Month: September 2016

Categories
Empathy

Properly Unprepared

It was late afternoon, and the current nursing shift would be relieved in less than ninety minutes. The feeling of impending Friday freedom was palpable on the floor of the intensive care unit. I was on my way to meet with my last patient of the week, who had been brought in for an unintentional drug overdose. My goal was to determine whether the overdose was truly accidental, and if she was a candidate for compulsory psychiatric hospitalization. I passed by a large bank of computers without stopping, and knocked on the patient’s door. When I walked in that room, all I knew was the patient’s name, her age, and the reason for her hospitalization. Other than those preliminary facts, she was a complete mystery to me. I spent fifty minutes with the patient, and had a relatively pleasant conversation. When I walked out of her room, I opened her medical chart for the first time.

Unfortunately, that day, the story that I received from the patient and the information that I got from her chart told two different stories. Numerous providers had noted that she was irresponsible with medications, and I got the sense from the chart that she only sought medical care to gain access to controlled substances. Now that I had established a good relationship with my patient, I would have to re-interview her in an attempt to reconcile the information I had seen in her chart with the picture she had painted for me in the moments prior. My Friday freedom would just have to wait.

I would not be surprised to find out that the ICU staff was laughing at me that day. After all, I ended up spending more than two hours with this patient when I could have conducted only one brief interview. Even though the majority of my first hour with the patient was pure confabulation, I viewed it as a valuable component of my assessment. That first hour represented my sole opportunity to get to know my patient without any bias. Had I looked at her chart before walking into the room, I unquestionably would have written her off as an irresponsible, drug-seeking troublemaker. I would have asked her pointed, perhaps accusatory questions about her behaviors, and worse, I would have known exactly when she was lying to me, further eroding any respect I may have had for this patient.

Electronic medical record systems help to facilitate the sequestration of large amounts of information about our patients with minimal effort, and it’s largely considered taboo to meet with patients without first researching their medical record.  The information physicians can learn from the medical record can be undoubtedly beneficial in many situations, but extensive chart reviews can also lure us into a false sense of security, allowing us to preconceive an identity for our patients before ever having met them.

Had I read my patient’s chart that afternoon, I am certain that I would have made judgments about her that would have influenced my interview. Instead, I learned about my patient by allowing her to tell her own story. I thought about the information she shared with me, and, perhaps more importantly, what she failed to tell me. Because the patient never discussed her well-documented mishandling and possible dependence on prescription medications, I felt confident in making an assessment that this patient had relatively poor insight about her problems.

Featured image:
hGraph: patient + clinician looking together by Juhan Sonin

Categories
Empathy Humanistic Psychology Patient-Centered Care Psychology Reflection

Applying Humanistic Psychology to Medical Practice

“People are just as wonderful as sunsets if you let them be. When I look at a sunset, I don’t find myself saying, ‘Soften the orange a bit on the right hand corner.’ I don’t try to control a sunset. I watch with awe as it unfolds.” –Carl Rogers1

We as human beings love categories. We enjoy dividing the body into its constituents, from the bones to the muscles to the skin, from the heart to the vessels to the blood cells. The more we can break something down, the more we can dissect it, understand it and build from it. It can be argued that this method of reductionism is what has led to many of the insights of the present day. It is by becoming so specialized within one area that one is able to build upon one’s expertise and develop novel ideas.

This method of classification, however, cannot be used to explain everything around us. While insightful in some areas, it can be destructive in others; namely, the human mind.

Look back at the history of Psychology and we see ourselves jumping through the same hoops of categorization, attempting to reduce our inner worlds into hierarchies and models. From the psychodynamic theories of Freud to the behavioristic perspectives popularized by Pavlov and Skinner, we are led to believe that if we can merely slice apart the human mind into chunk-sized pieces, perhaps we can gain insights into humanity itself.

But unlike the heart or the lungs, the way we choose to see a particular human mind can have profound effects upon that person. Tell someone that they are a mess of electrical impulses and chemicals, and they may see themselves and the world around them far differently than a person who believes that it is they themselves who have control over their lives.

There is a reason Psychology and Psychiatry garner so much criticism from the general public in a way that no other specialty does.  There is a reason that an anti-psychiatry movement exists, but there are no anti-surgery or anti-cardiology movements. It is because these theories, these categories, have an impact on how we see ourselves. They touch upon what it means to be human.

