Saturday, June 6, 2015

How much do you study what you're pretty sure you already know?

ultra-realistic synthetic organs, so that students can learn without killing anyone; we'll use those more next year

If you are I, the answer is "quite a lot."  My philosophy for learning, whether it concerned academic skills or those of a more physical nature, i.e. athletics, or even those of a combined nature, such as the playing of a musical instrument, was to over-learn almost to a point where it would be considered by an ordinary person to be silly.

While this may seem like nothing more than OCD behavior, there is actually a method behind it beyond the basic obsessive-compulsive traits possessed by most high-achieving students.  One never knows when one will be stricken with a dreaded stomach bug, an actual influenza virus, or an injury -- something powerful enough to pose a significant negative impact upon one's ability to demonstrate what he or she knows on either a paper-to-pen(cil or practical exam. For example, in my next-to-last year of undergrad school, just over a week before my juries, which are praxtical tests of skills on one's instrument as well as playing of pre-recital musical works to be performed before a faculty panel, (almost a form of a pre-recital) i developed an autoimmune condition known as myositosis.  With the number of doctors to whom I'm related and with the legitimacy of the illness itself, it would seem that a note from a doctor -- and it would have been easy enough to procure said note from one of the doctors who provided my care without even calling upon any relatives -- would have been more than enough to delay the juries until a time at which I was more  able to perform at an optimal level.

That's where the principle of overlearning  comes into play. The idea is that  learns to play a piece of music (the scales where never any big deal to me; I'd been playing them in all forms since i was three years old) so whell that nothing short of broken bones in one's upper extremities would keep one from performing the skills and music adequately. Facu;ty members have been known either not to honor notes excusing students from exams of sorts or to be adversely influenced by the written excusals. Who needs that sort of prejudice working against oneself? Sometimes it's best to get the job done with or without nan illness or injury, I took finals shortly after a spleen and gall-bladder removal for the same reasons. i didn't want the prospect of having to take them hanging over my head and ruining my winter break. it wa best just ton tske them at the assigned time (although i took them at an alternate location for several reasons, which didn't seem to bother any of my pros; they were just happy not to have a grade-holdout messing with their ability to complete a quarter's paperwork.

It would seem that I've essentially used up just about all the minor  bad luck ***  a person would ever need and that not too many disasters or near-disasters loo in my future. One can never be certain, however, so the principle of overlearning still applies. judge alex's family has been recently  stricken with a nasty stomach virus. They're on the east coast while I'm on the west coast, but i'm sure that same virus and its variants exists in a more or less continuous strand between California and Florida. I've had a relatively recent digestive bug myself, but this, unfair as it would seem, does not exempt me from the next one that comes along.

Were that to happen, i would be able to take my exam in a hallway or even outside (we're essentially on the honor system here, though the proctors pay at least a bit of attention to any obvious attempts to cheat) with a trash can nearby for convenience, but i would need to know the material all the better in order to come up with correct and cohesive-sounding answers between episodes of tossing cookies into a trash can. 
the principle of overlearning is most helpful in such instances. 

The toughest exam we'll all be facing should be our cardiology/pulmonary medicine exam. Because everything that happens in the body is either controlled by the heart and lungs  or so directly impacts the heart and lungs, knoweldge about the systems is absolutely critical. An inability to breathe, the cessation of heartbeat, or loss of blood will be the direct cause of the vast, vast majority of deaths any of us will ever see, but particularly in the E.R. Any of a great many other primary causes may very well leaed to know a great deal about it. d to the aforementioned circumstances, but what it's going to come down to is that the person's heart is going to stop beating and refuse to start again, the person is not going to be able to breathe any longer on his or her own other organs, or the person is going to bleed out.  Understanding both the basics of these elements and, ultimately, the conditions leading up to them, is what will allow us to save lives or keep us from doing so. It's complicated while at the same time being very simple.  Because the conditions leading to a breakdown in the lungs, heart, or other portions of the circulatory system are numerous, and because we're mere first year med students, we aren't yet expected to know everything there is to know about what in relation to these systems leads to serious illness or to death. We are expect to know a great deal about it, though.

