Studying In Medical School – A Timely Analysis

Today’s guest post comes from Ryan Nguyen, an osteopathic medical student who blogs at WhiteCoatDO. You can also connect with him on twitter via @RNguyenMed.

 “So how much do you really study?”

My non-medical friends often wonder where I’ve disappeared to for the past year, they’re fascinated by the idea that I spend just so much time studying. Sure, I had to put in a decent amount of work during college to even make it to this point, but my course load at UC Santa Barbara seems like a brisk walk in the park compared to the tidal wave of information that needs to be conquered for each exam now.

In an effort to quantify really just how much time I was studying, I tracked every single minute I spent preparing for one of my exams during the school year. What exactly did this mean? Every hour spent in-class, watching lecture playbacks, outlines powerpoints, or reviewing in group was written down. The exam, from my “Introduction to Disease, Immunity, and Therapies” block encompassed 2 weeks of material and roughly 37 hours of lecture material. To put that in comparison, a typical 4.0 unit class at UC Santa Barbara would cover about 30 hours of lecture material over a 10 week span. Medical school sure has a way of jam-packing information into a very brief amount of time.

In order to keep the data as accurate as possible I ONLY logged time that was spent studying. This meant I “clocked-out” any time I spent surfing the web or even going to the bathroom. For example, if I was at a coffee shop for 3 hours, I probably spent ~2.5 hours actually studying and 30 minutes for other things. After doing the actual studying and test-taking, the results were tabulated as follows.

What does this all mean?

I spent a lot of time studying

In total, I spent 76.8 hours studying for this one exam. That translates to roughly two hours spent dedicated to each hour of lecture material. On average, I would study for 4.8 hours/day, but there was a definite disparity between how much time I spent per day during the first week (3.5 hours/day) and the last five days before the exam (7.2 hours/day). Unfortunately, there’s no data on how many hours I spent studying as a premed, but I’m confident in saying my “light” 3.5 hour study days now would put some of my more “intense college study sessions” to shame. The only comparable experience is finals week in college, except the first year of medical school is finals week stretched out over a 9-month period.

I skip a lot of lectures.

One of the great things about WesternU COMP is the flexibility to learn at your own pace and style. Even with 37 hours of lecture material, I spent only 6.5 hours actually watching any lecture (in-class or via recordings). Professors provided powerpoints that encompassed testable material and I would fill in knowledge-gaps with resources from the internet (Wiki, Harrison’s, etc.). Even though I skipped the majority of my classes, I still spent a large amount of time (51.8 hours) studying by myself. This is one of the BIGGEST changes from college where skipping class was almost always detrimental to my grade. Now, I found more success tackling the material on my own.

One major note I’ll make about this study strategy is that as the year progressed and more of our lectures became clinically-based, I gradually watched more lectures. Not watching any lectures worked out in the basic sciences. However, at this point in our systems curriculum, I do watch every lecture (although rarely in person and almost always on 2x speed) in order to help learn more of the clinical applications of the material.

I use group review to break the monotony.

All those long hours of studying in front of a computer screen can get awfully lonely. Thankfully, I’ve found a study group of 3-5 classmates who I can group-review with before the exam. The amount of time spent reviewing the material was evenly split between group-study (16.5 hours) and self-review (16 hours). There were at least a few questions I got right just because of a connection one of my study partners brought up during our review sessions. Study groups can be very hit or miss, but can be worth their weight in gold if all the members get along properly.

Not Pictured: The Revolving Glass Door of Study Styles

After a year of medical school, I’ve found my study habits changing on a class-to-class basis. As I alluded to in the data analysis, one such example is the transition from watching barely any lectures to watching almost all of them. Some other strategies I’ve toyed with during the year include drawing things out for anatomy, making concept-based tables for biochemistry, self-quizzing with flashcards for pharmacology, making up patient presentations for neurology, and making absurd mnemonics for everything in between. Over the next few months, I’ll be going over a few of these study strategies on WhiteCoatDO.

Recharging the Mind and Spirit

It’s almost the end of my PGY1 (Intern) year and senior resident responsibilities loom nearby. Overall it’s been a good year. I got to see a lot of patients and be responsible for their care. Along the way I saw a wide variety of cases and learned to be a better clinician. I’m a better team-player and leader and I understand my role as a doctor more clearly.

But with having done nine months of 1 in 4 call and currently coming off a continuous 5 month block, I am tired. My life at home is disorganized with unfinished paperwork and dirty laundry piles. This blog has been in neglect. I have textbooks on my shelf that have gotten very little use this year.   It’s very easy to get caught up with your work life.

