Things I learned in Medical School (and  wish  I’d  learned  earlier) Casey Darrah, MD, MSBS - So, you got into

medical school! Congratulations. Now the fun begins. - What is this guide for? It's not a compendium of review work. You're not going to get a single question right because of information learned here. What you are going to get, though, are some tips for how to make these next four years as painless as possible, so you can finish with that MD or DO, hopefully without losing your mind. - Who am I? Well, to be specific, I'm a family medicine resident, class of 2012 medical school graduate. Were my scores great over the course of medical school? Nope. However, that's a good thing. There are thousands of guides out there written by the 99s, the guys who got insane scores on this exam and that exam, and that's just great. What there aren't are books on the living of medical school. The coursework, I can make some suggestions, but material is left o those better than me. Making it through mentally intact and without wrecking your body in the process? That's where I come in. I'm the Virgil to your Dante, the Samwise to your Frodo, the Van Helsing to your Harker. I can't walk all the paths with you, but I can at least show the way. - First off, let's start with a very basic concept. It doesn't matter how good a student you were in undergraduate, you're automatically in a different league now. It doesn't matter if you were the top one percent, the competition just got that much harder. If you expect that you're going to keep with a perfect GPA and put in the time you did in college, you're in for a surprise. This works two ways, though. Competition is harder, but that can be a good thing to remember. Using my school as an example, they accepted four thousand applications for my class. Four thousand applications generated two thousand requests for secondary applications. Two thousand secondaries became four hundred interviews. Four hundred interviews became two hundred acceptances for a class of one hundred and seventy. For all the toughness of the program, you're already in the top five percent of their applicants, just by virtue of getting accepted. Remember that. If they didn't think you could do it, they wouldn't have given you the spot in the class. Now that you're in, though, it looks daunting. It's like drinking from a fire hose, as the common analogy goes- too much data to really try and get it all. It looks daunting, and it is. It is more information and work than any other program you've ever done, and it can be a shock. That's okay. Remember that everyone else in that room is in the same boat. Even those who finished other degrees along the way (your narrator has an MSBS) are going to struggle. Even those who seem like they have it all down, the AOA locks, aren't getting it easily. This is not the worst thing that can happen.


I was a neutral party. Let's go with the basics. sit down for your three hour exam. You'll crash and burn.Keeping your head on straight. Drinking is common as a stress reliever in med school. with the bar near the school getting slammed right after every exam. Nice side benefit! Limit caffeine as much as you can. they were tortuous. There's also a nice benefit of being able to cook. it will eventually burn you. This suited me well enough. On the other hand. and you're spending lots of time sitting and studying. breaks your concentration and slows you down. Be careful. I was lucky.the same lack of knowledge of your peers. Slam a Monster.while it helps push back tiredness for a while. so I was essentially considered an outsider as far as drama was concerned. calories and money. those can be highly useful and rewarding. That's a good thing! . though. med school is like high school. Accept it.he detested them as much as I and we ended up mocking the system together. Often ignored is the social aspect of medical school.same age and station in life. This is a problem. Same with any sexual relationships. there's another problem. diet and nutrition. though. and other such immaturities. You have little money (unless your loan overage just came in). They assume you know it already. though. First off. . In a lot of ways. saving time. However. the same fresh start. and a reasonably homogenous group of people. The rest of it isn't anything you shouldn't already know. you're able to attack the material from a wealth of different ways. Eating right is tough to do in med school.Since you're all in the same boat. Most schools hold events to get the class to know each other. a recipe for weight gain and feeling like crap. As someone who hates most of the forced togetherness activities that are endemic in the professional world. The drama can be draining."As the Cadeuceus Turns". 2 .while there weren't any unplanned pregnancies during my time in med school. Go buy a rice cooker (should be less than 30 bucks) and a slow cooker (should be under fifty). where people were urged to shun a given classmate as they broke up with them. Free pizza is everywhere. so the drama just flowed around me without involving me. I often would bring a bottle of Gatorade along for exams. My wife and I married right before med school started. with some of my classmates attending class in clothing more fit for a club than a graduate school lecture. Caffeine is a diuretic. This leads to the same dramas that are more common to high schoolers. there were quite a few scares floating around in the ether. if you can offer them good food. and you'll need to use the bathroom soon enough. though. These make it possible to make reasonably healthy and cheap food with a minimum of fuss and interaction. You can make some great friends in the crucible that is medical school. Friendships. but be wary. and those can be a double edged sword. I did find a good friend in one. There are ways to help limit the problem. lots of stress. Some would end up in highly drama-laden relationships.stopping takes time. Unfortunately it's just like starting college.a sip here and there gave me a break to refocus. which helped keep me calm. These are set to be some of the most stressful years of your life.makes you look like a god to whomever you're dating. of course. as these are ones most people won't tell you.