The argument I wish to propound is to urge us all to go beyond these categorizations, be they biomedical, psychological or social, and to take a more holistic approach, which I believe can best be viewed through the lens of Humanistic Psychology.

What is Humanistic Psychology?

Humanistic Psychology arose in response to the more mechanistic views of human behaviour that were gaining popularity in the 1950s2. Rather than focusing on one aspect of a person, be it our childhoods or our innate animalistic needs, Humanistic Psychology proposes that what is important is how the person themselves experiences the world around them. The human being is central. It is not the objective measurement of chemicals, electrophysiology or set questionnaires that lies at the heart of humanity, but how we think and feel.3

There are many contributors to the Humanistic canon, but I wish to focus on just one aspect of it: Carl Rodgers’ person-centered therapy. Although the word “therapy” implies a form of treatment for those with mental health problems, I wish to apply these principles to the arena of healthcare as a whole. I believe the therapeutic relationship between therapist and client can teach us much about our own relationships with patients within hospitals, emergency rooms and clinics.

Person-centered therapy is built upon three principles4:

  1. Congruency
  2. Unconditional Positive Regard
  3. Empathy

I will go through each of these in turn and focus on how they can transform our relationships with our patients.

Congruency

Congruency refers to genuineness, that is, displaying ‘your actual self’4 when dealing with a patient. This involves letting go of one’s mask and revealing one’s true feelings as they come and go. It requires a level of self-awareness, which allows us to fully experience the moment instead of remaining walled-off from our true inner state.

Do not think of yourself just as a doctor, a medical student or a healthcare professional. Undoubtedly there are professional boundaries that must always be maintained, and a profession that you represent every day. But be careful that you do not let this professional façade get in the way of your relationship with your patients. Remember that you are only human and the last thing a sick patient needs is a robot. By displaying an open and trusting character, you give your patient the opportunity to relax, to feel at ease and to be open about what is truly troubling them.

Congruency takes us back to our humanity, reminding us that there is little difference between ourselves and the patient sitting opposite. If we can come to terms with our own thoughts and emotions as we deal with the chaos that occurs in the world of healthcare, then we will be able to display a level of respect and understanding that will allow our patients to appreciate that they are speaking to a human being and not just a title.

Unconditional Positive Regard

Unconditional Positive Regard refers to the belief that people should be accepted as they are. For the professional, it involves displaying a non-judgmental attitude that is provided unconditionally, i.e. without limitations or expectations.

Although this is a concept well known to most of us, it can be difficult to put into practice. We all have our prejudices and our own rigid lines that we draw across our horizons. The expectation is not to get rid of all prejudice, but to be aware of how they impact our behaviour towards others.

Do we at times place blame on our patients?
Does our heart sink when we go to speak to certain people?
Do we have certain beliefs about people based on their clothing, their lifestyle, or their occupation?

Of course we do. Think back to a time when any of these thoughts have come to your mind and think about their effects. It may not necessarily mean that you throw everything in the air and scream your prejudices out loud. But it does mean that the way you regard your patient may be subtly altered; you may show less enthusiasm towards certain patients or display less sympathy than you would for someone else. It is by being aware of these little discrepancies that will make us all better clinicians.

Undoubtedly, healthcare places us all into positions where we come face-to-face with lifestyles that we disagree with and behaviours that we feel uncomfortable around. The idea is to go beyond these actions and see the human being lying beneath the layers. We must accept them as they are, and may be surprised to find that the patient responds with gratefulness at being treated as an equal.

Empathy

Perhaps the term most popular out of the three, empathy refers to the ability to understand what the other person is feeling. It involves having an understanding of the other person’s beliefs and values, and being cognizant of why they care about the issues that are important to them – in other words, it involves fully stepping inside another person’s private world.

Within healthcare, it is important that we do not go through a list of tick boxes and forget that our versions of events are not the same as theirs. All too often we may accept simple words such as ‘I’m frightened’ with a mere nod of the head and a simple smile on our faces without digging deeper and asking, ‘What is it you are frightened of?’ Our job does not merely consist of diagnosis and treatment, but of going further into our patients’ lives and understanding what their illnesses mean to them. What it means for them to be in hospital, to be a patient, to lose their role as a parent or a provider. Without this aspect, we may well cure a disease with our drugs and our technology, but we will never get to the heart of the matter.

