MCAT Prep Materials

Doing well on the MCAT probably holds back more "pre-meds" from getting into medical school than any other single part of the application. In 2012, the MCAT was taken by 89,452 hopeful future medical school students. The average score...25.2. The average medical school matriculant on the other hand, scored 6 points higher, with an average score of 31.2! Each year this average increases just a bit; I can't even imagine what it will be ten years from now. The truth is, to have a good chance at getting into medical school you are going to have to score a 30 or better on the MCAT. I know there are exceptions but I wouldn't feel comfortable applying without a 30+ (and I took the test exactly 2 years ago today!). But enough with all this "tough-love," because the good thing is that beating the MCAT isn't just possible, it's probable. I should probably step back and clarify that last statement. It is "probable" if you use the right MCAT prep materials, dedicate enough time to studying, take lots of practice tests, and have decent reading comprehension skills. Not too bad, right? Most people don't study enough, or "study" by going to the library with a friend and flipping through a couple of random MCAT prep books. That doesn't count. I am talking hours of intense, dedicated, active reading and studying. It is a lot of work, but there are a ton of resources to aid you in your quest.

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Emergency Medicine

ED Wall I was a patient transporter for awhile, and the Emergency Department (ED) was my favorite place to work in the hospital. This post is all about my future (knock on wood) specialty.  In 1966, the National Academy of Sciences published the "Accidental Death and Disability, the Neglected Disease of Modern Society," more commonly known as The White Paper. This influential report highlighted the poor state of emergency care in the United States. Shortly thereafter the American College of Emergency Physicians (ACEP) was established with Dr. John Wiegenstein as the acting president. The ACEP worked to create a new specialty, along with a dedicated residency program...the idea for Emergency Medicine (EM) was born.

An educational program was developed including training material with the goal of attaining specialty board status and recognition. It seems simple now, but the idea that EM should be practiced by board-certified EM physicians was a foreign concept just 30 years ago. In the late 60's, Dr. Herbert Flessa applied to the AMA to start a new residency program (which interestingly fell under a family medicine residency) at the University of Cincinnati. A little trivia factoid for you: Dr. Bruce Janiak was the very first EM resident at Cincinnati in 1970.

Way back in the 1970s, the Los Angeles County, University of Southern California (LAC/USC) Medical Center was getting over 1,000 emergency visits per day. Something had to change, and the hospital came up with a great answer. They decided to create the very first Department of Emergency Medicine, and Dr. Gail Anderson was appointed chairman.

Since then, EM has come a long way. It is its own recognized medical specialty. EM residencies are 3 or 4 years in length, and there are over 150 different programs in the United States. Now there are even 1-2 year fellowships available for sub-specialization. These include: hospice/palliative medicine, medical toxicology, pediatric EM, sports medicine, hyperbaric medicine, and more.

One of my favorite aspects about EM is that it is shift work. That is, doctors know their exact schedule for the coming months, and they never take their work home with them. Most hospitals have shifts that are 8 to 12 hours long. From talking with EM physicians and reading the SDN forum; it is recommended that EM docs work around 40 hours a week or so (avoiding burnout).

I love the camaraderie of the ER. I really feel like it is one of the places in every hospital where nurses, technicians, doctors, social works, and administrators all like each other. You have to work well with others (think team sports), and have a sense of humor about things.

My favorite thing about EM is that it is a combination of thinking and using your hands. I want to be a "Jack of all trades" (or if you are negative a "master of nothing" haha). EM is all about breadth of knowledge rather than depth in any single specialty. Quickly diagnosing someone is crucial, especially if the problem is life threatening. However, as an ER doc you also get to perform some cool procedures. Airway management is paramount, which can involve intubation and sedation. Lumbar punctures, sutures, ultrasound guided central line placements, NG tube insertion, arthrocentesis, defibrillation, and putting in chest tubes are just some of the examples. For something a bit more intense (and very rare) check out an emergency thoracotomy **warning graphic picture**

Also awesome...the job pays quite well. According to the AAMC, the annual salary ranges from $239,000–$316,296. Take a look at the graph from MDsalaries.com for even more information.

