Falcon Reviews

THE WAY TO STUDY MEDICINE

On March 31, 2011, in COMLEX, USMLE Step 1, USMLE Step 2, by admin

The Way to Study Medicine
By Stephen Goldberg, MD

The following suggestions about how to study medicine are not the result of scientific survey, but reflect my own experience in teaching medical students for 25 years. The suggestions also arise from my service as President of the MedMaster Publishing Company for the past 27, years and from the feedback I have received from students and instructors throughout the world.

The biggest problem in medical education today is an old one: There is too much to know, and not enough time to learn it. The problem is more acute today than it has been in the past, because of the great increase in medical information and even the addition of new courses in medical school. How can you digest and remember so much information, whether it’s for your general medical education or your USMLE/COMLEX review?

While memory aids such as mnemonics and humor certainly can help, it is more important that you really understand the material rather than just memorize it. Understanding it is key, because you can apply the information to a great variety of medical situations instead of using a cookbook approach that lacks understanding and applies to only a narrow spectrum of textbook medical cases. Moreover, once you understand, it becomes much easier to pick up and remember more esoteric facts, as opposed to just trying to remember isolated bits of information.

Despite the importance of reference texts, it can be difficult to go through them in the short times allotted for medical-school courses. Also, the information can be so overwhelming that it becomes difficult to see the forest for the trees, and acquire an overall understanding. While it is important to have the reference text, the initial phase of acquiring understanding is best achieved through the small book that helps you see the big picture. Once you’ve managed that, you can delve into the reference texts or elsewhere in greater detail as time permits, and you’ll have greater success than just trying to memorize information.

Your time to study for the USMLE/COMLEX may be limited, especially since studying often needs to be done while other medical school courses are underway. While you could review a book that contains isolated facts that may appear on the boards, you won’t acquire an understanding this way. While passing the boards is important, so is having the understanding necessary to be a good clinician. Ideally, you should have this before you review isolated facts for the boards. Such understanding can be achieved through the small book that focuses on clinical relevance and overall understanding, ideally read at the time the course is taken, but later if needed. The focus of the USMLE/COMLEX is on clinically relevant material, so that small book will likely contain the most relevant facts for passing it.

Once you’re on the wards, the question is how to make the most efficient use of your time in continuing your medical education. Not only is your time limited, but you’ll often find yourself fatigued from long periods on call. Trying to study a book like Harrison’s Medicine from cover to cover is likely to be futile. You need a more efficient method of learning. Reading journals can help you keep up on current information, but your primary focus in the medical-school years should be on acquiring the general broad information that is common knowledge. This in itself is a very large task. It has often been said, and I agree, that the best way to learn and retain medicine is through patient interaction. But to supplement this learning experience, it is important to do a certain amount of critical reading. Learning from your residents can be very useful, but the literature is more likely to be accurate. The most efficient way to do this reading, in my view, is to ask specific questions about the patient conditions you’ve seen during the day, and then seek out specific information in your reading. You should have specific questions to research, and then look for specific answers. In that way, over time, you will have learned the most important information related to the common diseases you are likely to encounter.

In the old days, such research would mean either having the necessary reference texts at hand, which might not have the information you need, or which might be several years out of date, or going to the library to search through heavy tomes of Index Medicus for pertinent references, and then hoping the library had the corresponding journals for review. This could be time-consuming, though, and difficult to accomplish when you’re already fatigued from a busy day. Today, the Internet provides a much quicker and more efficient way of searching for information. By using a general or medical-specific search engine, it is now possible to find important current and practical information about virtually any medical condition.

The ideal way to learn medicine, then, in my view, is to:

• Learn from the patient.
• Acquire a general understanding through the small, clinically relevant book that provides the overall picture, so you can see the forest rather than the trees. Humor and mnemonics can help, but understanding is key.
• Seek out particular points of information through the Internet.
• Keep a reference text at hand.
• Read journals as time allows.