What does it all mean?

These are all terms that most of us are familiar with. They are words we may write time and again upon reflection, sayings that we repeat year after year during our interviews. But the idea is to put this into practice, which can only happen if we first take a step back and think about the times when perhaps these three concepts were not fulfilled. Those times when the relationship broke down, when the patient closed up, when we walked out of the consulting room thinking that could have gone better.

Remember that patients do not always come to us with a collapsed lung or a broken rib. They come to us as a whole. The idea behind Humanistic Psychology is to go beyond the reductionist theories that focused on one aspect of a person’s being, and to appreciate the totality of human experience.

Why do I think these three concepts are important? Because I believe these are concepts that make all of us much better clinicians, and ultimately much better people. I believe that almost all of the problems we face within healthcare, and indeed outside of it, revolve around our ability to relate to others. How differently would we act if we could truly see through the eyes of the person sitting next to us, feel their pain and suffering, think their thoughts as they swirl between their children, their loved ones, their aims and their worries? These concepts, although integral to person-centered therapy, transcend the therapist’s room and can be practiced in every dialogue across every hospital and by every person, including you and I.

“In my early professional years I was asking the question: How can I treat, or cure, or change this person? Now I would phrase the question in this way: How can I provide a relationship which this person may use for his own personal growth?” –Carl Rogers6

References

  1. Culture of Empathy. Carl Rogers Empathy Quotes. [Accessed: 28th May 2016]. Available from: http://cultureofempathy.com/references/Experts/Carl-Rogers-Quotes.htm [Accessed: 27th May 2016]
  2. com. Humanistic Approach in Psychology: Definition & History. [Accessed: 29th May 2016]. Available from: http://study.com/academy/lesson/humanistic-approach-in-psychology-definition-lesson-quiz.html
  3. McLeod, S. Humanism; 2007. [Accessed: 27th May 2016]. Available from: http://www.simplypsychology.org/humanistic.html
  4. McLeod, S. Person Centered Therapy [Online]; 2008. [Accessed: 27th May 2016]. Available from: http://www.simplypsychology.org/client-centred-therapy.html
  5. Gillon, E. A Person-Centred Theory of Psychological Therapy. In: Person-Centred Counselling Psychology: An Introduction. SAGE Publications Ltd; 2007. p.43-67.
  6. BrainyQuote. Carl Rogers Quotes. [Accessed: 28th May 2016]. Available from:                          http://www.brainyquote.com/quotes/quotes/c/carlrogers202206.html

Featured image:
Genetic inheritance by Patrik Nygren

Categories
Clinical Narrative

Why I Stand with Planned Parenthood

After writing “ Storytelling and Patient Advocacy,” I cuddled up to a cup of warm coffee and reflected on the various moments in my life that inspired me or motivated me to take action. I thought about my story; why I applied to medical school and why I have certain research interests. Then I asked why I want to improve access to and the quality of reproductive health care. Immediately I thought about the question friends and family frequently ask me: “Why would you support Planned Parenthood if you want to help women?” My answer is this story:

As a third year medical student who will soon be applying to an obstetrics and gynecology residency, I am afraid.  The recent violence in my community and continued aggression against Planned Parenthood suggests that aligning oneself with the organization is risky.  Becoming an obstetrician gynecologist (OB/GYN) has been my dream since elementary school, so I feel anxious when family members share concerns that publicly supporting Planned Parenthood ensures I will not match to an OB/GYN program.  Will standing with Planned Parenthood keep me out of a program?  Is it OK to discuss abortion training on a residency interview?  Or do I need to use code like, “What family planning training opportunities are available?”  And in light of the attack on the clinic in Colorado, is my life in danger?  A pro-reproductive rights provider and avid supporter of Planned Parenthood wrote to me, stating that she is afraid to rotate at their clinics for fear of an attack.  She hauntingly added, “The terrorism is working.”  I almost never employ self-censorship, yet I too hesitated to continue to develop a professional relationship with Planned Parenthood.  Even scarier is to discuss that affiliation publicly.  A friend reminded me that in times of confusion or fear, it is best to have a mantra that can elicit courage.  My inner voice reminds me, “Be a rock star woman.”

