question for upperclassmen/physicians

[albe]

---

Members do not see this ad.

I am a first year medical student. Like many of my classmates in medical school, I want to be the best physician that I can be. While I believe compassion/empathy are key to being a great physician, having a solid knowledge base in the sciences is also extremely important. One of the areas in which I feel like I am having trouble is retaining the information I learn from previous class/exams. For the most part, I understand the concepts and grasp the material for the exam. However, the pace of medical school seems to work against us really learning the material for the long term. The day after an exam, we are bombarded with new things to learn.

One of the things I have learned about memory is that we build on our long term memory by making connections with previous knowledge. A quick example: if we already have in our long term memory the fact that during energy exertion, we need sugar in our muscles and not for normal physiological maintenance, we can build on that -- after learning the steps/products of glycolysis, we can reason out what metabolic activities are going on at each location in our body (gluconeogenesis/glycogenolysis in liver while glycolysis in the muscles).

To me, this is the ideal way of learning. However, it doesn't always work because every day I am learning new things that I have trouble connecting to previously learned thigns. I am concerned that when it comes time to see patients (3rd year and beyond), I won't have the knowledge base/sharpness needed to do my job the best that I can. I'm especially concerned because I've found myself confused over things I knew very well even a week ago. I'm especially interested in hearing back from those who are currently practicing medicine. What can I do to work on this? For now, the best solution I can come up with is to review over everything I've learned when I get a long break (like winter vacation). I know some of you may suggest using that time for an actual break, but I don't want to "purge" everything I've learned this first semester. My plan is more along the lines of reflecting back on topics we've covered and trying to make connections between everything. I'm just looking for any advice to be the most competent physician that I can be. Feel free to PM me also.

 

[colbgw02]

You may either be relieved or dismayed to learn that nearly everything you learn during first year and most things you learn during second year don't really matter when you get to the wards or beyond. So if you're worried about not remember the steps of glycolysis, don't. No one remembers it, and after step 1 you won't have to.

Your point is still a good one. The iceberg is only so big, and if you put another penguin on the iceberg then one has to jump off.

First off, you're going to have to become resigned to the fact that medicine is so specialized that there is simply no way that you can learn it all. Second of all, you'll find things easier to remember when there is a face or situation associated with a learning point, like on the wards with a patient. Lastly, whatever you go into, you'll develop a subset of knowledge that you use more frequently, and you'll become very comfortable with that knowledge. For everything else, you either 1) don't need to know it, 2) refer them to a specialist, or 3) refer them back to their generalist.

 

[njbmd]

You don't have to remember everything from every class that you take in medical school but you can't review what you haven't learned in the first place. Your medical board exams are not about what you remember but what you can review, then recall and finally add to your knowledge base.

USMLE Step I, II and III are based on a solid knowledge base that you can apply. This knowledge is obtained by mastery of your medical school and PGY-1 teaching. If you attempt to memorize everything, you crash.

Right now, don't worry about what you can't remember but focus on what you have yet to learn and master. Your job is to continue to build upon your knowledge base. When you begin to practice from your clinical rotations to what every specialty you pursue, you will be constantly adding to your knowledge base and experience.

Skills that make a good physician are excellent problem-solving skills, an ability to perform disciplined study and a willingness to acquire the skills that you need to practice your specialty. You can add adaptability to that list too. My medical school prepared me very well for Boards and clinical practice. The rest was up to me. As a vascular surgeon, I spend at least 30-45 minutes per day reading and reinforcing my knowledge or not just vascular surgery but medicine too. When I am operating, I hone my surgical skills with each case and that's where adaptability comes in.

 

[enanareina]

I am a first year medical student. Like many of my classmates in medical school, I want to be the best physician that I can be. While I believe compassion/empathy are key to being a great physician, having a solid knowledge base in the sciences is also extremely important. One of the areas in which I feel like I am having trouble is retaining the information I learn from previous class/exams. For the most part, I understand the concepts and grasp the material for the exam. However, the pace of medical school seems to work against us really learning the material for the long term. The day after an exam, we are bombarded with new things to learn.

One of the things I have learned about memory is that we build on our long term memory by making connections with previous knowledge. A quick example: if we already have in our long term memory the fact that during energy exertion, we need sugar in our muscles and not for normal physiological maintenance, we can build on that -- after learning the steps/products of glycolysis, we can reason out what metabolic activities are going on at each location in our body (gluconeogenesis/glycogenolysis in liver while glycolysis in the muscles).

To me, this is the ideal way of learning. However, it doesn't always work because every day I am learning new things that I have trouble connecting to previously learned thigns. I am concerned that when it comes time to see patients (3rd year and beyond), I won't have the knowledge base/sharpness needed to do my job the best that I can. I'm especially concerned because I've found myself confused over things I knew very well even a week ago. I'm especially interested in hearing back from those who are currently practicing medicine. What can I do to work on this? For now, the best solution I can come up with is to review over everything I've learned when I get a long break (like winter vacation). I know some of you may suggest using that time for an actual break, but I don't want to "purge" everything I've learned this first semester. My plan is more along the lines of reflecting back on topics we've covered and trying to make connections between everything. I'm just looking for any advice to be the most competent physician that I can be. Feel free to PM me also.

I'm a fourth year student, so I'm not yet a practicing clinician, but I'll chime in too.

1) Being able to regurgitate the glycolytic pathways won't make you a good doctor. Having a basic understanding of how sugar is used and made in the body gives you some insight into diabetes that your patient probably won't have.

2) Vacations are just that. Those precious couple of weeks between the first and second semesters of first year should be spent relaxing as much as possible. You'll be learning so much material in the second semester that spending your Christmas reviewing biochem will not help you in the long run (IMHO only).

3) The material from your second year classes (path, pharm, etc) tend to be much more important as far as patient care goes. First year stuff can be largely memory-dumped after taking the Step 1. The important stuff from the first two years, the stuff you'll do over and over (like acid-base, for example) will be repeated ad nauseum throughout your medical career. Even residents can have issues with acid-base material.

4) I entirely agree that a physician should have a good foundation of knowledge in addition to empathy. However, just as was said above, you have to stay current, so you'll continue reading and learning well into your clinical practice. Therefore, you'll continue to review and refresh (and update) your knowledge over time. In a few years, you'll forget you ever knew the entire brachial plexus (unless you're in neuro), but you'll certainly refresh it quickly if you see a patient with Erb's palsy and you need to remember exactly how to examine them and locate the lesion. I think a more important point is to have a basic foundation of knowledge and know how to look up the information you need if you've forgotten.

5) When you can attach clinical memory to a fact, you will be more able to remember it (as was stated above). Since you'll have more memory connections to that fact, it will be easier to recall.

Step back, take a deep breath, and realize that being a good doctor takes work, but it is not an impossible task. It does, however, require spending time with your family and loved ones, especially during those precious times you get away from school.😉

 

[enanareina]

The iceberg is only so big, and if you put another penguin on the iceberg then one has to jump off.

I like this analogy!

 

[Blade28]

5) When you can attach clinical memory to a fact, you will be more able to remember it (as was stated above). Since you'll have more memory connections to that fact, it will be easier to recall.

This is key, and why we always tell our med students to read up on the diseases that their patients have. Acute appendicitis, for example, makes much more sense when you can picture that 20-year-old patient in distress, sitting on the ER gurney. At the very least, you'll really know the diseases that you've seen on your rotations.

I liked your description of the multiple "connections" - I like to call them "memory traces," after something I read in college once (some Neuroscience textbook, can't remember it now, ironically! 🙂 ).