This is part 2 of the Medical School Chronicles: A Third-Year Medical Student On Rotation.

Now for some particular subjects:

Anatomy

One of the more challenging subjects in medical school, students I teach either love or hate this subject.  Each school teaches Anatomy in very different ways, thus there is no one written way to master the material. Some tips are:

  • Start early.  If you have lectures on anatomical subjects and clinical correlations to this subject, start studying them early.  Break each lecture down into small pieces, work with chunks of material until you can start linking them together. For a nerve, can you tell me where it comes from and goes to?  What happens when that nerve is severed? For a muscle, what does it do?  What other muscles near it function in the same or opposite way? For an artery or vein, where does it branch from?  What is its purpose, is it deadly if it bleeds out?  Know where everything is first, then study the clinical correlations to that part of the body and explain to me (or your partner) why this correlation happens.
  • Practice. Each school should have a cadaver lab, and the lab should not be for just a few hours of dissection. Lab sessions themselves can be chaotic, go when the lab is empty and you can think. Focus on a particular section of the body (or part, like muscles or nerves) and practice identifying these on your body.  Then find another body of the opposite sex (this is especially important in the Pelvic region) and practice again.  Once you feel comfortable, have a study session with a small group and quiz one another.  Practice makes perfect, and more importantly, retention.

Physiology

Sometimes offered in partner with Anatomy, and sometimes a course on its own, this is the story of the body when everything goes right. Treat this as such, tell me the story of how a particular organ works on its own and as part of a larger system.  Explain to me (and maybe one day your patient) how the heart normally beats and how this shows up on an EKG in the pattern it does.  Tell me how muscles contract and why electrolyte levels are so crucial in this process.  How does the food you eat get digested and why?  How do neurons speak to one another, and with what neurotransmitter? This is the chance to be a story teller or chef, tell me how this system works from start to finish (like a heartbeat) or follow the recipe to reach an end product (digestion and absorption).  As stated earlier, when you feel comfortable knowing the material, teach it to another person.  If there are practice questions available, utilize them (be it from a textbook or teacher).  It’s one part to understand the story of proper bodily function, it’s another to decipher it when given a clinical question about it or what happens when this function goes awry. This leads me to my next subject…

Pathology

This class was not offered to me until 2nd year, but regardless of when or how it’s offered, this is the counterpart to Physiology. Understanding how the body works properly will make this, the study of the body gone wrong, much easier to understand.  To really get the most from this class, link this with Physiology.  Let’s take the example of an MI (myocardial infarction, heart attack). Review how the heart conducts and contracts, then explain what happens when parts of this system go wrong.  You block vessel X, what part suffers in what way? How does this affect the electrical system, and thus show up on an EKG?  What symptoms will the patient have, and why?

Another example: Pancreatic Insufficiency .  Review from Physiology how this organ functions, what triggers it to do so, and how this plays a role in absorbing what we need to function.  Now destroy this system (diabetes, pancreatitis, cystic fibrosis) and explain how this will affect the organ, but also the person in what way.  What will they suffer from in 1 year, 5, or for life?  Linking the two subjects together will not only help you recall the right and wrong of the body, but well prepare you for the Boards and Wards.  Patients will often question what went wrong, it’s your job to explain to them what happened and what could be done about this.  Pathology is not a vacuum of information, it’s interlinked with bodily function and what we can do to correct it, which leads me to my next subject….

Pharmacology

This was offered mainly in 2nd year, so as stated before each school has its own way of teaching this matter.  However, here is your chance to study this like a language.

First, what’s it called? What endings match each drug?  What category is it (antibiotic, anesthesia, pain killer)?

Second, what’s it do?  Where in the body or bacteria does it act?

Third, working and wasting takes how long?  How long does the patient need to take the medicine before an effect comes into play?  How is this drug eliminated from the body, and how is that clinically relevant if that elimination system does not work properly (example:  kidney or liver failure)?

Fourth, what should the patient be on the lookout for?  What side effects does this drug have, and if the patient experiences them, is there another drug that could be given instead? If a patient is already on medications, does this new medicine cause any interactions?  Example, some medications cause birth control to not function as effectively, due to the liver having to work with the medicine and birth control pill.  Rifampin does this, and if the patient is not told about this interaction, she could obtain an unwanted pregnancy!  Second, a patient on nitrates after his MI should not be taking Viagra (sildenafil), as this could cause a dangerous drop in blood pressure.

As a side note, always know what your patients are taking that’s prescribed, over the counter, herbal / supplement wise (this includes protein / workout supplements), and illicit. The last thing you want is an unexpected or harmful reaction from what you prescribed!  Educate your patients about the medicine and what to be watchful for, and arrange for follow up if needed to ensure the medication is working. The medicines you give are oftentimes quite powerful to fight off some of the most severe enemies to the human body, which leads me to my next subjects…

Micro/Immuno/Histology

My school combined Microbiology and Immunology, Histology being its own course. I put these 3 together because they are interlinked.  An infection causes an immune response in the body, leading to changes in the structure of an organ that can sometimes be identified microscopically.

For Microbiology, flash cards are effective at helping categorize each bacteria (Gram stain appearance for example). However, you must also be able to explain how each infection works.  Does the bacteria have a toxin?  If so, how does it work?  What are the symptoms for each infection that make it unique from other infections?  Once you understand this, what medication would you give and why? What vaccines would you give if applicable?  Are there complications to the infection?  Just like Physiology, tell me the story about this illness:  How did they get it, what organism causes it and how did it do it, and how do we treat it.

For Immunology, this is similar to an electrical circuit. For it to work, signals must travel between wires for activation and inactivation. For this subject, start at the beginning and explain the process. Even earlier, tell me the players in this process, such as T cells, B cells, and blood-borne cells like neutrophils, mast cells, and eosinophils. What are they, where are they, how are they made, and what do they do? The Immune System is all about cytokine signals, and to understand this, start with a simple infection from any antigen.  It gets eaten, broken up, and presented to the immune system, tell me how this occurs before proceeding further.  When the immune system encounters this presented antigen, the system is “switched on” via these cytokines, tell me where each comes from and what it does.  When you understand this, tell me how these cytokines help you fight off future infections (example: making antibodies of different classes). So, in short it’s presenting the antigen, turning on the system, creating the army (antibodies), and resolving the fight.   Once you understand the basic process, only then do you study the immunodeficiency diseases (both genetic and acquired).  If you understand the basic process, you will be able to predict the side effects of each immunodeficiency disease before reading it.  This method not only applies to studying a response to an infection, but also understanding allergic reactions to either environmental agents, medicines, or human products like blood.

Lastly, Histology is like visiting an art museum.  There is plenty of visual information here, break it down based on what you see and what you know.  Start with the image of something normal, then compare it side by side with the abnormal.  What’s different?  What stands out?  What’s characteristic on that abnormal sample that will help you identify a disease based on that picture alone?  For the normal image, tell me what each part of the picture is and what it does.  Tell me why something looks the way it does, for both abnormal and normal, and you will understand this subject and its clinical relevance well.
So, now you’ve mastered all I’ve just told you.  Pat yourself on the back, seriously.  This is half the battle.