A couple years ago, after my reproductive and endocrinology module, and after being influenced by readings about sexually transmitted disease (STD) pathology, I requested a full STD screen during my annual well-woman exam. The nurse told me, “We don’t do that here. You’ll have to go somewhere like Planned Parenthood.”  I left embarrassed and did not follow-up with another clinic.  Enter my third year clerkships when, on a pediatric service, my team treated a 15 year old female who was 21 weeks pregnant presenting with “vaginal pain and fainting during sex.”  I was ecstatic to finally manage an obstetrics (OB) case, and I excitedly took a medical history.  While writing my notes, I overheard a group of nurses say that this girl would not have “gotten herself pregnant” if she knew how to use a condom.  I interjected that the American College of Obstetrics and Gynecology now recommends long-acting intrauterine devices (IUDs) as the leading contraceptive option for adolescents because it is the most effective, safe, private, and does not rely on user consistency (ACOG, 2012).  Three nurses and a resident mistakenly retorted that IUDs cannot be given to adolescents or females who have not been pregnant due to increased risks to the uterus.  Because an intrauterine device is placed inside of the uterus during an office pelvic exam and contains a small string that trails into the vagina, old theories warned about uterine perforation, pelvic inflammatory disease (PID), and subsequent infertility.  They are wrong.  There are no cases of infertility following IUD use, no increased absolute risks for PID, and minimal incidence of uterine perforation (ACOG, 2012; ARHP, 2015).  Shockingly, this has been known in the medical community for more than a decade, yet there continues to be widespread ignorance about it among healthcare professionals.

I observed a similar case during a later clinical experience.  I listened to the physician refuse an IUD to a young woman with a history of unintended pregnancies based on his belief that adolescents are promiscuous and will develop pelvic infections.  His words, “We don’t offer those here.  You’ll have to go somewhere else like Planned Parenthood.”  Do you see the pattern?  It is no secret that judgement, ignorance, and prejudice exist in healthcare.   What is a medical student to do when faced with blatant disregard for clinical guidelines and scientific evidence that has been undisputed by science for over a decade?  I decided to contribute to the advancement of research and education by volunteering with Planned Parenthood, an organization that provides safe, up-to-date, and judgement-free care.

I regularly volunteer at Planned Parenthood as a patient escort, walking patients from their vehicles to the clinic doors.  Let me set the scene.  My local office is visited by anywhere from three to more than twenty protestors daily.  They stand on the sidewalk mostly shouting and waving signs at passing cars.  A few people silently pray with a rosary.  The first time I arrived, I had to excuse myself to the restroom because the hateful screams of “Baby killer with blood all over your hands!” were too shocking for me to bear.  Eventually I became better equipped to disregard protestors. However, that took time, and if I, a student medical provider, was mortified when my gynecologist’s office told me to go to Planned Parenthood for a standard STD screen, can you imagine the emotions a young patient experiences when walking from their car at a Planned Parenthood clinic, listening to protestors scream?  So I stand for hours in front of a Planned Parenthood clinic, deflecting the endless onslaught of insulting remarks, in the hopes that people can feel a little more secure receiving an STD screen, a pap smear, an IUD placement, or yes, an abortion.

The fact remains that Planned Parenthood is a leading provider of reproductive health care services.  A central focus is prevention, encompassing STD and cancer screening as well as contraception.  They provide prenatal services and references for those choosing to pursue adoption, in addition to abortion services and other reproductive health care.  The Guttmacher Institute, another source of global sexual and reproductive health, reported in July 2015 that half of all pregnancies each year (greater than 3 million) are unintended; the same statistic that has existed for two decades (Guttmacher, 2015).  More than half of women of reproductive age (13-44 years old; 38 million) need contraceptive services, and 20 million of those women require publicly funded services and supplies.  In addition, the average Planned Parenthood health center serves significantly more women seeking contraceptive services than all other publicly-funded safety-net clinics.