but if the mnemonic is too long to remember.Required  textbooks. Cost of the new printing.;  There  is  gross   anatomy. The legality is of course questionable. and quick to memorize.Exercise is a great stress reliever in med school. When I said old editions and similar books are good enough.pdf form.  and  they  do  require  an  atlas  for  that. $0. $100.Textbooks in general.Mnemonics. or snag an old copy out of the lab.    This  is  especially  common  with  Case  Files  books. though I know many people who pirated everything  they  couldn’t  buy  cheaply. it is useless. Just make sure your edition is not too old. having a . you can find any review book you want in handy . Studies have shown 3 . These are rare. but make sure before spending on the old ones. Look online long enough.    I  picked up nearly every book I could need for my Medicine. simple. and can be useful even as a study aid. Forty bucks for a small case review book is usurious. review books. Cost to use it in medical school. so no need to buy a perfect specimen. as are similar ones. Adding another point.  save  one. textbook piracy is common. but it adds up quickly.    99. Shaving ten bucks off the price of a book may not seem like much. Talk to those in years ahead of you. used books and international editions for any book you may need.44%  of  the  time. I got Blueprints for Pediatrics and Family Medicine and First Aid. Stress relief and studying! Core exercises are also great for stabilizing your back. The First Aid for the Medicine Clerkship book was unused. Mnemonics are best when they are short. I meant it. Family Medicine. Split the eighty bucks 4 ways with your group. . During my first two years. burning it. and will likely never leave the lab.  compared  to  $100  for  the   crisp new 2009 edition. and sometimes you will find great buys on books they’re  done  with. edit out the breaks and crud. The price new? $50. buy a decent used one. though there is a general guideline. along with the majority of textbooks. study groups. Five years for pharmacology is ancient. Spending an hour developing a 27-word mnemonic for the branches of the aorta between the pontine arteries and the aorta may be an interesting way to review. All three of these are generally personal decisions. or leaving it in the lab anyway. . of course. and online copies are plentiful. Even if you want a print copy to study from.  There’s  almost  never   a  time  where  a  professor  says  “Open  your  book  to  page  xyz…”. speed it up to about 140%.  It’s  a  consumable  atlas. I would record the lectures. and go for a ride on the stationary bike.the 2006 edition  of  Bates’  Guide  to  Physical  Examination  can  be  had  for  $20. You will be tossing it.   as they normally cost about $40.  “required”  means  no  such  thing. . Older editions are nearly always fine.ten years for physiology is no problem. and you can nearly always find old editions. My 1997 printing of Guyton & Hall Physiology was leftover from a Junior year physiology course.pdf version where you can simply copy a few cases to read during rounds is immensely valuable. Always check to be sure. Work Google to death. which really helps on long days standing.Surgery for less than $10 a book. Psychology and Surgery rotations for $150 from a fourth-year.

but which ones you use are your call entirely. I have appended a list of my favorites at the end as a guide. has attempted for years to start a peer-mentoring program with representatives of all four years. and one that my advisors swore by. but shorter is better. There simply is not enough time for a method like that to work.Study techniques. It fails when you have 4-6 hours of lecture daily.that  a  person’s  short-term memory can hold seven items fairly easily. I keep my mnemonics short. green tags 4 . Others swore by reading and rereading the book. Review books are extremely individualized. and record the lecture. Unlike college. causes of anion-gap acidosis with eight. My school. I popularized the use of a triage system in undergraduate. with retention dropping rapidly as the number increases. while others flounder and die within weeks.95 grade point average over the two years where I had this method perfected. Study groups are useful in some cases. Keep the mnemonic as short is effective to communicate the information. and devoting 12-18 hours strictly to studying leaves little time for worthless things such as sleep or basic human hygiene. parts of the patient history with nine) are longer. medical school is a different game entirely. My tried and true method through college was to attend lecture. Their Gross Anatomy one is mediocre. It served me well in undergraduate. It’s  based  off  the  classic  black-red-yellow-green tags seen in triage. Every student has their favorite series. and (blank) Made Ridiculously Simple are four common groups. I would later rewrite the notes. First Aid. Clinical Microbiology Made Ridiculously Simple is phenomenal. to the tune of a 3. due to the lack of chemistry. High Yield. Medical school is unlike any other educational scenario you have seen. but this is highly dependent on the dynamic you have between you and your group. as well as the second-year. The group we supposedly started my first year. Some classics (cranial nerves with twelve. The BRS Pathology and Physiology books are superb. with the common consensus being that reading the text three times was sufficient to crush any exam that would be encountered. medical school is different. in medical school such attention has to be given on a daily basis. no longer. for example. Read and discover which you can use best. It has failed miserably in the majority of cases. usually to six words or less. yellow tags can wait. their other books more hit-andmiss. take notes. Some groups can accomplish a great deal very quickly. With that in mind. and it persisted among many friends of mine even into medical school. but feel free to use what works best for you. while HY Neuroanatomy has a few tables that are lifesavers. third-year and fourth-year versions. Devoting 3 hours per hour of lecture is a noble goal in undergraduate. where one study method can work across a wide range of courses.the Board Review Series. and junk for others. Unfortunately. appending in useful data from the recording. Efficiency is the name of the game. High Yield Biochemistry is superficial at best. Some series are excellent for one subject. have never met aside from the mandatory orientations. . where red tags are those patients who need care the most and will benefit. While in undergraduate there may only be one or two classes for which this level of attention is needed.