EM Doctor Salary

I think that an ability to think quickly and care for a wide variety of patients including trauma victims and sick children is required in this profession. Generally EM docs are calm under pressure, and have a variety of interests in and outside of medicine. I have found that I have loved bits and pieces of every specialty and body system we have learned about so far in medical school. Also on a sidenote, I have always wanted to be the guy in the crowd that can answer the call when someone yells "Is anyone a doctor?!" If this sounds like you, EM may be something you want to research further.

However, Emergency Medicine does not come without its disadvantages...

  • The ER is open 24/7, 365 days a year. That means you will be working on Christmas or your birthday some years. 
  • No Follow-Ups - This isn't the specialty for you if you care about continuity of care. There is no getting to know your patients on a deeply personal level, or seeing little Johnny grow up and get married.
  • Pressure - Is that patient you sent home with "heartburn" having a massive coronary? Can you handle multiple crashing patients and their families. Chances are you will see death, child abuse, and other terrible things on a regular basis.
  • Circadian Rhythm Disturbances - Some shifts may be like a traditional work day, however you will work overnight or during other awkward hours. Constantly changing your sleep schedule can leave you tired and grumpy.
  • Drug Seekers - Every ER has "regulars" that come in with vague symptoms to game the system and get high on narcotics.
  • Working in a Fish Bowl - The ER is the entrance gate for the hospital. That means that if you admit a patient, every doctor that comes into contact with the patient afterwards will be evaluating and judging your workup of said patient.

Using Anki in Medical School

In the previous two posts I have introduced you to the science of spaced repetition, and also why it works for memorizing large quantities of information. I highly recommended the free program, Anki, which enables users to create digital flashcards and learn any subject that requires memorization. It makes perfect sense that plenty of people have used Anki to learn foreign languages, and I think it could really help premeds with MCAT preparation. I also have firsthand experience with spaced repetition learning. Since the first day of classes (almost 6 months ago), I have used Anki to learn the vast amounts of material presented in medical school. Using Anki in medical school is easy. It has worked wonders for my studying, and helped me honor over half of my courses. More importantly I am remembering information presented months ago, instead of forgetting everything right after the test.

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Being a Great Doctor: My Mom's Take

The following post first appeared on KevinMD, a popular medical blog. My mom wrote me the following letter during my first semester in medical school. She has been a patient, and a mother/wife/sister/daughter of patients. She has been around countless doctors. Here is her take on what makes a great one: Dear Son,

I am so very proud that you are becoming a physician and that you chose this profession, not for the prestige or the financial advantages, but because you want to help people.

You invested an unfathomable amount of your time, energy and money to become a doctor. Your patients are extremely grateful for your commitment to be the best health care provider for them, even if they never voice these words.

Being a great doctor requires more than years of medical education and thousands of hours spent in residency. You need to be trustworthy for your patients and in turn you need to trust them.

Remember that you will help those with more and with less education than you. You will treat people with more and with less money than you. You will aid patients that are very similar to you and those that couldn’t be more different. You must be trustworthy to each and every one of them. What do they have in common? They need you.

Your title and your knowledge may give you a presumed power over your patients. Always respect that power and never think so highly of yourself that you make your patients feel inferior. Remember when someone is in need, that someone is vulnerable. Don’t dishonor that vulnerability. Be kind. Be patient. Keep their secrets. If you don’t know how to treat someone, be honest and refer that patient to another physician. Your ego is never as important as your patients’ health.

You must be trustworthy so that your patient can feel safe enough to tell you what is really going on. When I was only 17, I exhibited some scary health symptoms for a teenager. However this fear is present in all patients when their body is not doing what it is supposed to do.You need to remember that fear in patients and respect it. To tell my mom what was going on with me was scary enough, but being able to tell my doctor was beyond terrifying. My physician was so kind, and so honest about what procedures I needed to have done and why I needed them done. He treated me with respect. He treated me as an adult. He was trustworthy. I am eternally grateful to him.

