Clerkship Years: Helpful Online Resources for Students

Nowadays books lag behind in updates (and sometimes forget they are addressing medical students not professors who understand everything about a topic) and reliable medical websites more than make up for it. The following are helpful every step of the way for students in their clerkship years (they include references and are reliable as sources to study from):

1. OSCE stop: One of the best resources for OSCE and DOCEE. It has many examination and history-taking checklists that we are not provided with for internal medicine, pediatrics and OBG especially - among many others.

2. Geeky Medics: Has not only OSCE checklists but also explanations for many subjects in surgery, medicine and emergency.

3. Learn Pediatrics: Many of us used this site for studying for the DOCEE. It tells you how to approach common pediatric problems by giving you the gist of things (as opposed to the endless blabber in many pediatrics reference books).

4. Dr. Smith's ECG Blog: This is not so much for studying purposes as learning and practicing ECG. Different interesting real patient cases are posted regularly with their ECG findings as well as any other investigation done.

Year 3: Go-To Books

Pathology

1. Pathoma and Pathology Secrets: read them before TBLs. Even though short and may not be able to answer every question in TBL but you get the main idea of everything as well as understanding the logical reasoning behind pathological processes. The purpose of skimming the topic before the session is to have an idea and not attend class like a useless statue.
   
2. Robbins Basic Pathology: Most students tend to miss a lot of the required topic while reading Robbins before TBLs because it is too much to finish before a class. This is not productive in terms of keeping information in your mind. Why? As the pathology teacher explains the topic you have not covered before class, you won't keep up. Make sure to go over Robbins after TBL and read it to consolidate your information. 

Anatomy

1. No specific book. I studied from many different books and I found that helped me gain an advantage of understanding the subject better than others. That is why I decided to make blog posts about the cranial nerves. The many books I read each had a new piece of information about the subject and I wanted to integrate all that in one place. Refer to the posts for the books used for each cranial nerve.
   
2. Gray's Anatomy Review: before the exam, it is imperative to solve questions in this book. As all questions, they introduce you to information you may have overlooked that is significant and help you remember it. (I still remember some information about the blood and nerve supply of the pharynx and larynx thanks to the questions.)

Physiology: 

1. Guyton's Physiology: many students don't like it because it goes into details. If you are like me and would like to understand things to minute levels, then you will like this book for neuroscience.
   
2. Costanza: I personally haven't read it, but I have heard many compliment this book. Try it and tell me if it's worth buying or not.

Pharmacology: 

1. Lange's Pharmacology Flashcards: obviously it's not a book, but this was helpful for quick revisions: when you're on your way to school on the bus/metro, during a 10 minute break between classes, when you're having lunch.
   
2. Lippincott's Illustrated Review - Pharmacology: This book has great summary pictures for side effects. It is the teacher's main reference book.
   
3. Lange's Basic and Clinical Pharmacology: This book is has more information than a medical student needs to know (such as chemical structure of each drug) but it's explanations of side effects and mechanisms of action is ample for understanding. You can opt for it's summarized version: Katzung Pharmacology Examination and Board Review. But this version is not comprehensive in the explanation department (hence the "Review").

Studying Evidence-Based Medicine (EBM)

You'll be introduced to EBM in 3rd Year. It may seem daunting in the beginning and useless, but once you arrive to your clinical years, you'll start facing questions whose answers are not found in guidelines or books. Questions like: does adding a non-insulin drug to a type 2 diabetic on insulin, help in reducing blood sugar levels and morbidity as opposed to monotherapy on insulin only? Is it worth it to make this patient pay money to buy yet another drug aside from insulin? Or should I just keep him on insulin?

The university is not very proficient in teaching this subject. That is why, you must take it upon yourself to learn about it (we pay 95K for self-directed learning after all). 

EBM Help:
This website is the best I have found in teaching EBM to people who need it explained in a common sense way like I do. Most of the time EBM will be explained statistically and that is not the way to go about it. The reason it was invented was to translate statistics to clinical practice. And that is how you and I need to understand it.

If you have found other useful websites, please share them in the comments so others may benefit as well.

An essential book for me for understanding statistical concepts in a simplified way (also useful for the community-based research course) is Medical Statistics Made Easy by M. Harris & G. Taylor.