Some of the specifics related to other systems and organs - the liver, the pancreas,even the brain, how cancer impacts whatever organ or system of the body that it invades, while it has been covered to some degree, largely waits for next year. for this year's primary exam, we'll need to know primarily everything a person can knw about basic heart, lung, and circulatory function as it affects everything else. Any one of us can -- and probably will -- have a few glitches in memory, we cannot have many and expect to be invited back for a second year with the program.  

Again, overlearning applies here.  One must know the basic facts so well that no level of crisis will cause a level ofpanic that will cause him or her to forget what he has learned. Some students are enamoured of the excuse "I'm a poor test-taker."  It really doesn't apply. Either a person knows the material on which he or she will be tested or a person does not know the material.  a person who is a "poor test taker" will likely be a poor performer in the E.R. or O. R. as well. All practice of medicine really consists of is one giant test - albeit of a practical nature -- thrown at a person in real-life situations. The person who couldn't produce the answers for the test probably won't recall the pertinent facts on the E.R. exam room or on the O. R. table, either. 

Fortunately, not all of the practice of medicine will take place in crisis mode. Often there will be time to pause and resonsider one's answers to questions. Furhtermore, doctors are not expected to be walking encyclopedias of medical knowledge of dignositc procedures and cures. books always existed, which could be consulted. The age of information has provided for doctors even quicker an more portable access to information wit the development of various forms of computers. inmost instances, such sources can be consulted. Furthermore, colleagues exist for that same purpose; in most cases, time will allow for  consultation.
ee throws?
Times will arise, however, whe a doctor has to know on the spot what is the best course of action. Chances are, these will be high-stress times. Learning material so well that a person can answer pertinent questions in his sleep will greatly increase the odds that the same person can produce the correct information in a high-anxiety environment, ideally in such a manner that he or she is not adding to the anxiety of everyone around him or her, thereby doing little to improve the patient's chances.

Why does a basketball player --  even a professional, who has probably been at it since he or she was a small child -- continue to practice free throws?  Wouldn't one think that a twenty-seven-year-old world-class athlete should have by that point in his or her athletic career mastered the smiple art of a free throw? A free throw is the same distance every time one attempts it. The ball is the same size and weight (the ball size will have  changed as the player grew and developed, but by the time he or she has reached the professional ranks, It's essentially the same ball every time. Even wind or weather really isn't a factor.  Many other aspects of shooting a basketball can deviate widely depending upon hosts of factors, including but not limited to the precise location from where a player shoots, whether he or she  is stationary or on the move, how much time he or she has to set up for the shot,  who or how many people  -- or the skill of said people -- are guarding him. There are  really too many factors to detail here. So, when there are so many incredibly complex components of basketball on which to focus, why does a professional athlete continue to practice free throws after so many years?  I'm oversimplifying matters, but it's largely that same principal of overlearning in effect.  The player, in his mind, may be trying  to simulate the conditions of pressure he or she may experience in an actual game -- particularly situations in which the outcome of a game is on the line as a result of the success or failure of the free throw. He may even be alering his technique ever so slightly after so many years, though this would seem unlikely. The bottom line is that the free throw is one of the few given eventualities  in a basketball game. And despite the sameness of it in each situation, its success is far from a guarantee.  so if one knows a particular circumstance  is going to happen in a basketball game, it would only make sense to prepare -- even to overprpare -- for the eventuality.
We're doing the same thing with our study of cardiovascular, circulatory, and pulmonary  conditions of medicine. Throughout our respective careers, we're going to be faced with medical conditions related -- either directly, or indirectly -- to heart, lungs, and circulation, because basically  everything in medicine ultimately boils down to one of these three things.