there are better or worse question banks depending on the subject.     Need to read over a disease or two for PBL in 2 days? Yellow tag. as often as you can. if a given lecturer seems to think that summarizing the textbook passes for an enthralling lecture. and base further attendance on that sampling.  With  that  said… In my experience. Have an FCP discussion tomorrow that you can handle without prep? Green tag. discontinuing attendance can be the best move. Here. cost approximately $300 a year or $30 a month. which. though expensive.  but  the  very  people  who  sat  in  your  chair  are  the  same  ones  you   don’t  want  to  teach  you. What question bank you use is largely up to you. . and never be reluctant to change it. and thus a poorer preparation tool. Some instructors. and from as many sources as you can.  you’re  doing  something   dramatically wrong. They 5 . but the bad news is that the most efficient study method can take time to develop and perfect.    You’ll  go  to  every  single  one.  take  copious  notes. However. like most medical schools.  and  black  tags  are  the  dead  and  dying  who  won’t  benefit . the lectures are  immensely  valuable. . If it turns out.Lecture attendance. Never commit fully to one. Kaplan is one that many students like.  it’s  medical  school.  look  at  the  letters  after  the  lecturer’s  name. those are rare. Do as many questions as you can. as it did in my case.  and  that’s  the   most efficient way to study. Yes. but tends to fall apart quickly with the other exams. The NMS book is decent for surgery.    Exam  coming  up  in  Anatomy  next  week?    Red  tag. My general advice is to attend the first lecture for every single instructor.    Unless  it’s  a   clinical correlate lecture or similar. then  yellow. It's a 2000 question bank. and to tune your study to whatever course you are taking at a given time. The key is to be efficient. not requiring attendance at all lectures.”  is  exactly  what  you  don’t want to see. questions are king. Lecturers tend to do a very poor job of summarizing. Your study methods deserve no loyalty if the y  aren’t  producing  results. However it tends to be easier than the actual shelf exam. The MKSAP questions and book are excellent for the internal medicine shelf. Classes would  be  “tagged”  on  a  daily  basis. Of course. The following is predicated on your school.  especially  if  they’re   stuck teaching an introductory level of something that they actually work on.  seeing  “M.  and  attend  those  lectures  deemed  mandatory  without  fail. The king of this particular ring is the USMLE World question bank.D.    If  you  have  black  tags  at  all. and comes the closest to simulating both the Shelf exam and the Step exam. Focus on red first. feel free to simply review the material on your own. The good news with that is that you may have more time to spend on extracurricular activities. or more than 1000 questions while studying for the Step exams. lectures are quite schizophrenic things. that a certain professor is simply a poor lecturer. and  those  hours  can  be  better  used  studying  on  one’s  own.     As  a  quick  and  dirty  guideline. There are other question banks.Study techniques while on clerkships. It is not uncommon to do 500 or more questions in the course of a five-week clerkship. know your school’s  specific  attendance   policies.    MDs  tend  to  be  very  poor  lecturers  indeed. Similarly. but only for the internal medicine shelf.can  go  without  care. However. is one of the best that there is.  then  green.

it's expensive. Their lecture style is often stilted and dry. If you don't have a tablet or smartphone.  it’s  painful. If you don't have a tablet or smartphone.Cellular and Molecular Biology . or just want to do it cheaply. and do something else while it cooks.    If  they  can’t  provide  a  product  worth  attending. I'm told). 8.Shopping List for Block I 6 . Slow cooker. Lets you put on some slow carbs. instructors and material where going to lecture is simply a waste of 2-4 hours.  nice  and  clear. but I promise you this.great for long cooking. don't rush out and buy one unless you feel you need. it wipes clean with Windex. it works quite well and is large enough to work with. Excellent review book for the first Step exam (or COMLEX.    Either  way. the Dean isn’t  going  to  be  pounding  on  your  door.  I’ll  say  it  again. and while it's not as good as a true whiteboard. either cramming 150 slides into 2 hours. Makes organizing the mountain of material easier.    There  will  be   courses. It is strange.    It’s  really  their  own  fault. FIRST YEAR Block I. Yes. but if you're low on cash. Inexpensive stethoscope. throw something in when you leave in the morning and it's ready when you get home. but highly useful in my experience. and my wife and I still have it up for note taking and other randomness.Shopping List for the First and Second Year 1. 6. Tarascon's Pharmacopeia can be had for about ten bucks. that money can be better spent elsewhere. Whiteboard.  the  most  that  might  happen   would be a few snide comments from the professor if only forty of 170 students attend a lecture. and are reasonably priced. about eighty bucks. 3. eight cups or so capacity. the day you skip that first one. 7. While many schools offer downloadable lecture recordings. and skipping that first lecture. First Aid for USMLE Step I. 4. this has the added benefit of being useful for making notes to yourself.Lowe's sells a four foot by eight foot sheet for less than fifty bucks. My whiteboard was twenty bucks from a store closure. Rice cooker.four feet by ten. three ring. Hold a ton of material. If you're low on money. 2. I have one. The king of your cookery. worth annotating during first and second year with extra materials. Micromedex. Micromedex and Medscape aren't quite as good as Epocrates. hold up well. preferably electric. The hardest part is making the first leap. Binders. but I found I can hear just as well with a ten dollar stethoscope from the bookstore. preferably D ring. Digital recorder. or taking an hour  to  work  through  12. but they are free.generally  can’t  make  the  mental  leap  from  teaching  well -versed PhD candidates to teaching first-year medical students who may have never seen the material before. No lightning bolts will fly from the heavens. 5.  why   should a student feel guilty for skipping? . They're nice to have.    Lecture  attendance  is  optional. Epocrates or Medscape application for your phone or tablet. melamine board can had easily. While many will recommend the Littmann Classic II. Optional.

Things get interesting further down. It's almost always the first block. Standing there. the Blue Histology site at they only have that block to worry about. from the second years all the way up to the faculty. others. in a sense. when they were taking a one year MSBS program to enhance their chances of getting into medical school. isn't too far different from what you've been through before. Attacking it.1. HY Embryology. There's the First Circle of this Dantean descent. and I would encourage working with them. first of the nine blocks most medical schools use to break up the first two years. They (and I was amongst them) were in Limbo. gross anatomy and human structure and development. Useful books include High Yield Biochemistry. They may join you. 7 . As for other resources. 3. I will simply use them interchangeably. cell and molecular but working with a friend can make it a little less mentally draining. histology and cellular biochemistry. Lots of binders. surgery and disassemble a human being. helps to cement things. Books as mentioned below. all the while trying to master such arcana as which laryngeal nerve is most commonly injured in thyroidectomy (left recurrent is spectacular. this block was also used by Master's students. This block goes under many names. so many similar and foreign names. that is what they want you to believe. in that at my school. a twenty week course where people have to face all their fears about death. dying. This block is the one case where I highly recommend a study partner. taunting you. Nothing can make it easy. At many schools it's a combination of embryology. and drop down a circle. the king of hell. biochemistry. they can bring an interesting perspective to the material that may be useful.lab. and by far the one most like the courses you would have taken in college.anhb. Let us bid farewell to those in Limbo. It's interesting for another reason. Highly useful for filling in drawings and descriptions. then. Binders. There are so many similar paths. Their judgement from Minos awaits. or at least some way of breaking the boredom. Microbiology. Free. My school gave enough materials for Block I that I managed to nearly fill an entire bookshelf between the binders and the textbooks. highly detailed and more than adequate to get you through. pens or fine felt tip markers. They are with you for that block and several others.uwa. but they cannot descend further yet. by the way). as they're the same thing with different titles. Colored pencils.Gross Anatomy This block only really has two names I've commonly seen. It's the widowmaker block. At least. that simply having another set of eyes can make life far simpler. 2. Block II.