Year 4: Pediatrics Clerkship - Part 5

Books
By now, you would have realized that being a medical student means 10 resource books for 1 topic:

1. Basis of Pediatrics by Pervez Akbar Khan: This book is the mother of all underrated books. All books can be trashed in pediatrics except for this. That Nelson book everyone praises so much? Nothing compared to this book. Granted it isn't updated and you need to study management guidelines from your everyday practice & PBL cases, this sets up your pediatric basics as they should be, not an inverted triangle of basics that topples soon as you start going into details. This is THE go to pediatrics book in this rotation.
2. Nelson's Essentials of Pediatrics: Great for certain topics such as respiratory tract problems and development. Not as comprehensive as everyone makes it seem. 
3. USMLE Step 2 CK by Conrad Fischer: great for revision and summarizing important topics before the finals or during short breaks. By no means exhaustive or comprehensive.
4. First Aid for the USMLE Step 2 CK: more comprehensive than the one above it, but it is merely a book of notes, it does not explain things as you might need to understand them. So, only good for revision or getting an overview of a topic before reading it in depth.

How to study

1. Study every PBL topic before the PBL class and ATTEND every PBL class as they are very important. I can't stress this enough. Don't focus on the unimportant uncommon topics in books. Wanna know the common things? Go to hospitals. Attend PBLs. That is exactly what you will encounter on exams.
2. Practice history-taking and physical examination because they are different than any other. Dealing with children is nerve-wrecking especially during exams. You want to be prepared and well-trained in physically examining them (doctors can detect students who have never touched a child before the exam because nervousness will be evaporating out of every pore of your body). 

Hospitals
Qassimi:

• To put it simply, you won't be taught anything here. I'll give the same advice as OBG:
• This hospital is only for exposure to a variety of cases.
• You can make use of self-directed learning here as it is the only kind you can get. Find willing patients, take history from them and examine them.

Note: you are not allowed to practice hands-on skills on pediatric patients (IV line insertion, etc.)

• Clinics:
• The best clinic I attended was at the pediatric cardiology clinic. I learned many important things about management and clinical presentations of congenital cardiac problems as well as assessing the heart with echocardiography (not required of you, merely curiosity).
• The general pediatric clinic is also useful to attend as you can probably be able to do neonatal physical exams here.

Baraha:

• They'll give you a schedule to follow. During the free time you have, go to patients and take histories and do physical examinations. For some reason, this hospital has cooperative, willing parents more than others.
• Make use of the bedside teachings as they are the best of all hospitals in this aspect. 

Dhaid:

• The most beneficial time you will have is with either of the consultants at this hospital. Write down whatever they tell you on the rounds, bedside teaching. Those are the important things of pediatrics that you'll encounter.

OSCE

• You will not have physical examinations as there are no patients available.
• The exam will be comprised of history-taking, consultations, computer stations.
• Important presentations for history-taking:
• Fever in a newborn, infant or child
• Jaundice in a newborn
• Vomiting in an infant or child
• Seizure in a child or infant
• Cough, strange noise on breathing or shortness of breath in an infant or child
• Diarrhea in a child or infant
• Constipation in a child (mostly in a girl)
• Rash in an infant or child
• Consultations are most likely for a Down Syndrome or autistic child's parents'.
• Computer stations give you a small case scenario with pictures of x-rays or signs on the child to diagnose.

DOCEE
On the exam (and every other clinical exam ever), taking a comprehensive history and doing a physical examination will get you far in the grading department. The rest of the things (differentials, management, information) is all just a decoy.

You can study the common problems (the PBLs) you are likely to encounter but don't bet on it. I got a complicated case no one had imagined. But my history-taking was comprehensive (presentation of fever, abdominal pain, vomiting and seizure. I had to explode each symptom on its own); I did a physical examination for all the systems I thought were important, gave an exhaustive differentials list with the most likely at the top and I scored as well as those with gastroenteritis and bronchiolitis cases (dare I say better?).

Written
Do not rely on the previous years' blueprints. The pediatric doctors are smart enough to change most of the questions (they have a never-ending bank of questions).

Intro to Med School (Dear Foundation Year Self, This One's For You) - Part 2

Dear Foundation Year Self, 

I have nothing new to tell you that you don't already know. The things that people usually advise others with? Turns out they're cliche because they are true!
Maybe you're expecting me to give you life saving advice, but the truth is, you're still too young. You're too eager for life and you shouldn't be. Take life now slowly and enjoy it because at this point you still don't have much to worry about. You don't need to worry about where to go after graduating or which path to take. You don't have to worry about being professional and acting like an adult in the workplace. You don't have to worry about how to get along with reluctant lazy colleagues. You don't have to worry about getting a fair assessment from your hospital/clinic mentor who you've said 'hello' to once on arrival to the place and never seen again.

So for now, hurry yourself to worrying. You will get sick of it later.