I remember reading Hot Lights, Cold Steel when I was in my 1st year of undergrad. In his book, Michael Collins describes how as an orthopedic resident he was working an upward of 80-100 hours of week to hone his craft. I remember I thought- “100 hours can’t be that bad, if given the chance, I’ll work as hard as I possibly can to make myself a great doctor.”

The truth is working 80 hours isn’t that hard. Working 90 hours or 100 hours isn’t that much harder too. The work itself is not the problem. The hardest part about working longs hours is the sacrifices you have to make with your limited time.

Out of the 168 hours of my week, approximately 60-90 hours are spent at the hospital each week. I spend about an hour commuting, and 1.5 hours for meals each day. I also sleep very little – averaging 5.5 hours a night/post-call which equals approximately 40 hours when rounded. On a busier week (80 hours) that would leave me with approximately 31 free hours in a week or about 5 hours each day.

The hard part about a resident’s life fitting the rest of your life into those 5 hours each day. You have to find time to do essential errands such as groceries, banking, shopping. You learn to make time for your significant other, family and friends. With what time you do have left, you try to read around your cases and improve your knowledge. If you’re not careful with your time, you personal life will come to a standstill.

Luckily, I have some time off before my PGY2 year starts to recharge a
nd refocus. It’s funny how our calendar year starts on July 1st, I don’t know of any other profession that follows a similar schedule. I’m hoping to revive this blog with a co-blogger and get around to outlining future posts. Finally, I’m going to sleep and get lots of it. I never appreciated continuous uninterrupted sleep as much as I do now.

June is always a good time to recharge yourself. A career in medicine can be long and arduous, but be glad there are breaks where you can reflect on what an amazing journey it’s been so far.

Supply and Demand

I just spent the last hour going through the 30+ applicant emails I received for my position of a coblogger. They were some of the hardest emails I have ever had to write.

In summary, there were many more qualified people than there were spots. Almost everyone was talented, ambitious and genuinely interested in helping others. I could see myself working well with many of them. I had to turn down many very qualified people. The decisions weren’t easy. I still have to select a final co-blogger out of the final few. It’s going to be a difficult choice.

I am humbled that so many talented individuals would want to work with me at creating content. I feel blessed and am grateful to my readers.

This whole process reminded me of medical school admissions, a game of supply and demand.

Every year, there are many more talented and caring applicants – many who would make fine physicians – than we have medical school spots. Many of these applicants end up pursuing their careers in the States or internationally (Ireland, Australia, Caribbean). It’s a real shame we can’t admit them all.

To everyone who may have recently been rejected from medical school, sometimes it’s not your fault. You did everything you could and the numbers just didn’t land in your favor.

I hope everyone I had to send a “rejection” email knows I feel the same way.

Note: The image is that of a Nuclear “MIBI” Scan used to assess the supply and demand of the heart

Residency Workload

Dr. Pauline Chen has written a great article on Workload for Doctors in Training, a topic I have been thinking about lately. From being feeling overworked to being on call by youself, it really makes you wonder if there is a better way to structure residency. The comments from the article are worth a read too as many residents, staff and the public weigh in on this heated topic.

Much of the recent kerfuffle arises from an article published in JAMA on Duty Hour Reforms. A lot of medical bloggers that I follow regularly have commented on it more elegantly than I can – Sims and Choppers, Precious Body Fluids, Med Rants.

In Canada, at least at my institution, we don’t have a 80 hour work week limitation. Our contracts states that call shifts are to be a max of 26 hours, though I have stayed longer many times post-call. We don’t have a night float system yet. There are still some vestiges of traditional work hours and I really don’t mind them. I guess I can consider myself lucky?

But based on my experience as a medical student and resident, I believe that work hours are not the main issue to be addressed. Medical errors are more likely to be made when processes are rushed and when you have to make clinical decisions for patients you are not familiar with. More handovers leads to more chances for errors to occur. Lack of supervision can be an issue too, as quoted from the NYT comments, “young docs left to make immediate decisions, only to be berated for their mistakes a day or two later when attending (supervisory) rounds were made. The mistakes, of course, were patient care.” Though for the most part newer attendings are more involved (JAMA article co-authored by Dr. Abraham Verghese) and I’ve had good experiences with academic staff.

How this all will play out – I’m not entirely clear and sure if it will benefit or disadvantage residents and patients. I think we will start having work hour restrictions here in Canada soon, some provinces have already adopted them.

To my regular readers – I am alive, eating, sleeping and getting by but not much more. I have not had time to write much. A string of multiple calls in a row can really be draining and can really sap all the remaining energy and motivation out of you. I”m on call five more times in the next two weeks… I can’t wait for the next block.

To those who applied to be a co-blogger, I haven’t forgotten. I’ve gotten a great response and getting back to everyone has taken longer than expected. I’ll try to finalize things by the end of April.

(Photo Cred: Ghz from Flickr)