An interview on Fresh Air with Jonathan Eig, author of The Birth of the Pill: How Four Crusaders Reinvented Sex and Launched a Revolution, made me think more about Planned Parenthood’s role in women’s health care.  In the book he describes the challenges scientists and Margaret Sanger faced when trying to develop a “magic pill that would allow women to control when and if they got pregnant”—Wouldn’t that be great?  Oh wait, we thankfully have that now in pill, patch, injection, implant, and intrauterine device forms.  The developers of the pill studied progesterone’s effect on inhibiting ovulation under the guise that they were studying infertility treatment.  I wonder if the current, hostile climate surrounding Planned Parenthood will later be compared to the ludicrousness of 1950s-era United States, when our country outlawed female contraception, while allowing men to easily purchase condoms.  When I learn about the backlash surrounding the development of birth control, arguably the most important invention of the 20th century, how could I let threats prevent me from supporting an organization that is one of the few to consistently provide safe and evidence-based services without judgement?  The answer is, I cannot.  My career goal is to help women access and achieve the best reproductive care.  That is why I stand with Planned Parenthood.

References:

American College of Obstetrics & Gynecology. (2012). ACOG committee opinion no. 539: Adolescents and Long-Acting Reversible Contraception: Implants and Intrauterine Devices. Obstet Gynecol. 117(6):1472-83.

Association of Reproductive Health Professionals (2015). The Facts About Intrauterine Contraception [Fact Sheet]. Retrieved from http://www.arhp.org/Publications-and-Resources/Clinical-Fact-Sheets/The-Facts-About-Intrauterine-Contraception-

Guttmacher Institute. (2015). Publicly Funded Family Planning Services in the United States [Fact Sheet]. Retrieved from http://www.guttmacher.org/pubs/fb_contraceptive_serv.html

Featured image:
Me (far left) escorting guests to the annual Planned Parenthood of Southwest and Central Florida Fundraising Gala.

Categories
General Narrative Public Health

Storytelling and Patient Advocacy

Yesterday, I received a perfectly-timed message on a group thread. My friend wrote that she loves patient advocacy.

“Me too,” I thought, as I filed away notes from a Planned Parenthood of Southwest and Central Florida Meeting hosted by the Leadership Action Team (LAT). What was the purpose of that meeting? To train volunteers on how to employ storytelling in their advocacy work. Planned Parenthood trains all of its staff members, and now volunteers, in the “Story of Self” curriculum created by Get Storied® , which is a program designed to teach businesses how to create social change through the art of storytelling.

The meeting began with introductions and a moment to safely process the recent shooting in our hometown. A young volunteer explained how the event affected her and her family:

I learned about the shooting on Facebook…And honestly, all I saw was, ‘Massive Shooting,’ and thought, ‘Oh, another shooting,’ and kept scrolling. I didn’t understand the gravity of the situation, until that night while watching the news with my mom. I looked over at my mom and she was crying. She just said, ‘I am afraid for you.’ She’s never before expressed concern about my activities. But now she says, ’I am afraid for you.’

This volunteer was young, but her voice carried a surprising amount of assuredness. I felt her confusion and fear. The next attendee shared their story, and then the next, and so forth as the meeting progressed.

We learned that there are three key components to one’s story of self: a challenge, a choice, and an outcome. Zac, the chair of the LAT, shared his story of self, which described the healthy relationship with his mother and the openness with which she educated him regarding sexual matters when he was an adolescent male. The two-to-three-minute story, complete with a joke about educational materials containing graphic penis pictures, ended powerfully with the line,

When I walk into a Planned Parenthood, it’s the same kind of environment my mom created for me for talking about sex.

We received our first assignment, which was to reflect on the experiences in our lives that have shaped the values which call us to leadership. The program will later have us refine the various details of our stories, practice in one-on-one and group sessions, identify ways in which we plan to use storytelling in our advocacy work, and take action. We had five minutes to silently reflect.

Ok, what is my campaign? Women’s health. Yeah, but what specifically? To help women access and achieve the best reproductive health care possible. Nice. So why do you want to do that? Because reproductive health is the most important thing in the world! Ok, but why?

Figures of maternal morbidity and mortality popped into my head. I could see again the absence of a clitoris and labia in my Nigerian patient who underwent female genital mutilation as a young girl. I remembered the way the vaginal introitus feels beneath my hands—stretched and strong—as a baby’s head begins to crown. The voice of an adolescent girl echoed, “I mean I want to have sex, but like, I’m not a slut.”