General Advice:

1. Time management. I only learned to master this 5 years into college. Learn it now! It'll save you lots of hair-pulling, eye-gouging events later on.
   
   Understand procrastination now to help you stop the 'addiction'.
   
   Why do I procrastinate? Your brain is on hash. Except it's the weed of procrastination. It is in a situation similar to drug addiction. Basically, your brain's reward system wants shortcuts to feeling good FAST and NOW. It doesn't want to exhaust itself with solving stressful tasks (studying, assignments) only to wait a few weeks/months to get rewarded (grades, finishing a course). So it starts doing things that give it immediate reward (social media every few minutes, series). It goes into a vicious cycle of reward and stress.
   
   
   
   How do I break the cycle? Self rehab. It won't be easy the first few times. There's no magic or shortcuts. It's all in your mind powers:
1. Start by either deleting or signing off social media apps on your phone/tablet. Your phone/tablet is the easiest to access (well it is to me). Once I did that, I found I had a lot more free time when not wasted on scrolling facebook, twitter or instagram feeds. (I actually have time to continue painting and reading novels now!)
2. If you don't want to do that, close your gadgets/turn off their wifi/keep them somewhere you can't access while studying/give them to someone to keep while you study. Please resist opening that tab on your computer and watching an episode of Vampire Diaries and whatever useless teenager crap that is on at the time or socializing on facebook..etc.
3. Put small goals for yourself to achieve with prizes afterwards: If I finish this short chapter/6 pages, I will get to watch a funny youtube video.
4. Plan something crazy every weekend you can look forward to. Knowing my weekend was filled with fun helped me stay focus during the week on studying to my limits. It doesn't have to be hardcore so as to go clubs and party or whatever; to me it was just a night of movie marathon with my family, a full day of painting, reading the next novel in a trilogy. A day that pleases YOU!
5. Spice up studying by staying in college some days. Knowing others are struggling to study just beside you in the other room/other table helps in keeping you grounded. It is also a fun way to socialize. I'd plan to study a chapter and take a break by talking with friends. Also, I've made new friends during this time. Stressful times bring people together.
2. Social life. I am still confused in this aspect, so I cannot give you advice. I can only give you my point of view:
1. I was a lone wolf in foundation year. Is that a good thing? Not sure. I was freer. I didn't have any commitments to friends. I got to study whenever I could during free time instead of talking, spend time going to the gym and doing hobbies. It was a freeing year.
2. I'm running out of time for socializing with my peers and I regret having wasted a year not doing that during my free time instead of running away from class soon as it was dismissed. You don't need to be a public relations expert, just enough for you to stay socially healthy (bet you learned that the definition of health includes a social aspect by now!). 

"How to study" Advice:

1. What to study? Books. Not Lectures! B.o.o.k.s. Many people study lecture presentations instead of books (chemistry, physics, biology). I was doing well on exams and I kept hearing students complaining about how the material was not in the lecture. Forget about the lectures. They aren't references and may have many mistakes.
2. How to consolidate memory with galaxies of information? 
1. Understand concepts. I read the chapter once before class. Once after class. Once before the quiz. Once a few minutes before the quiz. Once before the midterm. Then for the final. Why read so much, you might ask? It is a scientific fact that you never understand something fully from the first reading. Exams rely on full-rounded understanding. Every reading adds a piece to the clarifying puzzle. Interspaced reading and understanding helps solidify knowledge in long term memory. (After foundation year, you will never have the time to do this.)
2. Explain things to others! Explain concepts to your parents, siblings, friends in scientific terms and simple terms. You may hesitate at points, not knowing how to put them to words. These are your weak points. Go read more about those. When you know something, you will never hesitate to put it into words.
3. Chemistry & Physics. Practice, practice, practice exercises. Do not read the exercise and mentally solve problems. Put pen to paper and use your hand to solve.
3. How do I organize my electives? Take Intro to Medicine in the first semester and get it over with. Leave the second semester for electives because they are easier. The second semester is when you'll be near burn out because the end of the year is approaching. 2 approaches to electives in this year:
1. Take the harder electives in the second semester and leave the easier electives for later years when you'll be loaded with more important studying.
2. Take the easier electives in the second semester to raise your GPA. Leave the harder electives for later years because after foundation year, it is only a matter of pass/fail for them. Their grades don't matter starting in year 1.

Year 4: Obstetrics/Gynecology BOOK UPDATE

High Yield Obstetrics and Gynecology by Elmar P. Sakala:

I forgot to add this book to the OBG post. This book partially saved my life. Its name is descriptive of its content. It gives you the important information you need to know for the exams (written & DOCEE). 