First off. then next? If you snip the musculocutaneous nerve. one finds the Lustful Sinners. and it's not all you need down. though hopefully without the lye burns. but not what I'm here for. and I'm not asking much. something running laterally. Better get used to the 8 . Netter's Atlas is huge. So. back. Grab a scalpel and get to work. though? Go to anatomy. that place of dark corners. it is my contention that a passing knowledge of Greek or Latin would be invaluable. There are tons of useful lists and tables. Make your peace with your God if that is what you need.very bad. The material guides are nice. Oddly apropos. what gets cut first. let's go a little further. let's take the latissimus dorsi and the biceps brachii or biceps flexor cubiti. if you've hung with me this far. you're going to be slicing open a human being. start thinking directionally. though a bit simplistic. wouldn't you think? Now. Cubiti. try either its location (pectoralis. It's not. There are also a lot of useful quiz questions and videos of dissections. rhomboideus). Taking the musculature as an example. If you're stumped on what a muscle. So. cubit. thoracodorsal artery). first off. good both for in the lab and in the exam. Brachii. what it looks like (deltoid. Bleed that site DRY. Bingo. why don't you cut the left renal vein at its origin? You sacrifice the left ovarian vein. Best of the reviews.umich. but either way. Latissimus looks a bit like latitude. a few good review books and resources. I mean a Fight Club style. Saved my bacon more than once. artery or nerve is named. However. If you've never sat down and really come to terms at a deep and abiding level that you are going to die. Sure as hell. This is the first real kick in the teeth from med school. BRS Anatomy is nice as a general review. Dorsi. supraspinatus). Break the names down. though. foul smells and weird noises? Well. Biceps brachii or biceps flexor cubiti? Biceps is Greek for two-headed. Greek for arm. So how do you survive anatomy? First. I don't mean an intellectual knowledge that you're mortal. what happens to the arm? If you're doing a left nephrectomy. knowledge and acceptance. same as dorsal. Let's go. Got it? Still here? Good. the long muscle of the back. If you don't the first few days on anatomy will be exceptionally difficult. make sure you have it down now. that's only a start. especially the ones listed under Anatomy For example. Another way to get the anatomy square in your head is to start mentally performing major surgery or major injuries.So what's the scoop? What's really going on in that lab. If you stab into the abdomen. What will work for you is to know why they are named as they are. it's known as either the two headed muscle of the arm. it is. Down the steps from Limbo. Don't just memorize names and say that's it. High Yield Gross Anatomy is great for embryology and has a few life saving tables and figures. or the two headed flexor of the elbow. a warning. or where it is going (brachiocephalic artery. elbow.

UltraSwim shampoo 2. though. Last of the tips before further descent is attire for the lab. My other secret weapon is to get rid of the formaldehyde smell. in that two of my lab partners were great. when we first opened the bag. and formaldehyde is a persistent smell unless you use something similar. and this was what worked for me. You're going to be working in close quarters for hours on end. usually purple.  though . but at least be on good terms with them. Crocs. Wear  whatever  you  like  as  long  as  you  don’t  mind  the  crud. Smear some around your nostrils when you know it's going to be a rough day. Managing the smell is a persistent problem in anatomy lab. Less than ten bucks a bottle. . I have two secret weapons. First is Vicks Vaporub.there. About five weeks in. Double-glove on those. and get one yourself that stays clean. Anatomy is also the one block where you HAVE to rely on your classmates to survive. but can be spotty. go to the pharmacy and buy a bottle of UltraSwim chlorine removal shampoo.  you’re  also  not  going  to  get  lab  odors  sticking   to your hands nearly as often. It gets the smell off. leave the lab copy behind at the end of the year. Scrubs are common. but at least things were civil. Nitrile gloves 4.we weren't friends. For that one.  Shoes. That solved that. when he joked he was going to meet me in the parking lot after I trimmed a renal vessel too tight. The lab atlas is going to get incredibly nasty over the next twenty weeks.easy to recognize. it's just tough to do that unless everything is copacetic. and use it as a shampoo and body wash.  it’s   worth the money to do was my school).There are useful computer programs for the anatomy as well. boots. Aside from those.Shopping List for Block II 1. I used it for day one. I just gave him a thousand yard stare and said he was welcome to try. but get something you can stand in all day long. but unnecessary. but worth having one where you don't care if it is gross. Vicks Vaporub 3. and you don't smell like formaldehyde when you go out later that night. I'm not saying you need to be best friends with your three to five labmates. most of my classmates just left it in there. but one simply conflicted with my personality from day one. not so nice for lab practical exams.Anatomy and Physiology Revealed is nice (and I'm not just saying that because I know all the creators. the day we opened the abdominal cavity. It's twenty bucks each.  they’re  usually  cheap  and  crappy  vinyl  or  latex. I had issues with this. I tried other brands. Nice for exam review. whatever works.    Comfortable  shoes  you  don’t  mind  gunking  up 9 . and it cuts the smell down a bit. Though  the  school  provides  gloves.  and  you’re  not  only  better  protected. Use your clean one in lecture and to study from. the smell isn't that bad.  Spend  th e few dollars for a box of nitrile gloves. Chip in a few bucks each to buy an atlas to keep in the lab. and the days we ran the bowel.