Sometimes, things are going on in a family that can affect the health of everyone even if there are no bruises, blood or fever. My mother was a battered wife. My stepfather beat her regularly. He inflicted pain that did not cause external scarring so no one would know what was going on. I told my grandmother and other relatives; they believed me, but no one could convince my mother to leave him for more than a few days at a time. I told someone with authority, my pastor, what was going on at home. He did not believe the teenage girl I was then. My pastor did not help my mother. You need to trust that teenage girl. No, not everyone will be honest with you. But, still you must trust. I am not saying don’t try to verify. But, don’t become so cynical that your instinct is to question and deny. You may save that battered woman. You may help heal her whole family. My mother is safe now but I will always remember the pastor that turned his head at my pleas for help.

So my son, my pride for you is beyond measure. My words are inadequate to describe my awe of what you have accomplished in your life. But as moms are wont to do, I am going to offer you some advice as you get closer and closer to becoming a doctor.

Be trustworthy and trust in both your professional and your personal life. Sometimes you will get hurt. That happens when you trust people. But, please realize your patients are also hurting and they need to trust in you. They are vulnerable. You can only create the openness they need to reveal their secrets to you if they feel that you understand them, and you won’t judge them. Being trustworthy and trusting others are the keystones to being a great doctor. Never lose your faith in people and in a power greater than your own. These things are crucial to being a good person, and you can’t be a good physician if you are not first a good person.

Love, Mom

Spaced Repetition Using Anki

spaced repetitionRepetition and learning have gone hand in hand for centuries. In 1885, a German psychologist, and pioneer in the study of memory, Hermann Ebbinghaus, wrote about a phenomenon known as the “spacing effect.” The spacing effect theorizes that animals and humans remember information longer and can recall facts easier when that information is studied multiple times over a long period of time. This theory led to a new way of learning large amounts of information, known now as spaced repetition. In the 1960’s and 70’s, the majority of spaced repetition included flipping through thousands of flash cards to try to learn languages and other subjects where immense memorization is required. Fortunately for us, the process has been improved. Algorithms have been developed to increase the efficiency of spaced repetition, and thus memorizing large quantities of info is easier than ever. As mentioned, repetition is probably the most important tool for learning any new skill or mastering information. Athletes practice endlessly; repeating movements until they are embedded in muscle memory. Why should learning be any different? In my opinion, the brain may be the most important “muscle” we have. Unfortunately, most of us don’t prepare for exams like athletes do for games.  Take a look at some evidence for all of this, it is called the “Forgetting Curve.” You may have seen it in a psychology class.

Forgetting Curve

The graph shows what your brain does with new information. It is estimated that after a week, if you have not reviewed the information at all, you will probably forget at least 90% of what you originally learned! Sadly, the brain forgets things exponentially. That is terrible, especially for pre-meds getting ready for the MCAT or medical students preparing for Step 1. However notice what happens with just a few reviews! You retain more information, and eventually it becomes a part of your long-term memory, and will always be available for recall. Imagine if you reviewed important information constantly; how much could you store in your brain?

Enter Anki (which is actually the Japanese word for “memorizing”). Anki is a free online application that is downloaded and compatible with both Macs and PCs. Follow this link and go download it....now. It is an amazing spaced repetition flashcard program. Users can create their own note cards, or use decks of flashcards already created by others. Once you have a deck, you can then study the flashcards!

 

 

The above is what you see when using this program to study, it is a prime example of a Anki flashcard. Does anyone know the answer to this one? Either way, once you have thought about it, and attempted to come up with the correct response, you click the "Show Answer" button...

 

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How many of you said "Conjugated Protein"? As you can see, the answer shows up underneath the prompt.  You then are faced with some options, did you get the answer wrong? Then you probably want to press "Again" so that the flashcard will be redelivered to you shortly. If you got it right, you can decide how difficult this card was for you. Based upon your answer and how long it took you to answer the question, Anki's algorithm will decide when to resend you the flashcard for optimal memorization and recall ability. You can modify this algorithm, however I have found that the default settings work great for me.

The key here is to take advantage of the science of spaced repetition. Anki works best when you review your flashcards every single day. Luckily, as the facts become part of your long-term memory, you will only have to review the flashcards every few months. It becomes a habit and really does not take up much time at all.