It may not be up to date, but that is what you have UpToDate.com for. Take the main guidelines and outlines from the book and update the information from new sources (which is first line management and which is second; what are updated drugs and doses).

It is particularly useful to have on rounds or in clinics when you free time is abundant, quickly reviewing topics and memorizing on the go from this book.

Year 4: Obstetrics/Gynecology Clerkship - Part 4

Books
Most read from Kaplan Obstetrics & Gynecology USMLE Step 2CK Lecture Notes.
Many also read from Blueprints Obstetrics & Gynecology for covering the more important topics.

However, I like to read important topics in a full-rounded way - and this has been satisfying during exams for me. Meaning cover every aspect of them as you will be quizzed in detail in the DOCEE on common problems. Therefore I have done the following:

1. Kaplan Obstetrics & Gynecology USMLE Step 2CK Lecture Notes for getting a general idea about the topic and as the only source for low-yield uncommon problems
2. Combined Blueprints Obstetrics & Gynecology + Obstetrics by Ten Teachers + Gynecology by Ten Teachers for the high-yield topics I need to know in detail.
3. UpToDate for the most recent information I need to know on important topics: management, drugs, lab result numbers

How to study
Most students say the last 2 weeks are enough to study for OBG. This is somewhat true. Here was my routine:

1. In the first 6-7 weeks, you can study lightly. When you have free time during the hospital use them to study the high-yield topics. 
2. At home, you will have A LOT of free time. Spend it wisely. During this time, you can spend an hour or so watching some Kaplan videos at home. Or go over the low yield topics. Both only take about an hour.
3. In the last 2 weeks, you need to be studious. They will be more than enough to cover the high-yield topics in detail. You will most probably be revising them as you would have read them during the days in the hospital or adding in missing points.
4. You may study the important topics for the first time in these 2 weeks. It is still enough.
5. These high-yield topics are important for all exams, but mostly the DOCEE.

Hospitals
Qassimi:

• You will not learn much. This hospital is only for exposure to a variety of cases as well as exposure to many operations. 
• You can make use of self-directed learning here as it is the only kind you can get. Find willing patients, take history from them and examine them. You may observe women in labor (there are MANY!).
• Clinics:
• Attend clinics as they are a golden opportunity to see patient communication and learn about the elements of OBG ultrasound.
• Clinics are also great for seeing the elements of a history. It is only from the clinics that we were able to understand how organize a proper history.
• Labor suites: you can get many hands on experience here from the mid-wives.
• OT gets you exposure to D&Cs, uterine prolapse repairs and C-sections.

Baraha:

• Clinics with Dr Nabeela, Dr Mansoura and Dr Wafaa are quite useful - matter of fact, the most beneficial learning you will do.
• Labor suites: beneficial for learning and observing, not hands-on training

Dhaid:

• Clinics get you lots of exposure, hands-on practice and learning
• Labor suites (which are empty most of the time) are great for hands-on delivery by guidance of the doctor herself.
• OT gets you exposure to D&Cs, uterine prolapse repairs and C-sections.

OSCE

1. Know the uses and names of OBG instruments as you may have a station on them
2. Histories:
1. Discharge
2. PV bleeding
3. Pelvic Pain
4. Infertility
3. Physical examination:
1. Pap smear
2. Pelvic exam

DOCEE

1. High-yield topics will be given to you by the doctors at the hospital (ask them)
2. You will be taken to one patient for history-taking. You will not be doing a full history because it is too long. Only chief complaint and history of presenting illness. Other parts of the history will only be asked if necessary to the illness. If you are a girl, you WILL be asked to do physical examination.

Written

1. Important and low-yield topics in the practical exams are of equal importance here. You would therefore already have studied them from previous exams and daily training.
2. It is also important to study the blueprint from previous years.

Boys, This One's For You
Many of you will be reluctant to train. Many of you will stay home most days because of the conservative female culture here. Many of you won't care because you believe OBG is useless to your training. Ultimately, the decision is based on your conscience and circumstances.

If you do not attend because you believe you won't be able to do anything anyway, that is not always true. Doctors try their best to get you learning opportunities if you show your enthusiasm.

If however you choose not to attend, you will graduate with absolutely no practical knowledge in this field. Remember the amount of money you are paying to learn. You will not get another opportunity to learn like this in the future should you need it. Also if you are planning internship outside the country, your gender would not matter in OBG and you would not want to look incompetent.