except brain-only.Shopping list for Block III 1.if they're bleeding. to be blunt. never use contrast. Andreasen and Black's Introductory Textbook of Psychiatry can be useful. Case Files Psychiatry is great for presenting a ton of cases. 256 Hertz tends to work well for the Weber and Rinne tests. this block can seem like a vacation. know well how to do the neuro exam. contrast mimics blood. To a lot of clinicians. Adjustment disorder is also very common on exams. Books as above. I also know a number of students also would role play various disorders.     Compared to anatomy. It's a combination block.Neuroscience and Behavioral Science Welcome  to  the  glutton’s  circle. Whether you want to go into psych or have anything to do with psych. Believe that at your peril. HY Behavioral Science and Neuroanatomy are both nice and cheap. about ten percent of the questions were psych derived. Pretty much. just using the same strategies for neuroscience as you did in gross anatomy will serve well. Anything to get it in your head! As a trick for the exams. When I took Step I. 10 . The cheap triangular hammer that is very common isn't the best for smaller reflexes. it is at the very least easy points on the Step exams and the Shelf exams in third and fourth year. Much calmer hours working. and if you're interested in psych. For psych. the psychiatric curriculum is not considered real medicine. Block III. obtaining a more focused history and exam is always a possible answer. neurology and psychology. psychoanalyze movie characters (horror movies are best for this. a different tack is needed. Getting a better neuro examination with a patient is always good. which is golden for exams. Neuroscience is essentially anatomy. So how to survive? Behavioral science is arguably the hardest block to care about. Good tuning fork. and not a really large amount of information in behavioral science. Oe that worked for me was to read as many case presentations as possible. Good reflex hammer that is heavy enough to elicit a good reflex. while a round hammer works well at getting borderline reflexes to appear. and can be tough in some cases if you don't have a background in psychiatry. Books are a bit personalized. Books as listed. and is often loud enough to work nicely for hearing tests. and why various altered results can be seen. to try and get a complete picture of what is seen with each disorder. 2. though Gollum was also popular). so knowing your psych can make a very large difference in your board scores. and works well as a fallback if you have no other ideas as to what the answer might be. 3. when doing a psych exam. .5. or even psychoanalyze professors and lecturers. For the neurology exams. For possible stroke patients. only a few labs in neuroscience in most cases.

really Block V. There are many mnemonics for the history. At many schools.  there’s  a  block  dedicated  to  solving  clinical  cases. what happens and any detail you have). Not all problems use this. C is characterization. ethics and other issues that might show up with your medical career. If you know a way that works better for you. marital status.Shopping List for Block IV 1. S is social history. work status.    It’s  usually  once  or  twice  a  week. For examination. H is hospital history. which I break into nine sections. Next is MASH. Easy. how to do an exam. tobacco. Survival is  easy  as  pie. Next is history of present illness. FS. my stay is short. what makes it better. S is surgical history. but toe the line with the examination days.Block IV. 11 . P is progression. S is severity. FCP is your medical skills block. A complete history and physical is vital for effective care. others call it other names. residency prep. sexual history. . so what the problem is doing. FCP was my school's name.  meeting  with  a  preceptor  to  discuss  a   case.Fundamentals of Clinical Practice This and Block V are essentially your vacation blocks. O is onset. after fourth. usually pass-fail. l is location. drug use.  and  Dante’s  use  of  the  wrathful here is appropriate.while there are thousands of videos all over YouTube and other places to do the H&P.  and  nothing  you  can’t  already  do. T is timing. but LOTSACRAP works for a base. After second year is Step 1. F is family history.    Maxwell’s  pocket  guide. either sudden or gradual. M is medical history and medications. what makes it worse. It's telling just how expendable this pair of blocks are when they hold the pair during anatomy at many schools. minimal work and studying. A is allergies (list what. A is aggravating factors. A is associated’s  the  last  worry-free  one  you’ll   have for a while. your exam still relies on what you've been shown. and you can greedily catch up on sleep! Very easy indeed. your skills should come fairly naturally from your coursework. From the description it should be reasonably clear what block at your school is the same. dirt cheap 2. Nothing else.    As  it’s  mostly  just  a  review  of  the  other  blocks  you’re   actually in. Dante used the fourth circle for greed. how to do a history.  usually  linked  to  whatever   you’re  studying  at  the  time.essential for the next four years. Go chill on a beach. First is chief complaint. Guess what? You just survived first year! Go enjoy summer. after third is worrying about applying to residency. alcohol. and I have my own. use it as you wish. low hours. My favorite is this format.Problem-Based Learning This  is  kind  of  a  catchall  block.exactly what does the problem look or feel like? R is remitting factors. So what is it? This block goes under many names.