Stephen Goldberg, MD
Professor Emeritus, University of Miami School of Medicine
President, the MedMaster Publishing Company
www.medmaster.net
Author of:
Clinical Neuroanatomy Made Ridiculously Simple
Clinical Anatomy Made Ridiculously Simple
Clinical Biochemistry Made Ridiculously Simple
Clinical Physiology Made Ridiculously Simple
Ophthalmology Made Ridiculously Simple
The Four-Minute Neurologic Exam
Differential Diagnosis (CD part of Clinical Pathophysiology Made Ridiculously Simple)

 

RESIDENT WELLNESS

On March 24, 2011, in Residency, by admin

Resident Wellness
By: Paul O’Leary, M.D.

Healthy residents care for their patients. However, multiple studies focusing on stress, burnout, and well-being demonstrate that the opposite may also be true. Burned-out, unhealthy residents simply don’t do as well at caring for patients.

The study of stress and well-being aids our understanding of how to quantitatively improve the work environment using multiple models and validated scales that measure burnout. Initial studies in the late 1970s focused on how stress affected hotel staff and nurses. Then, in the early 1980s, studies about how stress affects resident physicians began to appear in publications, as well. These publications assisted efforts, during the late 1980s and 1990s, to legislate improvements in resident work environments, culminating in the 80-hour workweek that began in July of 2003. Now, researchers are broadening their focus to include resident well-being and quality of life, as well as including ‘well’ residents and ‘stressed’ residents.

As a resident, I became very interested in improving the well-being of my fellow residents. I understood that even with the changes in the work hours and the oversight of the GRE, residents were still at risk for burnout. However, workload is not the only thing that can affect one’s risk. Research shows there are six major aspects to work satisfaction, and  the combination of these factors can lead to either protective or detrimental effects.

Naturally, workload is one of the factors, as being overworked can lead to burnout. Another important factor is the amount of control a resident has over their workload. By having the resources necessary to do work efficiently, and by having flexibility in one’s schedule, residents may protect themselves from burnout. The third factor is collegiality, or how well one gets along with others in the workplace. Fourth is rewards, not only through financial compensation, but also in recognition of a job well done. Fifth is fairness — whether tasks are divided fairly, and everyone is expected to meet the same requirements. The sixth factor is personal values; it is important that residents share the same values as the group for whom they are working.

By discussing these six aspects of work with the Residency Director, we were able to make changes to the program, which reduced the stress and level of burnout a lot of the residents were feeling. As we learn more about how to create a healthier workplace for residents, we create a healthier environment for patients, too. And that makes everyone feel better.

Paul O’Leary M.D.
AMA Psychiatry Section Council
Resident & Fellow Section Delegate
1225 50th St. South
Birmingham, AL 35222

 

Falcon Faculty Member Featured in New York Times
Dr. Michael Rafii’s Research into Alzheimer’s Disease makes Front Page News

At Falcon Reviews, our faculty members are more than top-quality PhD and MD professors with USMLE experience — they’re also experienced in real-world science and research. Falcon staff member Dr. Michael Rafii’s research into Alzheimer’s disease was recently featured on the front page of the New York Times.

A neurologist at the University of California, San Diego, Dr. Rafii is also an investigator in a large federal study exploring the early signs of Alzheimer’s. New diagnostic tests, including spinal taps, M.R.I.s, and PET scans, have made it possible for doctors to recognize the disease in its very early stages, before it manifests through observable symptoms. The advanced knowledge that an individual may be at increased risk for Alzheimer’s has led to a moral dilemma regarding whether or not to share this news with patients. The New York Times article, titled “Tests Detect Alzheimer’s Risks, but Should Patients Be Told?” is part of The Vanishing Mind series, focusing on the disease.