Year 4: To be on-call or not to be? - Part 2

This was a confusing post for me to write because being "on-call" has no concrete rules.
Being "on-call" is really not what it sounds like. You just need to be in the hospital from say 3pm-8pm. It is not an all-nighter thing like the future will be. The purpose of this is to help you gain extra hours to train and practice. I know there are many questions in your head, most answered below I promise!

Each rotation, you have 10 nights, where you need to go to a hospital and stay there for a few hours to learn.

1. You can choose any day you desire.
2. You can stay any time you desire at any hour of the day. You can stay for 3 hours, 4 hours or even a whole night (some people are over-enthusiastic in this regard. Don't push it. You'll have plenty sleepless nights in the future. Stock up on energy now and do your 'calls' during the evening.)
   To give you an example: I used to stay after university depending on what time I finish either 3 pm or 6pm till 8-11pm depending on when I started. Sometimes, I'd be too tired during the week, so I go during the weekend.
3. Generally they tell you to stick to the hospital you are training at.
   Surgery and Internal medicine: preferable to do so. However, people in Dhaid Hospital have the option of choosing where. People in other hospitals who do not like to follow rules will probably also choose.
   OBG and pediatrics: there is only one hospital to be on-call at --> Qassimi and Baraha.
4. If you decide not to follow university rules, you can choose the hospital. Choosing the hospital really depends on personal preference and ease of access. Qassimi offers many cases and varied patients and is usually the best to learn from. Kuwaiti has a small variety of cases but you may still pick up a few things here and there. As for Baraha, I have never been on-call there so I cannot advise you. Dhaid....does anyone want to be on-call in the end of the universe...unless you live nearby.
5. Many/most students opt not to be on-call as they believe it to be a waste of time that they can use to study to increase their grades. However, you should not be influenced by others. You must do what fits into your goals and criteria. Do you need extra practice outside of regular hospital hours? Or do you feel you are more deficient in information and need to spend time reading?

Year 4: How to behave in hospitals - Part 3

1. First week: You will need to revise physical examinations and history taking as you may be doing them alone and then asked to present your findings to the doctor before they start teaching you things on your first week and before you start remembering them as they teach you. So get a head-start by freshening up your memory.
2. Be punctual. ALWAYS be on time (or before time)!
3. Have your white coat neatly on you (crinkled white coats and splotched ones make for an unsightly disheveled look. Patients already do not want to see your faces, us being students and all. Add an unkempt look to the list and you may not be welcome anywhere.)
4. Have your stethoscope on you, a quick reference guidebook or ipad, a notepad and pen (and a measuring tape if OBG). Make sure you have an ID tag on you at all times (certain hospitals are strict about this).
5. Be confident NOT COCKY! Be polite and respectful to ALL staff. Doctors. Nurses (are your best buddies in a hospital ya hear me! Make good friends with them. They run the place.). Janitors (good possible translators).
6. Do not talk to each other in ward rounds. Only talk to ask the doctor/nurse a pertinent question that absolutely cannot wait or when they are not utterly busy.
7. You can tell the doctor at the beginning of the rotation/week what your group goals are for that time period so he can help you achieve them. Is there a certain something you want to learn? Haven't learned something yet? Doctors are there to help you.
8. When you are not given a task, do not sit in a room and wait. Follow the doctor around and observe him, do not wait for him/her in a room until they tell you to do something (unless he/she tells you so). That way you miss out on many things you could be learning by observing. 
9. If a doctor says something you find contradictory to something you read, bring it up in a gentle manner. Doctors may feel challenged when you do that and few may get offended enough to get angry (I've seen it happen...). You may start with a: I would like to ask a question regarding this point, I read in this so [site reliable reference], that so-and-so is supposed to be like this-and-that....you get the hang of it.
10. Make educated guesses. Say "I don't know" when you don't know something. Doctors respect someone who is honest and not conceited in their own knowledge. Most doctors do not like random guessing of answers (the ones who do will let you know). Many a time have I witnessed students being berated for uneducated guesses.
11. Do not be afraid to ask questions that seem stupid. Do not be afraid of looking inexperienced. You are. Do not be afraid to try new things in order to learn. At this stage, everyone knows we are at the beginning of learning and expect us to be idiots anyhow. No matter the geniuses we were at university academically, this is clinical life. A person's life is either renewed or taken here. Allow yourself to make mistakes now - because that is truly the only way to learn - when you do not have a person's life hanging on your hands. When you are under the care and protection of the people responsible. Learning is done now, or in the future you would be too shy to admit inexperience as a full-fledged doctor. So seize the opportunity and learn to become great later!

    
    

    

    No those are not flowered diapers! But that is us now and for another few years...or maybe even till we retire!

