Advice for 2nd Year
General
?X I found the lecture quality to be extremely variable and poorer overall as compared to first year. Most of the lecturers now are clinicians, as opposed to last year where they were mostly researchers. This can make things scatterbrained, because some folks will emphase the clinical, some the basic science, some whatever comes to mind. Clinicians may or may not have an interest in organizing their lectures or even making usable handouts.
?X Therefore, this year you have to be a more independent learner. You have to search out some things on your own b/c the handouts and lecturers may not explain them.
?X A medical dictionary is essential.
?X Pathology is kind of confusing in the beginning because it??s general info and not specific to an organ system. Bear with it and keep referring back to this first stuff (Inflammatory process, wound healing etc.) and it will gradually make sense. As the year goes on you will gain a clearer understanding of this discipline. (It really is a discipline!)
?X The key to pathology is learning how to categorize all the diseases pertaining to an organ system, so that you have a sense of where they fit into the puzzle, what overall things can go wrong, and how they compare to each other. By seeing what??s different about the diseases, you learn them.
?X For renal and GI you will rely heavily on Robbins.
?X Robbins isn??t the greatest book because it is wordy and not always readily understandable. Some parts are good. The renal path is good. It makes sense when you review it and read more than once, but who has the time?
?X The material this year is learned by memorization. You need to discover your own most effective method of memorizing material. For example, some people use flash cards. (They write the cards from memory as they're reading--read a section, stop, think about it, regurgitate it onto a flash card. It doesn't work if you just copy the info from a book to a card.) For me this approach is too disjointed, because I like to see the big picture and how everything is interrelated. Here is a technique that I found worked for me.
o #1 list all the info you need to know (ex?Xall the drugs)
o find a way to compare them, interrelate them?Xa lot of memorization is aided by comparing things to each other and noting the differences
o put all the info on one page
o re-write the info on the subway/bus/etc.
o pathology & pharmacology?Xuse the method of categorization. Ex: Renal Path: Categories could be:
1) Damage to glomerulus
a) Nephritic
i)acute poststreptococcal GN
ii) crescentic GN
iii) IgA nephropathy
b) Nephrotic
i) membranoproliferative glomerulonephritis
ii) membranous glomerulonephritis
iii) lipoid nephrosis
iv) focal segmental GN
2) Damage to tubules
a) pyelonephritis
b) acute tubular necrosis
3) Cystic diseases of the kidney
a) APKD
b) ARPKD
4) Neoplasia
Etc. now once you have your diseases categorized, be able to approach them systematically:
-what is the etiology?
-pathogenesis?
-histopathology?
-gross pathology?
-clinical manifestations?
-diagnosis?
-treatment?
(Don't worry too much about the last two, just have a general idea--this comes into play next year.)
To help you remember these facts, compare and contrast the diseases. Ex: what's the difference in glomerular destruction between lipoid nephrosis and membranous GN? Etc.
Immunology-- it helped me to start off with the Lange step 1 review book for micro/immuno. Gives great overview with enough details to be pretty comprehensive.
Cardio:
?X Use the Lilly textbook. I cannot stress this enough. It is amazing.
USMLE:
?X A lot of people say to get review books ahead of time and use them for your review during the year for block exams. This has pros and cons:
o Pros: This is helpful if you tend to remember things by the way they were presented on the page, because it makes you familiar with a particular review sheet and then it??s quicker and easier to fill in any gaps when you review it at the end of the year.
o Cons: The review for the USLME is not as detailed as the level of detail you need to know for each block exam. In review materials the concepts may be oversimplified. It needs to be this way in order to test for the USMLE because that test can??t question the nuances of a particular approach the way a block exam can.
?X Something that is very helpful is to make your own review sheets while studying for the block that are simple and short and that put all the concepts together. These you created from your own mental image and you will be able to look back on them and remember more easily than a picture created by an author of a book. Ex: putting all the GI hormones in one diagram. Easy to look back on, easy to remember.
?X You must find your own way and believe in it. We are all different. Only you know how you work best and what will work for you.
?X Take as much time as you need. Some people study in 4 weeks, some 6. If you know you need 6, don??t try to push it into 5. If you know you will go nuts after 4 weeks, don??t try to stretch it out to 6.
?X While reviewing for the block exam, make concise review notes. Collect these notes at the end of the block in a binder. Save them throughout the year and at the end of the year, when you go back to review for step 1, you will have a nice collection of your own material to work with.
?X It??s true that the best preparation for the USMLE that you can do during the year is to learn the material well the first time. This means that when you study for boards it will truly be review. This is important for two reasons: It makes it so that when you re-review things make sense in a way that they didn??t before. And, you will need speed; the only way to get through the material fast enough is if it is truly review. You don??t have time to be learning new things. This is the time to solidify what you know, refresh your memory and maybe add some new facts here and there.
?X Getting acclimated to review books during the school year. Personally, I found this hard to do b/c I didn??t have enough time to look through them and often they were too general for good block review. But, in retrospect, I think it would be good to get First Aid, and just read through the pertinent sections to the block. This will help clarify/give an overview to some of the trickier path like lymphomas and leukemias, as well as keep you familiar with the book. First Aid is a good review anchor. It is not thorough, but it gives a good framework, a good jumping off point. It is a good guide during the last few days before the exam in order to focus on last min review. It??s good to annotate this book (from memory if possible) for the last review. And if you??re already used to it ahead of time, then things will stick a lot better. Step Up is a systems based review book. It is also pretty good. First edition had a lot of mistakes.
?X First Aid is a tool. Not a comprehensive review source. Learn how to use it as a tool. The pharm and micro is viewed as pretty complete.