While it’s exciting to discover new advances in disease detection, the information can be devastating for patients — especially when there may not be an effective treatment. Will patients benefit from the information, or will they be harmed by the certainty of an impending disease, over which they have no control? In a study conducted by Boston University, nearly a quarter of patients requested their diagnosis be revealed. So far, the psychological impact has not been negative. In fact, many patients with high-risk diagnoses responded by increasing exercise, and beginning vitamin and nutritional supplement usage, although these measures have not been shown to reduce Alzheimer’s risk.

If your doctor knew you had a degenerative disease about which you could do nothing, would you want to know? As doctors, what is the greater responsibility to our patients — to inform, or to do no harm?

Click here to read the full article, and learn how a Falcon faculty member is making a difference in the world today. And be sure to explore our “Faculty” section to learn more about Falcon faculty members and how they’re contributing to the world of medicine.

 

WAS

On March 7, 2011, in COMLEX, USMLE Step 1, USMLE Step 2, by admin

Wiskott-Aldrich Syndrome
By: Nathan York

Wiskott–Aldrich Syndrome (WAS) is a primary genetic disorder that results in a combined immunodeficiency syndrome in children. It is a rare disease (four cases per million live male births), with a characteristic clinical presentation, making it a good case for the USMLE. It is characterized by the triad of eczema, thrombocytopenia and recurrent fungal, bacterial and viral infections. This disease is caused by a mutation in the gene that encodes Wiskott–Aldrich syndrome protein, or WASP, which is located on the X chromosome. This gene is expressed in all hematopoietic stem cells and appears to be involved in cytoskeletal functions. Dysfunction of this protein results in progressive decrease in the number and function of T cells. This lack of functional T cells also causes an inappropriate B cell response, due to the lack of necessary cytokines for activation and class-switching. The result is an ineffectual response to foreign antigens. Interestingly, these patients develop allergic reactions and eczema as a result of elevated IgE levels in the blood.

Presentation
As an X-linked disorder, this disease will only appear in males. It can manifest itself in several different ways, because of its effect on hematopoietic development. Within the first few months of life, gastrointestinal bleeding can be detected due to thrombocytopenia, and is often the first sign of the disease. This bleeding tends to become less severe as the child matures. Other early signs include the appearance of purpura and excess bleeding from circumcision. As maternal IgG decreases in the infant’s blood (around six months of age), recurrent infections begin to occur, with particularly poor protection from polysaccharide and protein antigens leading to pneumonia and meningitis. Recurrent infections of any kind should automatically suggest some sort of immune deficiency in the differential diagnosis. As the child approaches one year of age, eczema and food allergies develop (See Figure 1). Remember, for the USMLE, WAS presents as the classic triad of immunodeficiency (recurrent infections), eczema and thrombocytopenia.

Figure 1: Atopic Eczema

Diagnosis, Treatment and Prognosis
Diagnosis of WAS can be made by the following criteria:
-Demonstration of thrombocytopenia (platelet count of 5,000-10,000/uL)
-Presence of small platelets by histology (see Figure 2)

Figure 2: Microplatelets in Blood Smear

-characteristic of WAS

-Progressive decline in T cell number
-Immunoglobulin profile (decreased IgM, increased IgA and IgE, normal IgG)

Treatment of WAS includes the following:
-Bone marrow transplant (reconstitution of T and B cells)
-Splenectomy to manage thrombocytopenia
-Prompt treatment with antimicrobial agents upon infection

Prognosis of patients with WAS is bleak, if not detected. Without treatment, the average life span is approximately three years. With aggressive treatment, the average life span increases greatly, with some living more than 30 years. However, long-term survival increases risk of malignancies, especially within the lymphoid compartment.

References:

1.  Coico, R., Sunshine, G., Benjamini, E.  Immunology: A Short Course (5th edition).  2003.  John Wiley & Sons, Inc.  Hoboken, NJ.

2.  Gupta, K., Pulliam, L.  Concepts in Microbiology, Immunology and Infectious Disease.  1997.  Parthenon Publishing Group.  New York, NY.