Anything I missed out on?

Year 4: Clerkship Starts Here! - Part 1

That is the general outline of your year! Yes those are back to back 10 weeks...get used to this life :D

You will have 4 rotations, each rotation is 10 weeks long. Absolutely no vacations in between. 9 weeks in the hospital and the 10^th week is exam week.

BUT YOU ALREADY KNEW THAT!!

The 9 weeks:

• 8 weeks in the hospital
• Usually the entire 9^th week or half of it are taken as study-break. You must take the permission of your responsible doctor to go on this study break (sometimes it may require begging depending on the doctor. And 1 doctor in specific may give you only 1 day – Thursday – as a study break from this 9^th week). I'm not sure if the university is aware of this trend among students.....

The exam week usually starts with the DOCEE followed by the OSCE and finally the written is always on Thursday for all rotations together. (The DOCEE and OSCE may be interchangeable in OBG and Pediatrics.)

DOCEE: (I still don’t know if it is with a double ‘E’ or one ‘E’ -_-) is a hospital based exam. In surgery and internal medicine, the doctor will usually ask you to choose a day in the 9^th week or 10^th week that you would like to do your exam (some doctors may decide on their own). Certain doctors do this differently. However, generally, you come at the designated time to the hospital and are taken in turns to the same/different patients. Usually each student has 1 patient (certain doctors put multiple patients where you do history on one and physical exam on the next…etc.). You are told to take a full history, do a relevant physical exam on the patient. It is not as hard as it sounds as you would have had 8-9  weeks of experience in observing the doctors and doing it yourself. They allot you a time, however it is not as strict a timing as the DOCEE. They are lenient with it. Doctors may pause you to ask about why you are asking such or why you are doing such. The key is confidence. You either know or you confidently can say: I don’t know. I will consult with my senior doctor or read up on this matter and let you know.

Then they will ask you about your differential/provisional diagnosis. After which you will be asked to plan a management line for the patient along with investigations. Basics. Basics. Basics. Vague. Vague. Vague. That is all I can say with management. Eg.: Do not jump to MRIs and CTs before doing the easy stuff (or unless it is absolutely indicated). Another eg.: Do not say “metronidazole” for a disease unless you are prepared to answer the array of questions that will be fired at you when you could have easily said “antibiotics” and breezed by the answer without the teacher second-guessing you. Then you may or may not be asked to exclude the differentials based on the investigation results they provide you with. Your diagnosis is the least important part of the exam. I assure you. Do well on the history and physical exam parts and that is a big chunk of your grade. What they want you to learn during clerkship is how to be a good historian and examiner. The rest (management, diagnosis) comes with experience and reading.

OSCE: unlike the pre-clerkship phase, there are no longer merely 2-3 stations in the OSCE with 15-20 minutes each. That was the honeymoon phase dearest. Now it’s reality time. 10-12 stations with 5-6minutes each and 2-3 break stations between. 6-8 stations are a focused task that can definitely be completed in time. You will either be asked to do a focused abdominal exam, or peripheral vascular exam….etc. They do not teach you in previous years how to be focused in history or physical exams. I cannot predict all the scenarios you will get, so I can’t post any help here (I will try). Therefore what you need to do is to make sure you inform your hospital doctors of this at the start of your rotation. Let them know, you want to “learn how to take focused histories and do focused exams in 6 minutes tops”.

Along with history taking and physical examinations, you may have stations with:

•        Breaking bad news
•        Counseling on:

o   How to use a device

o   Major/minor operation

o   Contraceptives (for OBG)

3-4 stations will be computerized unmanned stations. 

FOR THE LOVE OF GOD WHAT DOES THAT MEAN?! You will go inside the room but instead of a doctor testing you, there is a computer with a picture and a paper in front of you with questions you have to answer about the picture on the computer. It could be a disease case, imaging, devices…etc. Sort of like OSPE.

Written: need I say anything? >70 questions: MCQs + EMQs.

How You Can Spend Summer As A Medical Student

This is advice I would have appreciated before summers of the past years of med school. Unfortunately very few people in life - especially med students - like to share information that might help others (one of the main reasons I started this blog, to provide information that might help everyone)

1. Summer after Foundation year: Foundation year is like an extension of high school. So unless you need to repeat a course you got a less than optimum mark in, then this is pure beach- and sleep-filled vacation. There is nothing career - medical career that is - related you can do, that I know of, at this stage.


