The decision to move to a different country and work in a different medical system can be daunting. When one trains in a certain system, one is prepared for working within that system, often having mentors and a sophisticated understanding of what is expected of them. However, specialist training in the U.S. provides a multitude of benefits that help to reconcile the complications of moving out of one’s comfort zone.
By Molly Lewis
Whether you are a first year in Physical Diagnosis class, a second year in Continuity Clinic, a third year seeing consults, or an attending deciding if a patient needs emergency surgery, taking a complete history is a key aspect of patient care. How can you remember everything you need to ask? Try a mnemonic!
The evaluation of your study process should be continual throughout medical school. However, it is particularly important to fine-tune your study methods in the months leading up to your dedicated study period for Step 1. It is important to evaluate the things you’re doing well and the things you aren’t doing as well, so that you can maximize your efficiency with studying each subject. You’ll likely find that what works well for you in one subject does not work as well in other areas. There may be other aspects of your study process that change as time goes along, as well. This post will cover some of the stumbling blocks I ran across and the “executive decisions” I made to get around them.
You just started medical school and are beginning to get used to the routine of lectures, labs, studying, and taking tests. While this is quite nostalgic of your undergraduate days, medical school will certainly challenge you in different ways. To help you navigate the next four years, we’ve prepared an overview of what to expect and when to make those important decisions.
A 4-year-old boy is brought to the emergency department after being seen shaking on the floor. He had been playing with a video game when the episode began. He has no prior history of seizures or neurologic disorders. The episode resolved after 2 minutes.
>>>What is the most likely diagnosis for this patient?
>>>What is the most appropriate treatment for this condition?
>>>What are the side effects of the drugs associated with treatment?
>>>If the boy were in class answering a question and suddenly stopped for 30 seconds, then continued with his explanation, what would be the diagnosis and treatment?
>>>Which two commonly used seizure medications may cause Stevens-Johnson syndrome?
—click “more” for the answers—
Know the answers? Post them below! Don’t forget to check back tomorrow for an update with the correct answers and explanations.
A bright medical student is studying for the USMLE Step 1 in the library basement. Although he feels that he would much rather be enjoying the company of his friends who have decided to go to the beach that day, he knows that he has to finish his studying first. In order to empty the thoughts of the beach from his mind, he chooses to focus on his studying of behavioral sciences and smirks when he looks over the ego defenses.
>>>What two things qualify an ego defense as a reaction to psychological stress?
An ego defense must be automatic and unconscious.
>>>What are some examples of mature ego defenses?
Some mature ego defenses include Sublimation, Altruism, Suppression, and Humor. As a mnemonic, one can remember the phrase “Mature women wear a SASH.”
>>>What ego defense is this medical student using?
The medical student is using suppression. He is voluntarily withholding the idea of going to the beach from his conscious awareness by focusing on behavioral sciences. The difference between suppression and repression is that suppression is a voluntary process. It is therefore important to note that suppression is an exception to the rule that ego defenses must be unconscious.
>>>What are some examples of immature ego defenses?
Examples of immature ego defenses include acting out, denial, projection, reaction formation, regression, repression, and splitting, among others.
>>>What ego defense would the medical student be using if he could not handle the stress of studying for the examination and instead chose to go to the beach every day?
By involuntarily withholding the idea of taking the test as a reaction to his stress, the student would be exhibiting classic repression, the basic mechanism underlying all others.
This case study was contributed by Rakesh Razdan Ahuja, class of 2010, Yale University School of Medicine; in association with Le TT, Takiar V, eds: First Aid Cases for the USMLE Step 1. New York: McGraw-Hill, 2009.
This practice case study is representative of the studies available in the First Aid™ Cases for the USMLE Step 1. First Aid™ Cases for the USMLE Step 1 features 400 well-illustrated cases to help you relate basic science concepts to clinical situations. Each case includes drawings or clinical images with Q&As that reinforce key concepts. Get more Step 1 study help at USMLE-Rx.com.
In a post this past January, I highlighted some important reasons to use a question bank to study for Step 1 and gave my advice for selecting a question bank. I’ll include this advice again below; however, instead of talking about why you should choose a question bank, I’d like to briefly address the question of when you should start using one. Ideally, as you are proceeding through your preclinical classes, you will be using resources to cue you in as to which topics are important for Step 1 and, therefore, will make an effort to really learn these topics. Typically, 2nd year is the time you start focusing on systems pathophysiology.