Second year is hard || CRS || SGU Term 4
Life:
Mental health
Kal’s first puppicino!
This module was the toughest for me so far. I felt so overwhelmed! I started studying at 9AM and would study until 10-11PM. So long all that balance stuff I was trying to institute went right out the window. In the end, I felt like I knew nothing and my body felt like it was breaking apart. My hair fell out, treatment-resistant acne, GI problems, constant migraines, and panic attacks - wow! Beware those coming this way, it’s a toughie.
Trying new things: camping edition
After CRS, Kalbi and I went tent camping for the first time at Idyllwild campground. It was amazing to just sit and watch the campfire crackle with literally nothing on my mind. On the other hand, being my first time I was so ill-prepared. The blow-up sleeping pad was thinner than my CRS notes and it was cold as heck. I couldn’t feel my toes for 2 days after returning.
Whole 30
Tail end of last year, I felt like I lost my own health. After years of forcing a regimen of exercise and diet, that too went out the window when I got stressed. I really wanted to dedicated year 2 to myself especially since I knew it could destroy me. I’ve been eating according to the “whole 30” guidelines to see if any of my GI problems are related to any specific food. Not surprisingly the painful bloating and well as some weight have left me! It’s much harder to prepare wholesome foods, but 14 days in it’s still worth it.
Term 4 CRS:
Cardiovascular and Renal Systems (CRS) was painful. I mean I know I’m mid-T4, but I already want to award it the worst module ever. The content requires you to remember and understand everything from CPR very well! I know I didn’t. Maybe I should’ve reviewed normal physiology and anatomy the first week.
CRS Pace
The first week of every module always gives me false self-confidence, but it did feel like waiting to get punched in the face by an invisible man. I knew it was coming, but when it would land…would be the diuretics lectures.
I see my small group more than my family
I’m lucky that my small group members are very chill and supportive because I see them every day (practically). I can’t believe there’s an expectation to prep for pharm, path, patient interviews every day while learning the most difficult concepts so far. I do actually appreciate the pathology small groups because my classmates are great teachers and highlight what I need to know because histology often takes a back seat.
Patient care on zoom: 10 people listened to me talk for 5 minutes at the speed for light for the soap exam
The strangeness of interviewing a fake patient with a terrible internet connection while 10 people watch always surprises me, but I hope it gets more comfortable. I always hated how growing up my physicians only spent 10 minutes with me while reading off their checklists. But here I am, losing the humanity of talking to someone as a person. Trying to squeeze information out of them like they’re purposely holding information from me within 8 minutes. It’s impossible to get someone’s life story and what brought them to you in less than 10 minutes.
Anyways, the SOAP assessments are a strange thing online. The procedure to take the test is anxiety-producing in itself. The facilitator asks you to show your ears, your forearms, the whole room around you, under your tests, the two pieces of paper you’re allowed to have. Someone else in my group and I had an external monitor on the desk. They wanted us to push it as far away as possible. Meanwhile, everyone is just waiting on us.
Basically, one person interviews the patient, and someone else (me this time) dictates the technique of the physical exam all in 15 minutes. We discuss our differentials based on the interview and exam. Then someone returns to the patient and explains what we believe is wrong and what our plan will be. Then we get 10 minutes to type up the SOAP note. No templates nothing, just finger cramps. I’m so lucky that I worked as a scribe, the 10 minutes fly by.
CRS Content & Outside Resources
The amount of content is overwhelming. Then add in the number of small groups. The 3-hour IMCQ right before the test. I can’t forget about the 100-page lecture with a 20-page companion less than a week before the test. I tried to follow Firehouse Prep’s schedule, but about 2 weeks in I did a modified version. I just can’t find the time to rewatch Sketchy!
By the end of the module, I stopped listening to lectures and only watched Pathoma and Sketchy. I added in some Ninja Nerds, Boards & Beyond, and physeo when I needed a little more TLC. Sketchy saved me! Especially since the Zanki cards line up very nicely with it. Sketchy Path was a little weak for me in some of the cardio topics, however, I’m so grateful to have used sketchy. The premade M1M2 deck has all the Sketchy worked into it.
My guess is that I was underutilizing Anki this whole time! After searching the whole M1M2 deck for cards when I saw the SGU ones were sparse, there was an overwhelming number of cards waiting to be reviewed. Sheesh.
A notable mention is USMLE-rx. I had bought a package during Black Friday without knowing that SGU will give us USMLE-rx in Term 5. I was only using it for Flash Facts, but their Express Videos and workbook pages were so helpful! I wish I utilized them earlier. This is also a wonderful resource to help integrate First Aid.
How I set up my notes in notability
How i changed my note-taking
I officially stopped writing my own notes in CRS for time’s sake. That seems to be the theme of Term 4, not enough time. I made a folder called “CRS Goodies” where I put summary charts and student notes. I would have one note per system and subject like “MICRO - Cardio” and “ MICRO - Renal”. This felt more efficient because I wouldn’t have to look through each lecture to find things. I would annotate these pre-made materials with things I picked up in Pathoma, my sketchy pictures, and B&B. Honestly, it was difficult to pull away from writing my own notes. I was nervous that I wouldn’t retain anything because notes have been my way of slowing down to get to know the material. However, it freed up so much more time to do the scary amount of Anki cards I had to do. I actually ended up retaining more information since I had more time for Anki, practice questions, and workbooks.