2. Summer after Year 1:
   A) Summer courses (university electives and compulsory courses), if need be, are preferably taken here.
   A chat about summer courses is overdue at this point: In foundation year, lecturers scare you about not finishing elective and compulsory courses before graduation. They tell you stories of students in their final year of medical school but who had not finished the elective and compulsory university courses and were not allowed to graduate because of that. Scared shitless, many medical students spend all 3 summers after foundation year trying to finish these courses during the summer semester. This is an utter waste of time, unless you feel you cannot manage studying an elective course with your usual medical studies. With a little planning, you can finish all your university compulsory and elective courses before Year 3. I felt confident enough to juggle elective and compulsory courses alongside with my medical studies. Based on that, I laid the following plan for myself. Remember, lay down the plan you feel suits you. You don't need to compare yourself to others. By year 2, students who had taken 2 summers filled with courses were nearly done but I wasn't. Yet they spent a 3rd summer to finish these courses while I got to enjoy 2 summers more than they did.

B) Start preparing for USMLE Step 1 if you are planning to take it in the next few years. Most, if not all, students think that the USMLE, like all exams, is cramming. Exams are not about cramming. Give your brain time to consolidate memories of information. Read and re-read. Then read again the same information. And again. Over time. That is the real secret to understanding and keeping information in your long-term store for use even past the USMLE and college exams (which I assure you, you will need). Even though cramming works, students know it is only a temporary storage of information. Yet we are forced into it because of a lack of time.


3. Summer after Year 2: If you are interested in research, allocate a time during this summer to learning about research (whether in our university or elsewhere). Research labs. Community research. Whatever interests you. Contact professors in university or other universities who are conducting research and ask to be mentored. (This is a point I wish I had known about at the right time. I only discovered the fact that our university conducts research a few weeks ago.)


4. Summer after Year 3: This summer should be for a clinical attachment. Public hospitals may have clinical attachment programs (Rashid Hospital, Dubai Hospital, you may want to try Qassimi Hospital in Sharjah. There are many more hospitals but these are the ones I know of.). Contact the department you are interested in and ask them or visit their website.



Alternatively, you can take a break in the summer after Year 2 (I know how hectic that year is). Then in this summer, allocate 1 month to research and 1 month to clinical attachment.
(I juggled both research and clinical attachment in 2 months at the same time. It was utterly exhausting. Why did I do this? I didn't know till this summer that our university conducted research.)


5. Summer after Year 4: shortest summer of med school. You will have 6 weeks to do your elective in any place of your choosing (I'll write a post after I've stepped in a few puddles myself and found the solutions and right way of stepping over the puddles)

Note to all med students reading this: Medical life is tough because of the competition. It's easy to get lost in the heat and jumble of things, lose yourself, your health and your life. Summers were meant to be a break for the mind and body. The above is only a humble suggestion from yours truly. But you can always spend summers to grow your talents. 

Year 3: Semester 1

Note: All books I recommend are books I've read unless otherwise stated. 
Also, please don't hesitate to contact me if you have more questions or are in need of any books or help.

The 2 poles of opinion on this semester:
1. This semester gave me a brain-gasm! 
2. I don't think I could hate medicine more than I do now.

No gray area in the Neuroscience Unit. What team you are depends on how you're studying. I am not going to sugar coat this one for you.

Pros of semester:
1. It's all about neuroscience. Not a billion units in one semester. Advantage? Your study is focused. 
Disadvantage? Delving into minute details.
2. Pathology here is the most fun and easiest of all units. But this is mainly because you will understand neuropathology like no other pathology you have taken before. It will still be imprinted in your brain a year later.
3. A lot of pharmacology will be repeated over the weeks.

Cons of semester
1. Pharmacology is not very logical (few exceptions) and includes many classes and each class contains many drugs (but then again, I hate pharmacology. For a reason might I add. Not blind hate.).
2. The final 2 weeks are in the wrong place. That is to say they shouldn't be the final 2 weeks. What smart organizer places the introduction of TWO new systems (hearing and vision) in the final 2 weeks before the exam? Incompetent fools is who. But there is no changing that. Or is there? (Do I hear the Student Academic Council anyone?)

General Tips:

1. Study the Sight and Hearing unit lectures before the teachers give you the material and after they give you. Then when you study for the exam make sure you start with these two weeks first and work your way backward. Why? I found this helped me a lot. How? Well the neuroscience unit is connected each week with the next. So by the time you reach the final few weeks you would have gone over the material of the first few weeks a bunch of times. But not too much for the last few weeks. So starting from the last weeks helps consolidate the material better. But if you feel near the exam times that you still do not have a good grab on material, then start chronologically. Each to his own after all.
2. Every student knows the key to this semester. That is why a lot of our class scored somewhere in the lower 90s spectrum. Repetition. This will come indirectly with the weeks. But you must also spend considerable effort and time on your own. Do not rely solely on lectures. Library books are free. Rummage the library for books you feel suit you best. Read material from different sources. This way, you may chance upon facts missed by one source or you may find clearer explanations in another. But do not confuse yourself with TOO much sources. Find one or two to your taste and stick to them in a particular subject.

