become a team player than in your first year class.

I am but one medical student in the sea of many. If you have something you wish you knew before your first year of medical school, please share.