Pathology
Micro, pharm, and path were constantly running each over. I think there were 2 or 3 days where the second lecture was the same topic as the first lecture. It was “same same but different”. Not similar enough to check out, but similar enough that you wanted to. It felt so chaotic. The topics from CRS last year seemed to be 10-second flybys.
For example, endocarditis. We learned about what that was back in CRS last year, but now we’re to know is it acute? Subacute? What predisposing factors cause it? (For micro, when you hear those factors like prosthetic valve or history of cardiac abnormality you have to think of certain bugs). What is pathogenesis? What does it look like, grossly and on histology? How does it present? How to diagnose? How to treat?
Okay, it was a lot to just type that. But that is basically everything we needed to put in our brains for each concept. Listening in pathology small groups was actually very helpful. I would have flashbacks to that person’s presentation during the exam.
Strategy
I’m so thankful for Stella Yun’s golden notes. I would combine her pathology notes into one document so I’d have one document to come back to for the whole lecture for Cardio path. I did the same thing for Renal Path.
So first I would read over her notes for the day’s lecture. Then would watch Pathoma and if there’s time Sketchy Path. While I watched the videos, I would annotate her notes and add any Sketchy notes.
This helped me check if I was on par with the SGU lectures. I felt the way information was presented in class was confusing especially when there was a hand-offs between path and micro. Pathoma keeps everything structured, simple, and high-yield. Sketchy path would reinforce the information and give me memory hooks to latch onto.
My Micro Notes
Micro: like path but not
Pathology will tell you the disease mechanism. In theory, micro would pick up and describe the etiology. Overall, it just felt chaotic. However, there are 2 micro professors who were my absolute favorites. They made charts and bolded high-yield things that you could trust. Amazing. Micro CRS was not as overwhelming as FTMC.
Strategy for micro
I couldn’t find micro charts like for the other modules. I tried to make time to make my own charts, but they ended up looking and feeling too shotgunned. I used Stella’s micro notes again and annotated them with Sketchy micro. I don’t think I could memorize any micro without Sketchy.
Learning to think like a test-writer really came into play here. The questions in Term 4 are no longer straightforward toss and retrieve. It took me a long time to realize that questions will be written to point you to a certain answer. Sounds simple, but when drowning in all the content they throw it can be tempting to just try and catch everything. For micro, I found it most helpful to see the most defining aspects of a bug. There’s a cleaner version of this chart in First aid, but writing this out helped me see the defining characteristics and the situations where you’d be looking at a certain bug. Like IV drug use + endocarditis, jump on Staph Aureus!
Another helpful cumulative video I watched after learning about all the bugs was CK med’s micro vids, very helpful from a past SGU student!
Ninja on Fleek Pharm Charts
Pharm
I look back at Year 1 vignettes with envy. Out of nowhere, the buzzwords can no longer carry me all the way to the correct answer. They can get you part of the way, but know the patients have multiple diseases taking multiple medications (like real life). I had to tease out the specific adverse effect, mechanism of action, or interaction they’re asking for. It’s a huge jump compared to anything else asked in the past.
Strategy for pharm
There are a lot of cardiorenal drugs. They come at you at lightspeed.
For information input, Sketchy Pharm really holds it down. I used the “Ninja on Fleek” pharm charts to annotate and store my sketchy pictures.
I didn’t know how to approach pharm at first because well these drugs do the same things. Like micro, it’s best to key into the unique situations that call for a certain drug. That will usually get you part of the way there, but questions often ask you to get there and then remember adverse effects, or contraindications, or mechanisms of action.
As far as making sure the information stays in your brain, Sketchy + M1M2 Anki deck helped so much with seeing the information at a regular interval. Practice questions are given by the school and other question banks like USMLE-Rx and Kaplan helped me run into all the situations that might clue me into a certain drug.
The exam
I’m writing this the day before the exam because I had to submit for a completion (make-up exam) which I will complete the week after our final exam in June. From what I heard, it was the most difficult exam in our class cohort history and the curve reflected that.
What would I do differently?
I would have given up lectures earlier. They just were not working for me and I spent sooo many hours trying to understand the content using outside resources.
Get some charts! For drugs, for path. Having the layout of what’s to learn might have helped me keep that bigger picture in mind because the organization was not A1
The best time to learn things is right now. I know I used to allow post-reads to naturally beat information into my brain, but there really is no time to wait for the next day. If I could, I would have been more proactive about learning things the day we covered them.
Nutrition Medicine Club & Extracurriculars
I really didn’t have time for any extracurriculars. I know this isn’t the case for everyone. My PLG partner is a rockstar and was able to crank some reviews out. However, for me, I couldn’t handle it. My advice would be to give yourself some more patience than usual. This module is 11/11 tough!
Okay onto Respiratory & Hematology/Oncology!