3.  http://www.emedicine.com/med/topic1162.htm

 

31 Do’s and Don’ts for Writing a Medical School Personal Statement
by: Mohammad O. Hussaini,MD

Do’s of Writing a Medical School Personal Statement

1.  Be concise.
2.  Be unique.
3.  Be concrete. Show; don’t tell.
4.  Have a theme.
5.  Start early.
6.  Have friends and family look over your essay.
7.  Have your essay professionally edited.
8.  Address any weaknesses or irregularities in a succinct, effective manner when possible.
9.  Be positive.
10.Be mature and dignified in your writing style.
11. Get to the point.
12. Be interesting.
13. Subtly highlight your achievements. State them; don’t harp on them.
14. Explain any transitions in your life (such as going from a corporate job to medical school).
15. Brainstorm for a long time before writing.
16. Keep the grammar and punctuation flawless.
17. Try to spin negatives into positives without dwelling on them.
18. Write in active voice, e.g., “Completed reports” instead of “Reports were completed.”
19. Stay focused on one thing at a time.
20. Use stories when you can.
21. Try to get a physician to look over your personal statement.
22. Contact the admissions officer at the medical school(s) to which you are applying,
and get their input as to what they are looking for in a candidate.
23. Include wording that reflects the input from #22 above, in your personal statement.
24. Come up with an outline before writing the personal statement.
25. Revise your essay several times before submitting.
26. Even if your life is just plain blah, try your best to give it a fresh angle. Market, Market, Market.
27. Make sure your essay flows and is easy to read.
28. Be personal.
29. Demonstrate diversity, interest, honesty, commitment, compassion, drive, sensitivity and/or enthusiasm
in your essay if you can. Medical schools are looking for these qualities.
30. Close with your paragraph that summarizes the essay and ties in everything.
31. Be YOURSELF! (This is what the admissions officers repeatedly request from applicants).

Don’ts of Writing a Medical School Personal Statement

1.  Don’t exaggerate.
2.  Don’t make up information.
3.  Don’t wait until the last minute.
4.  Don’t make excuses.
5.  Don’t put down other applicants.
6.  Don’t brag.
7.  Don’t use the personal statement as a comedy forum.
8.  Don’t use clichés.
9.  Don’t be general.
10.Don’t be too philosophical.
11. Don’t be vague.
12. Don’t try to use language or vocabulary that is unfamiliar to you.
13. Don’t rewrite your CV or resume in prose.
14. Don’t bring up negatives for which you don’t have a positive explanation.
15. Don’t make your personal statement one long story.
16. Don’t come off as too naïve.
17. In trying to be unique, don’t come across as weird.
18. Don’t get into controversial topics.
19. Don’t copy someone else’s essay.
20. Don’t submit your personal statement without thorough editing.
21. Don’t rely solely on Microsoft Word’s spelling and grammar check.
22. Don’t be fake.
23. Don’t mention that the real reason you want to go to medical school is to make a lot of money
and drive a nice car.
24. Don’t fail to let the real you shine through.
25. Don’t include too much information about high school achievements.
26. Don’t forget to include references to research projects and publications in which you have been involved.
27. Don’t include information that you will have difficult substantiating during an interview.
28. Don’t start your essay with, “I want to be a doctor because….” or end your essay with, “In summary
…” or “In conclusion…”
29. Don’t be afraid to start over if the essay is just not coming out right.
30. Don’t be cute.
31. Don’t underestimate the importance of your essay in the admission process.

References:

http://www.uic.edu/depts/mcam/osa/careers/index.html

http://www.bestpremed.com/essayedge/lesson1.htm

http://education.yahoo.com/college/essentials/articles/med/medicalschoolessaysecrets.html

http://www.ama-assn.org/ama/pub/category/6700.html

http://owl.english.purdue.edu/handouts/pw/p_perstate.html

http://www.stanford.edu/group/spa/admit/pstmnt.html