It is easy for me to think of patient stories that depict why I am pursuing a career in Obstetrics and Gynecology. But a story of self is just that. A story of SELF. I struggled to think of inspiring personal experiences.

Time is up! No.

Each person in my small group shared their story and received feedback. My turn circled around and I rambled on about women’s health. I managed to state two strong lines, “I volunteer at Planned Parenthood because it still remains the one place to offer judgement-free care. Not even my own gynecologist can say that.” But my story lacked focus and a compelling personal example.

That night after receiving my friend’s text, I began to think more about the meaning of patient advocacy. As a medical student, I think my primary role in patient advocacy is to ensure that my medical team knows about our patients’ health histories and needs. During my internal medicine/family medicine clerkship, in order to help care for a patient, I compiled a short document of excerpts from the World Health Organization, Centers for Disease Control, and American College of Obstetrics and Gynecology regarding HIV prophylaxis treatment in pregnant women with negative HIV status who have regular, unprotected sex with an HIV positive partner. In that instance, helping my resident defend her treatment plan was my way of advocating for my patient’s health. Patient advocacy means that I volunteer monthly to escort patients safely into Planned Parenthood clinics. It is the reason why I study exercise and pregnancy, so that I can advocate for pregnant athletes seeking to find a balance in the pre- and post-partum periods. Additionally, patient advocacy means that I write on the MSPress Blog about topics that matter.

Stories in medicine can break stigma, help people relate to the struggles of others, and empower someone to raise their voice.  Stories identify why we should care about an issue, and can inspire others to take action. Although I do not yet have an organized understanding of the many personal experiences that inspire me daily to fight for reproductive health care, I think I am well on my way to becoming a strong patient advocate. Fortunately, I do have a clear goal: support the improvement of access to reproductive healthcare and higher quality of reproductive healthcare for all.

Quoted persons in this paper gave permission to be on the record.

Featured image:
Story by Alexander Affleck

Categories
General

Study Tools and Tricks to Doing Your Best in Medical School

Congratulations, you have made it into medical school! Now what? Where do you begin with all the resources designed to help you do your best in medical school? Not to worry, for no matter what type of curriculum your medical school may use, the fundamental resources that most medical students use remain the same. The following is a concise list of the best study tools to help you do well in your course work, as well as to best prepare you for your future board exams.

Best study tools:

  1. First Aid for USMLE Step 1. This book provides a generalized overview of the concepts taught in each of your courses. It is worth annotating as you go through the curriculum in your first and second years because the book is a compilation of key concepts tested by “the boards”. The boards, aka the Step 1 exam, is a key exam that you will take at the end of your second year of medical school, and the score you receive will help determine where you are matched for residencies. Needless to say, the boards are VERY important. Keep in mind that First Aid is only a simplified version of most of what you need to know for the boards, so annotating from lecture material is a must. Otherwise, you will likely not receive the board score you want. It is also worth noting that each year a new version is released, so aim to get the most recent one. The 2016 version is available here on Amazon for $45.
  2. First Aid Organ Systems. This book goes into greater detail than the First Aid for USMLE Step 1 book and is excellent for organ systems based curriculums. Though many USMLE blog forums have pointed out that there are more mistakes in this book than the USMLE First Aid book, the book is revised each year and any spelling and/or grammatical mistakes noted are made available online. Despite this, I’ve personally used and annotated the book, and it has greatly helped me in my organ systems courses. I will be using this, alongside First Aid for USMLE Step 1, as my step 1 study guides. The newest version is available in a two pack (one is organ systems and the other is basic sciences) on Amazon for $124.50.
  3. Pathoma. This book is gold for pathology. Every medical student should have a copy. It hits the high yield points for both in-class exams and for the boards, has videos available for more in-depth explanations, and is sectioned by different organ system pathologies. It also provides histological pictures and explanations as well, and is easy to read. Annotating lecture notes in Pathoma with also help you in preparing for the boards. A free trial version is available online. Full access, along with a hard copy, is available on the same website for $84.95.
  4. Goljan Rapid Review Pathology. This is another popular pathology book. It goes into much more detail than Pathoma, but it can be cumbersome to read. Most medical students prefer Pathoma along with lecture annotation, but if you prefer a more detail-intensive textbook, this is the one for you. The newest edition can be found on Amazon for $45. A newer edition (5th edition) is set to come out sometime soon this year, so keep a look out if you choose this text.
  5. Firecracker: While textbooks are great for learning, self-testing is equally, if not more, important. Firecracker is a USMLE Step 1 prep question bank that helps quiz you on material you learn throughout your course work. Starting from day 1, if you use one of the first aid books listed above in conjunction with your lectures, and begin quizzing yourself on the material with a question bank like Firecracker, you will be very prepared for your course exams and for your board exams. Firecracker is a tool that is best used throughout the school year to reinforce what you are learning in lecture. Firecracker is available for a free trial and for various prices for different lengths of time.
  6. USMLE Rx. This is another excellent online question bank that is designed to help prepare you for your board exams, and it is integrated with the first aid book. This question bank can also be used throughout the year to reinforce what you learn in lecture and has more questions overall than Firecracker, but it is also more expensive than Firecracker.  You can try a trial version online.
  7. First Aid USMLE Q&A Book: This book is like the aforementioned question banks but in book format. It provides questions, along with answer explanations in the back. One of the advantages of having a hard copy Q&A book is the ability to easily annotate and review notes; while you still have a note taking option in firecracker and USMLE Rx, it is more difficult to track. Nevertheless, the online question banks are easier to mark and review difficult concepts than the book. You can buy it on Amazon for $36.