 mnemonics  are  nice  but  limited. Nothing intense. though some took it as early as the Monday after class let out and as late as the first week of July.  that  you  can   do this thing! As a first non-block idea.Organ Systems 12 . but drop the 300 bucks for a yearly subscription to USMLEWorld and work through questions related to what you're studying. Beyond  that. Dante. Most schools let out in early May. just working through some questions. This one’s  essentially  a  grad  school  immunology  course. Helpful things include reading as many articles on disease outbreak as possible. Getting either Step Up to Step 1 or First Aid for Step 1 is also a good plan. and it'll make life a bit easier when in crunch time for your exam. from pencil. ink and highlighter. that's something that needs to be personalized.  folks.SECOND YEAR Back  to  the  grindstone. acronyms. just figure out the logic why. So how to survive? Oddly. the same techniques that worked in Block I are valid again. It is just as it sounds.but most is just finding your own way to get the words into the brain. . parasites. Whatever works for you to get it in your head. and make a note to schedule it for a convenient time over summer.Immunology and Infection Say hello to the heretics.   your “genius”  classmate  who  thinks  he  doesn’t  need  to  study  is  an  idiot. At this point. Don't worry about getting questions wrong. Block VI.  Second.some only clicked for me after finding the older works. prions. I scheduled mine mid-June.    Going  for  a  34  word  version  simply  isn’t  going  to   work for 99% of people. study using tutor mode. and read the explanations for each answer. annotate it into the book with more details. My copy of First Aid is noticeably heavier than it was new. aside from what I mentioned above.Block VII. and require you take the exam before third year starts in July. Read as many cases as you can. Annotate it with useful bits you find in your courses. it's time to start studying for Step 1. No real shopping list for this one. add it into the margins in the book! If you get a question wrong in the bank.bacteria. Also. If you find a good way to remember something. It's expensive. immunology along with study of the bugs. and do what you can to hammer it home.  First. save up some cash to pay for Step I. Just when you thought you were loose. this one comes along to slap you around some more.    If  you’ve  made  it  this  far. viruses. There are useful books. You're going to get a lot wrong at this point.I would not have passed without Clinical Microbiology Made Ridiculously Simple. silly rhymes.  you’ve  learned  a  few  things.

many. Hair falling out. lung and kidney infections. In this case. whatever. disorder. Exams tend to give the prototypical members of each class (say. one thing that worked for me was to grab a disease. The ultimate secret. slow healing. be it a person. impotent. the low energy state. and there are usually naming tricks to identify members of each class. sex. that's this one. Cancer does the same. and placed on starvation rations at a camp in the one useful trick is to remember the major members of classes. cilia of the airway. It can be a fun block. gastrointestinal lining. For pharmacology. -mycin. You need energy to replenish cells. John is on a medication that blocks the formation of new cells. it's also common for proofs to cheat the rules a bit and lift questions from it for exams. constant stress. heart disease and depression? Much more difficult. and severe lung cancer for which he's in methotrexate. vomiting. Another thing that worked was practice questions. but unlike the others (exception of Neuro) it links up easily with the more practical aspects of medicine. Change race. build a patient with it. He's been captured by the Japanese.the diseases and how to treat them! Survival is actually a bit easier than the first year blocks and Block VI. 125 kg black female with sarcoidosis. Altering it to a 77 year old. starvation. Antibiotics always carry the last name of the class. looks like two B's next to each other. starting out at 70 kg. In the case of our POW. depressed. situation. cillin. the block of nearly infinite names! Organ Systems. nausea. Angiotensin converting enzyme inhibitors all end in -opril. and tend to hang on the classic reasons and side effects around each. a classic chemotherapy drug. diarrhea. Treating a standard 70 kg. all end in -olol. to be very honest indeed. age. Why? The low energy state. and also much more realistic for what you'll be seeing in the real world. 25 year old white male with no other problems for hypertension is one thing. he's starving to death and has nothing coming in. For added difficulty. lining of the bladder. though? Master one concept. What does that mean? Well. drugs and other stuff. It's the key to all disease processes. a Sergeant in the US Army during World War Two. Which ones are a problem? Those are the cells that divide quickest. and so on. diabetes. It's hard as hell. start adding comorbid diseases. captopril instead of the more common lisinopril). for example. Bill is a 19 year old white male with no medical issues. occupation. Clinical Micro from above is also key. Come back in two years. and so on. and any reason you wouldn't give them. and they look the same. germ cells. Pathology and Pharmacology. hair. then see what happens. skin thin. If there is a block where it covers pathology and disease processes. Beta blockers. In addition to being useful for understanding. many others. kidney disease. 13 . let's make two patients. Knowing one or two members of each class is usually sufficient. and work through it. and see now what you do. many disorders.Behold. how they work. then figure out what to do with them. Grab the question book that goes along with Robbins' Pathology. John is a 77 year old black male with hypertension.

and you should have started to think you can do this. preferably with the ones you struggle with last. Split those up as well. and let's do this thing. you say? Yes. That will put them closer to the exam and fresher in your mind. Each day. It's shortness of breath and weakness. grab your book and your computer with your question bank. then you should have been doing a few things all along. If you haven't. Why? With weakness. It's the same as the first go. on the clock with breaks and 14 . Aside from that. Your scheduled date for Step I is whatever number.    Now  it’s  time  to  get  serious  about  Step  I. On the nines. You should already have everything aside from the books I mentioned above. but leave every ninth day open for more. Just take a deep breath. all subjects. If you're a loyal reader of this guide.I did pharmacology last. Also add to the calendar times to do three full length exams in addition to your questions. you should have hundreds of questions under your belt. With shortness of breath. and if you're still here I know you are. just a bit more intense. you say? I'm insane. but we can do this. The day after your last day of classes is day one. for sake of argument. pull out a question book or bank you only use for those.but the reason people stop using the medication is different. That's true. but it works! Med side effects have a similar trick. Next up. no? There isn't much of a list for this one.the leader for captopril is cough. find your center.    It’s  a  tough  exam. Give yourself one day in ten to relax and breathe. Master that. fifty to one hundred questions. For those of you who actually have been doing all the above for a while. don't sweat too much. First off. It's a tough one to get used to. Your copy of First Aid or Step Up should be gloriously festooned with tons of colors and ink. according to the calendar you just made. How should you do the full length exams? There. in addition to the sections and questions for that day. and everything else comes far easier.It's the core of all diseases. totally off from coursework.  sure. What's that. except for the nines. Take it strictly. and make a full length exam. STEP I Okay. Block VIII. It is a long way to go and a short time to get there. as it is most amenable to quick review and point memorization. Logical. the patient is afraid they can't work. Let's say forty five. grab a calendar. the day before your listed break day. Say. you're going to do a short overall review. you're sitting reasonably well.  but  w e will get you through it.Fundamentals of Clinical Practice II and Block IX. It doesn't matter what the leading side effect is. split up the remaining forty amongst the sections of the exam.Problem-Based Learning II Nothing to report here. you'll be doing those questions that correspond to your section. relax. they're afraid they're dying.