Next post, I am going to write about why I love Anki for medical school. I have used it since day 1. If you are interested in using spaced repetition and Anki to dominate the MCAT, take a look at the study deck I am offering.

Using Anki to Ace the MCAT

I was one of those fortunate students who was able to glide through high school and college without much problem. Learning (and good test-taking skills) came easily to me, and so I enjoyed school. However, I knew that my study methods of the past weren't going to work in medical school. I couldn't just attend lecture, take a few notes, read a couple pages in a book, and expect to do well on a 7-hour block exam. It isn't that medical school is that much harder than undergraduate, but it is so much more information. For instance, 1/3 of my undergraduate biochemistry class was covered in 4 lectures in medical school. I knew that I needed to come up with a much better way of studying.  The summer before medical school, I came across an amazing post over at Dr. Wilbe, which is a great blog and resource for any pre-med/medical student. He described this incredible, free, downloadable program called "Anki," which he was using to study and retain all the material in medical school. He wrote:

"People use Anki for lots of things. Foreign language learners love it. But I love Anki for med school. There is no way around it. You need to commit lots of information to memory. Brute force is not enough. Studying smarter, not harder is the goal, and in my opinion, Anki is the way to achieve that."

After using Anki on my own, I couldn't agree more. I love Anki, and it has helped me honor most of my first year medical school classes. However, I think that it can be just as helpful for pre-meds studying for the Medical College Admission Test (MCAT). As we all know, there are tons of terms and definitions that must be in a test-takers useable memory in order to score that treasured 30+ on the MCAT. Anki worked incredibly well for Dr. Wilbe on the USMLE Step 1 exam and it has been instrumental in helping me honor courses in medical school, so I am sure it will work on the MCAT.

Anki uses a concept called spaced repetition, which is a learning technique with a lot of science (and common sense) behind it. Over the course of the next week I will be writing posts about spaced repetition, online flash cards, and why I love using Anki in medical school. One of these reasons is that electronic flashcards are incredibly easy to use anywhere you have access to your computer, phone, or tablet (although you have to buy the Anki app).

I know for many of you, it is too late to start making Anki cards for all of your pre-requisite science classes. However, you can still use your MCAT prep-books to make a study deck during your MCAT review period. Or, if you want a head start on MCAT studying and would prefer to have an already-made resource, you can buy my MCAT Study Deck, and instantly have access to over 650 must-know definitions and principles from the two science subsections. The deck is selling for $5.00, which is many times less than what competitors are charging. If your time and money are valuable, start off your MCAT study period with this cheap resource!

The Day I Got Called "Doc"

Being Called Doctor I will never forget, on September 21st, 2012, at roughly 5 pm, I was called "doc" by a real patient in a real hospital. I was on a required "hospital visit" which is basically just a shadowing experience that the medical school makes first-year students do 3 times a semester. At each visit, we have to wear our white coats, and bring our stethoscopes. So I guess...(besides the fact that my face makes me look like I am 12) I sort of...kind of...looked like an actual physician. Anyways, I was following a nurse around on a step-down unit, and we were giving out medications to all of the wards. We made our way to a private room where the patient had been in hospital for a couple of weeks with an infection. He was quite a talker, and went into a story about his past. I was sucked into talking with him, and before I knew it, 20 minutes had past. The nurse was long gone, on her way to give medications to other patients.

I made up an excuse about having to catch up with the nurse, and started to walk out of the room. That's when it happened. I heard the patient say, "Doc?" I immediately turned around, expecting to see a real doctor hiding somewhere in the room. However, I was the only person there. I wish I could tell you all that I said something smart or professional, but I just turned and looked at him with a stupid grin on my face. The patient then said "thanks for talking with me."

Looking back on this, it is still pretty awesome, and a little bit scary. I am 25% of the way done with the classroom learning of medical school. I have learned more in the last 4 months than I have ever before in my life. However, there is SO much that I don't know yet. One day I actually will have the responsibility attached to being called "doctor." That is a lot to live up to.