Taking stock of year one: Advice for incoming first-years

With the second year of medical school fast approaching, I've found myself reflecting on year one. What worked well for me and what didn't work so well? Having gone through that experience, what would I do differently if I could do it over again? What advice might I offer incoming first-year medical students? The following are five suggestions that I wish someone had given me before starting medical school. Everyone is unique, and there are many different learning styles out there, so these suggestions should be taken with that in mind.

1. Preparation for medical school: learn what you're going to learn before you start learning. I wish that someone had told me to buy First Aid for the USMLE Step 1 and flip through it during the Summer before starting medical school. Don't go crazy - don't try to memorize anything - rather, pay attention to the topics and types of knowledge for which you will eventually be held accountable. This may seem like overkill to a lot of people, but I know that I learn best when I can put what I'm trying to learn in a larger context.

2. Hone in on what's important. Medical school throws so much information at you that trying to memorize it all might literally drive you crazy. Instead, learn everything conceptually then identify what must be memorized. When it comes right down to it, the first two years of medical school are about cramming as much medical information as possible into your brain and demonstrating mastery of that knowledge by performing well on the Step 1 exam. First Aid is basically a road map of what a medical student needs to know in order to do well on that exam.

Another student a few classes ahead of me, offering advice to those following him just as I'm doing now, suggested reading the relevant sections of First Aid before each block then taking important class notes in the book so information is centralized. I didn't get that advice until after I finished my first year, but I plan on doing that during this coming year.

3. Anatomy: spend as much time in the cadaver lab as possible. I didn't do this at first, partly because it took me some time to adjust to the reality of dissecting a human cadaver. I noticed a substantial improvement of my understanding of the material when I prepared well prior to each dissection lab and when I spent time outside of dissection studying the anatomical structures. Study in a group and quiz each other.

4. Anatomy: Use multiple atlases. Everyone is infatuated with Netter's Atlas of Human Anatomy. The drawings are very well done, and they are helpful in showing anatomical relationships. So when I was shopping around for an atlas, I naturally bought Netter's. I found that it wasn't enough, though, and I ended up getting a second atlas: Grant's Atlas of Anatomy. It's drawings may not be nearly as pretty as Netter's, but Grant's includes a lot of additional information not found in Netter's. There are photographs, radiological images, and tables that organize complicated information like the fascial layers of the inguinal canal or the nerves and of the brachial plexus. My mind works well with tables.

I understand that not everyone is able to buy two atlases, but that shouldn't stop you from studying from more than one atlas. The library has many copies of both Netter's and Grant's. You can also borrow an atlas from a second-year, or study with a friend who has a different atlas than what you have. Bottom line: during anatomy, get your information from multiple sources.

5. Study the way you'll be tested. For the anatomy dissection lab, that means quizzing each other by tagging anatomical structures with pins. For everything beyond anatomy, that means answering USMLE-style questions. Subscribe to a question bank and use those questions to study during the last few days before an exam. It's most important that you do this during the CVPR block, since that block marks a significant shift toward more clinical material. However, I think doing this during the Molecules to Medicine, Blood and Lymph, and Disease and Defense blocks would have also proven helpful for me. I only started using a question bank to study during the renal section of CVPR and immediately wished that I had done so for the cardiovascular and pulmonary sections.

There are many question banks out there: USMLE World, Kaplan, USMLE Rx. Those are all subscription services. There is also a free question bank called Exam Master available through the Health Sciences library website, and also an up-and-coming free question bank called WikiTestPrep.

With so many question banks out there, what is the best approach? I am currently using USMLE World because many people I trust have told me that their questions are most comparable to those found on the real test. Also, for now, I only use this question bank in "tutor" mode, which means that my quizzes are not timed and that I get the benefit of reading explanations for each question. If you do start using a question bank to study during your first year, do yourself a favor and don't time yourself.

The long white coat

I was running around University Hospital today and bumped into a friend in the elevator. I knew him back when he was a lowly medical student with his short white coat, a fourth year. But today in the elevator, my friend who used to be a fourth year medical student was sporting a long white coat and looking very doctor-like. "I'm just an intern," he dodged. "It's a very steep learning curve."

It felt gratifying to see evidence of the progression: that medical students do actually graduate, get an M.D. after their name, and become an intern. That implies that interns do actually become residents and that residents in fact end their formal training to become full-fledged doctors (after a fellowship, maybe, but that's beside the point).

Such periodic reminders of progress is good for keeping up the morale.