How to Study:

Pathology

1. ATTEND ALL THE PATHOLOGY SESSIONS. Do not just solve the TBL and leave the class discussion and teacher explanation.
2. Attend all practical labs. You may get one-on-one teacher explanations of histopathological pictures if you ask. Important for getting information stuck in your synapses till the OSPE.

Anatomy

1. There are 2 main domains: 
1. Head and Neck
2. Neuroanatomy
2. They go hand in hand. Study them in chronological order if you can because they are connected. Do not study them as separate sections because one is related to the other. If you miss out on a few lectures, you may be lost later on because of the inter-connectedness of the subject.
3. Try to integrate the studying of anatomy. At the end of the semester by the time of the exams, study everything all over because everything will fall in line and you will feel satisfaction as you everything goes single file through your neurons (you understand everything thoroughly in other words).
4. Make the most of your anatomy lab timings this semester. Then, go to the anatomy labs after class hours. Bring your anatomy atlas along (you may be quite lost without it). Go at least 3 times before the exam (before written, OSPE and OSCE) because this is the time you will have finished all the theoretical knowledge and can finally put everything together in your imagination using models.
5. If you feel you may not manage alone, bring a study partner along. (Make sure it is someone who is willing to learn, optimistic and fast-paced. Be sure it is someone encouraging, and not someone envious and greedy for self-knowledge only.)
6. You may find it helpful to do as I did if studying alone is what gets information in your mind but you need a partner to consolidate information and make sure you are not learning wrong information: alternate visiting the lab alone and with a partner. I used to think studying alone was more efficient. But while revising with a partner, we joked and that helped the information stick till now.
7. In the first week, focus on scrupulously understanding the motor and sensory spinal tracts. Why? They are of utmost importance in nearly all the upcoming cases. (At least this is how I felt when I studied them in the first week. The PBL cases and mini PBL problems during the rest of the semester were a breeze to diagnose based on the signs and symptoms that relate to motor and spinal tracts.)
8. Books specifically for neuroanatomy - in addition to your traditional anatomy books:
1. BRS Neuroanatomy: great for reviewing things just before each lecture of neuroanatomy or the exam
2. Clinical Neuroanatomy Made Ridiculously Simple
3. High Yield Series - Neuroanatomy
4. Snell's Clinical Neuroanatomy

Physiology

1. In summary: studying the lectures is enough for exams if you are lazy. 
2. If you are genuinely interested in neuroscience physiology (because the brain physiology is truly breathtaking and grand to behold), I suggest not only reading books but also websites with animations and explanations (not that I need to recommend that to a 21st century student).
3. Books: 
1. Guyton's Physiology: many students don't like it because it goes into details. If you are like me and would like to understand things to minute levels, then you will like this book for neuroscience.
2. Costanza: I personally haven't read it, but I have heard many compliment this book for not only the neuroscience unit.

Pharmacology

1. Study each week as you pass it. Do not leave lectures to accumulate till the end of the semester. Neurogenic drugs are many.
2. If you don't know some neuroanatomy and physiology, you may not understand the mechanisms involved in neurological drugs. Therefore, if you miss out on lectures, it is most important to read neurophysiology and anatomy before proceeding to the pharmacology.

Microbiology
The written exam (Paper 2) was filled with microbiology. I managed to breeze through it because I had studied the microbiology lectures thoroughly (up to the minute boring details). Others were not so fortunate because they thought microbiology was a joke - wasn't so funny in the finals though. 

Refer to the microbiology post for the books I used: 
http://taleoftwoidentities.blogspot.ae/2014/06/best-medical-microbiology-books-for-med.html

Neuroscience is all about understanding. If you memorize, you are doomed to find it difficult to answer the exam. It is also the most enjoyable of units. So enjoy it. Do not wait for day by day to pass so you can "get over with it" and enjoy the holidays. Enjoy each day as it comes. 
Life is passing too as your medical years pass. Young years of life. Keep in mind that you are studying to try to cure others and thus bring back hope and happiness into their lives so don't forget to bring the optimism and pleasure to your life as well.

Next post will be about how to spend summer as a medical student.