Other resources:

  1. Planner: Organization is KEY in medical school. If you find yourself lacking time to study, get a planner and start writing down your hourly/daily goals. It will help a lot, especially as exam time rolls around.
  2. Academic Success Advisor: Every medical school has one, and they may be called something different, but the function is the same – to help you find the best study strategies and tools that work for you. Make an appointment (soon after you begin classes) with your school’s academic success advisor and ask for tips and pointers on possible study strategies. Also, if you have questions about resources, advisors are the “go-to” people.
  3. Medical school textbooks: If your school does not include textbooks in their tuition fees, but you are still “required” to buy them, attempt to find free versions online first. Often, review books alongside lectures will give you the information you need. However, if the information still feels insufficient, old editions of the required textbook are a cheaper alternative to the required, new ones, and will give you all of the content you need. (For cardiology, I highly recommend Lilly’s Pathophysiology of Heart Disease. Well-written and easy to read.)
  4. Notecards: I started my first year with notecards/flashcards but realized soon that I was taking more time to make them than I was using them to study. However, many of my classmates swear by note cards and it works well for them. I still use flashcards for memorizing drugs or for difficult-to-remember concepts, but otherwise I have stopped using them. As I said, do not be afraid to try out new strategies when studying – you are still developing the study habits that will work best for you in the future.
  5. Whiteboard: Repetition is key for memorization. Drawing out mechanisms of action, or making charts and diagrams repeatedly on a white board can really help the facts stick. I’d highly recommend investing in one.
  6. OneNote: Most new computers come with the OneNote software and it is a great tool for organizing your notes online and retrieving them easily months later. I personally like to print out and write handwritten notes (I’m old-fashioned) but I used OneNote in the beginning and really liked it. Plus, if your laptop were to suddenly stop working, OneNote backs up all your information so you can retrieve it from the application on another computer.

Before going out and buying all of these books and purchasing subscriptions to the online question banks, do a little research this summer and decide which ones are the best fit for you. One of the things to keep in mind is that not only do you want to find good study resources to do well in your coursework, but also those that will best prepare you for your upcoming board exams. Doing well in your courses will set the ground work for being prepared for your Step 1 board exam. The best combination of resources is one general review book, one pathology book, and one question bank.

When you get closer to preparing for your board exam, you will be using the notes from your general review and pathology books, in conjunction with more intensive question banks such as UWorld. It is best not to overwhelm yourself with resources in the beginning, and it is OK to experiment with techniques and resources that work best for you. Of course I have not listed all the possible resources, as there are far too many. However, the ones listed here will provide a solid start to your academic success.

Featured image:
Contemplate by Walt Stoneburner