Making sense of what doesn’t || DERS || SGU Term 4
Adding our Bernedoodle, Mochacinno, to our family <3
Life:
Adding to the family
About a week before my finals, we found our Mochaccino! He was only 11 weeks old when we adopted him and we’ve fallen in love with him. But, that doesn’t change how hard it is to raise a puppy. 6 years ago I adopted Kalbi and it seems like in those 6 years I forgot all the work that goes into this kind of love. It feels like a preview into parenthood. We’re waking up at 6AM, hand feed him every meal so we can train him, and have our eye on him 24/7. Oh and we have to replace our white rug. It’s been both a huge change and a huge love added to my life.
Rennovating our front yard
One day a landscaper knocked on our door and offered to take care of our front yard shrubs. We had been debating hiring someone to remove them for some time. We ended up removing them and so we had to design our front yard. We dug out 2-3 inches all around our front yard and added those rocks wheelbarrow by wheelbarrow. I can’t believe how much I love transforming our house. Also, our first avocado got burned by that 100F+ weather, so that’s our replacement standing by the door. I’m too scared to put it in the sun.
Health Coaching
I’m about 3 months into the ADAPT health coach course. I can’t believe how much I’m learning about myself. Both in health coaching and in medical school, there’s practice conversations. My experience is making me wonder, do I have a tendency to speak at people? Am I wrong for the grab for empathy points? We don’t really learn about nutrition, vitamins, diet, and motivational interviewing/helping, but feels like untapped value for real patients.
Taking Breaks
Term 3/4 is just too long. It’s 6 weeks + 18 weeks. Normal terms are 16 weeks. I read some advice that you should make break time to go home or rest somewhere in Term 4. I thought that was wild, but it’s truly needed at least for me. I went home to Northern California to spend time with my family for about 4 days. I did some anki, but mostly checked out. It’s always nice to root myself when I feel like I’m flying away.
Term 4 DERS:
Okay it’s onto the good stuff. The last module of Term 4! What’s sadistic about this module is that it’s long (~5-6 weeks) and it’s three systems (Digestion, Endocrine, Reproductive) compared to the usual two. Midway through the module, we had a multiple-choice PE assessment which started off the flurry of tests. Then we ended with the OCEX and DERS exam and for me the CRS completion exam.
DERS in general
So by the time we arrived on the DERS doorstep, as a collective we were exhausted. We saw the term behind us finish up their Term 2 and we finished days before they came back for Term 3. It was by far the worst exam score I had and I’m not surprised because I was dwindling by the end.
The small groups don’t stop, won’t stop until I hit that 80%
I read a bunch of advice before taking on T4. In addition to advice to go home and relax somewhere in the term, the advice to save all the attendance misses to use at the end in case something happens is gold. In no way am I encouraging missing class, but I remember the day I could stop attending small groups and lectures. It was bliss to focus on studying because I was so overwhelmed.
Lectures aren’t working for me anymore.
I’ve spent way too much money on outside resources. I learned everything from Pathoma, sketchy, some Osmosis, and used Kaplan, USMLErx, Amboss qbanks. Now writing this, I know I went overboard. I’ll write my resource reviews below. A word of caution, resource dilution is real! Having too many resources to consult is just as unhelpful as having none because time is such a limiting factor in Term 4.
Schedule
My schedule was pretty consistent with the image above. Even better once I could dedicate all my time to studying. In summary, my study system was to spend 1 hour per lecture of watching the associated pathoma or sketchy and annotating premade charts or Stella Yun’s amazing note summaries. No more personal notes! It was the sacrifice I was willing to make to gain more time for anki/qbanks/workbooks. I’d spend 30 minutes - 1 hour prepping for small group, then 15 minutes of pre-read. Pre-read being collecting all the topics and finding the associated videos for the next day. I use “Todoist” so I would put all these tasks in this app to check track. The rest of the day would be dedicated to Anki > Qbanks > ITI stop points > Workbooks.