there is plenty of time per question. and again if you need to. but there are ways to smooth the transition out a bit. go forget about the exam. and exam day. eat something! Hold off on the caffeine for a while. radiology. Doing a hundred procedures a week is nothing  if  you  don’t  have  time  enough  to  actually  get  some  studying  done. unless you had your heart set on dermatology. Does it slow me down? Yes. Get plenty of sleep. there are many useful points. There is no real right answer. I made this mistake. Go watch a movie. For prepping the few days before the exam. Doctor's orders. Not the end of the world. Afterward. 15 . If you need a sixty second break in a block. take some time to take stock. though they recommend no more than sixty. and I paid a heavy price for that. But what if the worst happens. Another key point is to keep time to study. Most cram. take one. I hear your inner doubts say? If you fail. take one. Don't go home and look up answers. don't even think about it. relax. listen to your body. see if you can get into either some flex time (what my school called time off) or a low-hour rotation for a while to prep and go at it again. Don't talk about it. It's a bastard of a year. I'd rather take an extra five minutes of break during my day and feel normal than have those five to spare and feel dehydrated. When done. Aside from those. and that's the exact wrong answer. There is no right answer. over a minute. don't worry about it. Some say to save those for last. One key one is to know your rights. if you fail. I routinely got stuck doing over a hundred on OB.timing to best simulate the real exam. which was very helpful. to make the start easier. Go enjoy your time off before third year starts. take a walk. I'll write them in the order I took them. Slow down. work out a while. Certification board maximum that a medical student or resident can work in a week is eighty hours. power through on Red Bull and adrenaline. but it's not necessarily the right way. and that's the point. you take it again. As some general survival techniques. whatever helps you chill out. as then you'll have a better chance to do well on the exam with more knowledge under your belt. If you need a break. it's actually counter to what most people say. use the next few days to wade through and review it. The answer is this. some say to take the rotations you're interested in first. THIRD YEAR Welcome to actually using all this knowledge they've been cramming in your brain for the last two years. and plenty of fluids. I used deep breathing techniques during Step II to stay calm. Not the end of the world. take something reasonably balanced for lunch. plastics or ortho. During the day itself. Just let go. Day before the exam. Taking sixty seconds to slow down and breathe won't wreck your chances. Biggest question my class had was what order to take the rotations in.

com. It’s an absolute mainstay. you can do that. First Aid for Step 2. 6. 16 . but they were nice while they questions.0mm is great. and it comes with some stickers on the outside that contain lab values and other useful bits. Makes you look prepared. Crush Step 2.    Know  your  patients  well.    I’ve  been   on services where if you were told to be there at 0630. I’ve  been  on  services  where  saying  to  be  there  at  0800  meant  just  be  there  by  about  0830. not counting 2-hour long commutes. most comes down to how much you want to do. Now. was not studying enough.  and  keep   a small notebook or something similar on hand for keeping track of their results. Folding clipboard.mine’s from whitecoatclipboards. Most of them are about the same. . In addition to making an easier note to write. and small enough to hide in a pocket to carry.mine’s roughly 3x5. If you want to deliver a baby on day one. Anything that writes cleanly and for a long time is good. First Aid. 2.Obstetrics and Gynecology and Pediatrics OB was the absolute last thing I wanted to. MMSE. no matter how you need to do so. lab values. Moleskine notebook or something similar in size. a small eye chart and other bits. 3. 5. you were considered late at 0615. Presenting is tough.without a doubt the best ten bucks you’ll spend on a book in med school. Make the time. it was impossible to actually find time to work.7mm or fine 0. and 1. 4. vitals and other bits below.Shopping List for Third Year 1. so I chose to knock it out as early as was practical. but my favorite is First Aid. USMLEWorld Step 2. First of the mistakes I made. . but that knocks off the edge. Maxwell’s pocket guide. I tried 0. blank progress note on you.As  for  floor  work. I still use mine. Pens. It has the basics of the neuro exam. and makes writing notes a bit easier. come learn from my mistakes. Step Up to Step 2. Last out.     If  it’s  a  strict  service.  a  lot  comes  from  simply  knowing  the  service  and  its  temperament.  then  add  in  all   their lab results. I peeled them off since they started to get ratty. and you won’t if you’re wise. You always have a flat surface to write on. painted red. I love Pilot G-2 pens in either the medium 0. very important. and it’s held together with tape and prayer. but I will list out as many tips as I have. Get your hands dirty and decide from there. period.  being  there  early  is  always  a  good  plan. When I was working 100 hours a week. There are many. If you want to do the bare minimum to survive. you can do that. Works very well indeed for keeping notes for rounds and later logging.  sticker  it  with  the  patient’s  label. read. but hard to write small in the very small spaces. but helps. it also makes life a lot easier on rounds. These write-ups will be a bit shorter than the other ones. It’s not enough to be a primary guide. It’s plain steel.5mm. When it comes to procedures. My strategy  was  to  date  the  top  of  a  page. always keep a spare. pay attention.38mm and it’s too fine for me.