Our "Practice of Medicine" exams will consist both of practical and pen-to-paper assessments.  a heavy percentage of these exams will involve the basics of diagnostics, relating primarily to ordering the correct diagnostic procedures. some of our evaluation will be based upon decisions made based on the results of the diagnostic procedures, but we're still focusing heavily upon requesting the correct procedures. Some will fail this because they'll try to cover themselves by ordering every test under the sun in the hope that at least one or rtwo of the tests was the right one. This strategy will not succeed for a panaorama of reasons. Primarily, both time and money are of the essence here. precious time cannot be wasted with unnecessary procedures when a patient's life is on the line. more importantly, whether or not it should be more importasnt, cost is a factor.  someone has to pay for these diagnostic procedures. the biggies - CTs and MRIs in particular, are astronomically expensive procedures. insurance carriers balk at paying for them when they are necessary, much less when they are frivolous. Not all patients have insurance. Public insurance (Medi-Cal, Healthy Families, whatever any given state's equivalent is) do not usually cover the entire cost of the procedure. (The cost is passed along to the hospital rather thsn to the patient) in most instances of public insurance when procedures are not covered in full. 

It's a balance that must be struck. Most lab procedures won't be questioned by our evaluators, although if they have re we're ordering random tests just to make sure we include the right one by chance, that will be judged harshly. the major factor of pass/fail in our pass/fail grading system -- both on the pencil-to-paper tests as well as on the practical exams -- will be in achieving the balance where expensive radiologic procedures are concerned.  One important facotr here is not to forget the old-fashioned ultrasound. it's less expensive, less invasive, and exposes the patient to less radiation.  If there's time and if there's a reasonable chance that an ultrasound may reveal or rule out something, The profs are going ot be favorably impressed by students' remembering to utilize it before resorting to the more expensive and invasive radiological or even surgical procedures. Nonetheless, the ultimate mistake at least one of us is going to make is to let a "patient" die on a gurney or in a hospital bed when a CT with contrast would have diagnosed ischemic colitis.

We're fortunate that for the moment, our "patients" exist only on paper or in the form of actors from the Berkeley Repertory Theatre. Such will not always be the case, though. Next year, we'll be making some rounds with "real" patients and sitting in on actual procedures, though no decision-making powers will yet be ours, nor will we actually perform any of the procedures ourselves, as is as it should be. No patient  in the U.S., where we have the resources to control such things,  should die because he had the misfortune of having his colon scoped by a second-year medical student.

I've studied all night. It is time for a nap, which will be followed by more studying.


  1. I share your philosophy. I read all day. Every day. I bought a high school chemistry text book so that I can brush up on my skills before taking actual chemistry in the spring. I also emailed one of the professors to ask if there was anything that I could do to prepare myself prior to classes. I think for me (and maybe for you too), not feeling secure in the information leads to anxiety. There is comfort in familiarity and repetition. As long as you leave the anxiety out of the test room you're golden. There's a saying ... I am not sure what it is verbatim, however it states "whether you think you can or you can't, you're right." If studying and looking over material makes you feel comfortable and relaxed for the test, I say go for it.

    1. I agree. And this, too, shall pass.

  2. Correct me if I am wrong but you can say that the heart and lungs are best friends. The heart pumps blood to all the cells in the body. The purpose of the blood is to bring nutrients to the cells and to bring waste products away from the cells. Although most of the blood that goes to the cells comes back to the heart as lymph fluid.

    This is not the case with the lungs. The heart pumps the blood to the lungs first so it can be oxygenated. Then that oxygenated blood goes back to the heart to be pumped to the rest of the body. This is because the most important nutrient in the blood is the oxygen. So the heart gets the most oxygenated blood first before it gets pumped elsewhere.

    When people do exercise, their heart rate increases to pump the blood around the body faster. Also to keep up with this faster circulation of blood, the lungs need to breathe at a faster rate. When people do cardio exercise, it causes their left ventricle (over time) to get bigger so the heart can pump more blood with each beat. When people do resistance training, like weight lifting, it causes the heart muscles to get bigger and stronger (over time) since it is pumping against more resistance.

    One main thing that makes bones stronger is weight bearing exercise. So when a fat person walks, it is more weight bearing than when a thin person walks. But the most weight bearing exercise that exists is weight lifting. So that is the best exercise to make your bones stronger.

  3. I promoted this blog on a Google+ page called Promote Your Blog. I said on it about you "She is a great and passionate writer."

    I already have a first cousin that is an M.D. (Hazel Bluestein). Today a second cousin of mine graduated and became a D.O. (Doctor of Osteopathy). She has a husband that is a lawyer.