and found it wasn’t for me. It’s by far the most important one in terms of the Step 2 exam. FM is mostly outpatient. and also go get the MKSAP book. and don’t fake it. and you’ll be in good stead for the others. When dealing with kids. It’s a book of almost all medicine questions. Study is much the same. Next up.Review questions are key for every shelf exam. UWorld questions are essential. However. . I can’t do that. also filter in some Psych.Family Medicine Family medicine is essentially medicine in a different coat. Master the preventative medicine segments of the course. Study for this one pulls out essentially all the stops. Never refer to a specialist on the exam unless it’s ABSOLUTELY necessaryyour job is to solve the patient. for this one. I also like the Osler Medical Handbook. and pick up those easy points. impossible to logically derive if you don’t know them. I know people who used only that book for the exam and did well’s mostly retired Step 2 questions and is spectacular for the exam. many students. it’s one of the long blocks (12 weeks at my school). Master the STDs and contraceptives. though it is a bit expensive and a bit detailed for the third year. though there are those who adored Beckmann for such. . and it’s pretty clear the patient can tell. I tried using the textbook to study. same two resources as the OB version. and very common on the exams. Just be who you are.Medicine Internal medicine is the big daddy of the makes me thoroughly nuts. As such. nurses and clinicians try to act more informal and at their level. medicine mostly inpatient. Still excellent. Study is the big key here. Far easier hours. Treat it like Step 2. and it’s an easy group of points to lock down. just flat memorize the milestones and the vaccination schedule. and I’m glad I got it. and a fantastic one. and 99% of them can be figured out based off what you have available. and covers a ton of material. this one is just a small blurb! 17 . but much more complex patients. Pediatrics almost seems like a vacation compared to OB. use First Aid and a ton of questions. and the rest essentially applies. My favorites are Case Files and the OB section out of First Aid for Step 2. Those are reasonably straightforward to memorize.a lot of the psych disorders start to show up in childhood.

Parkinson’s and the other dementias are very key. Master those and you’re 99% of the way there. bipolar disorder and ADHD. and you’ll thank me later. but more the medical management of surgical patients. Not much. Kill this and it ’s all over. but well worth it. always eat something before surgery. Bookwise. and see as many oddball cases as you can. and so will I. . as many reflexes as you can. . It’s a simple exam.Step 2 CS This one is kind of weird. most take it after Medicine. though.. and seeing a bunch of odd stuff makes it a bit easier. Step 2CS and Step 2CK. about fifty bucks. the Andreasen and Black book I mentioned above for Behavioral Science is great. as it’s really written for primary care specialists. Practice your neuro exam as much as you can. so register early. As for surviving the wards themselves. Read as many MRIs and CTs as you can. It ’s superb for rounds and lectures. and learn what the various disorders and injuries look like. 25 18 . I’ve seen both happen.don’t worry so much about techniques for surgical procedures.Neurology and Psychiatry Most schools link these two. be careful to not fall into the patient or the instrument tray. That’s the bulk of the exam. and your life becomes much simpler. Neuro is a very picky exam. and you’ll see it over and over again on the exam. . and master as many of the personality disorders as you can. For Neuro. There are only a few sites for it. as is Case Files. we all need it. how? Read everything you can get your hands on. but a protein bar.Guess what? That’s all third year has! Now for two little considerations. Same with depression. and collect yourself. peanut butter sandwich. anxiety. It ’s expensive. the better. learn the interview process very well. If you’re going to pass out. It was originally designed as a required exam for foreign medical graduates. Master the neurologic exam. Now. Alzheimer’s. 12 patient exams. but my savior was the Mont Reid Surgical Handbook. back away from the table. Case Files is king along with First Aid. For Psych. FA Surgery is good. Adjustment disorder is key. Now. to verify they could communicate with patients effectively. You can take it essentially whenever you like in third year. or something similar will keep hypoglycemia at bay without risking needing to back out to use the facility. and the more cases you see. and stuffed with very useful information. MS.Surgery The last one standing. exams you may have heard of. If you feel sick.

   Doesn’t  work  for  me.    Vander’s  Renal  Physiology The Ugly. His Step 1 review is mediocre at best. Blueprints OB/GYN is so bad as to be banned recently at my medical school. but take it seriously.Pathology. but the passage rate for an American/Canadian medical grad is about 98%.Definitely worth it 1.Worth  the  money  if  you  like  them.Use  only  if  you  know  they’re  best  for  you. High Yield Neuroanatomy 9. . It’s all over at this point. Pretest series.Review books: The Good. Pediatrics is maddening in its alternating over-complexity and over-simplicity. Goljan USMLE Step 1 review (Deserves an addendum. The Match and residency application process will wait for another day. you just graduated medical school! No. Physiology and Pharmacology 7. BRS Physiology 3. the Bad. Congratulations. Rapid Review Pathology (Goljan) 8.disorganized. Underground Clinical Vignette series.Step 2 CK Studying for this one is really beyond the scope of this guide. . Other than that.    Normally  to  be  avoided. but treat it a lot like Step 1 in terms of how you approach it. Board Review Series Pathology 2. it ’s the same. 1. 1. of which 15 are for the exam and 10 for the writeup. it is pass/fail. People do fail. though. and a similar schedule to the Step 1 exam. and the Ugly The Good. Blueprints.minutes each. First Aid for the USMLE Step 1 6. Kaplan MedEssentials 3. HY Gross Anatomy 2. you’re a fourth year.  but  make  sure  they’re  best  for  you  first. HY Biochemistry 3. but that day is coming! 19 . Lange Road Map to USMLE Pharmacology 4. and the audio is in essence a seemingly  demented  person  yelling  pathology  facts  at  you.Goljan RR Pathology is excellent. If all has gone well to this point.any of them.) 2. Psychiatry is so basic as to be insulting. Use the same materials you used for the shelf exams. Oddly. seriously. Clinical Microbiology Made Ridiculously Simple 4. HY Embryology The Bad.mediocre explanations at best 4. HY Pharmacology 5. It ’s not a difficult exam. Step-Up to USMLE Step 1 5.

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