Stella Yun’s AMAZING notes, I owe her big time
DERS Content
So Digestion Endocrine Reproductive - it follows pretty well with Pathoma and sketchy until Reproductive specifically pharm. What I started doing differently which helped enormously is reviewing normal physiology once we start a new system. For example, watching a quick video from USMLE-rx or osmosis for ~10 minutes reminds me of what I learned last year. There’s an expectation that you’ve mastered and remembered (not me) exactly what we learned last year and can use it for path and pharm mind tricks.
Path:
My process was to listen to the pathoma associated with the lecture of the day. Then annotate Sketchy while I was watching the video(s). Last, I would move all the tagged anki cards to a subdeck for the day to review. I would review the anki cards the day of, compared to last year when I would review with a day delay. There’s just no time in Term 4. I would move these back to the associated week subdeck after I finished them.
Pharm & Micro:
Sketchy saved my life with this one. I would annotate the picture of the sketchy pictures in my notes. Then I would read over the lecture notes that are associated with the slides and annotate the premade chart. Like path, I’d add over the anki cards from the Zanki deck.
The Exams
PE Assessment
This exam is a multiple-choice exam based on PE procedures. Luckily, there’s no need for diagnosis or deducing what’s going on. It’s purely on the procedures. The timing is weirdly thrown in 3 weeks into DERS. The schedule was impressively nonchalant. We had 2 hours of IMCQ starting at 8:30 am, then a 10-minute break before jumped right into the PE Assessment Exam. Following that, 2 hours of lecture. It was incredibly difficult to find time to prep for this, especially since there are so many PEs we learned this term.
I started studying 2 days before the exam but would have benefited from a couple more days of prep. I’m so grateful that our classmates made a review PPT, basically like a workbook to run through all the procedures. In addition to doing those questions, I would read the procedures and test myself by writing them down without looking at the rubric. I was hoping this extensive work would pay forward for the OCEX. Also grateful in retrospect, that I ended up doing 3 of the PEs during our clinical small groups.
OCEX
My stress for the OCEX was out of proportion to what it was worth (40 points). I took so much time to make differentials and test myself on the PE procedures that I could recite and how fast I could read them. My exam was Sunday 8AM, but testing started on Friday and ended the following Sunday.
My experience started out very tense. Since we’re remote, our facilitators had us spin around our laptop to capture all our surroundings. We had to show our ears and forearms, under our seats, under our desks. If that was not anxiety building enough, my first facilitator had a problem that my computer monitor was on my desk. No one had mentioned it to me prior because it’s a screen without a computer and turned to the side. It has been zip-tied in place so it was impossible to move. Gratefully, he let it go and told me to calm down. The patients were so kind and we’re not at all like the difficult patients module we had. The grading was also kind because I know the first patient didn’t have the diagnosis I came up with, but I was so nervous that my brain cells left me.
If you have Amboss, they have an awesome video resource of all the PE procedures but also have mock cases that you can use with someone else. I had my boyfriend read the script while I timed our encounter. It was really helpful to run through it a couple times.
DERS Outside Resources
Amboss (+osmosis)
Pros
Fast wiki to look up things I don’t know
Qbank is great because explanations link straight to the subject and also has osmosis prime videos (not sure if all the osmosis tho)
You can do questions from a specific topic like “colon cancer” but in other qbanks you can only do “GI path”
Who’s it for: You want a detailed qbank with wiki-style notes to reference
USMLE-rx
*disclaimer: I bought this as a black Friday deal before I knew SGU will give us a version of it
Pros
Videos: efficient short vids focused on summarizing and high yield stuff with a bit of humor (i dig it)
Flash facts: Flashcards
Bricks: i love the bricks! Which are basically like a compact summary of a topic like “Acute Renal Injury”. They’re easy reads and feel more accessible than lecture slides because of the organization. Also at the end of the brick or video, there are links to the other resources connected to the topic.
Workbook: omg as a child who grew up in the workbook era where my parents gave me workbooks to go through during summer, I really responded well to these fill in the blank workbooks provided
Directly referenced to First Aid, allowed me to explore first aid efficiently
Qbank: Decent? I get too many wrong in all the qbanks to rate the difficulty and likeliness to NBME.
Kaplan Qbank
I don’t know why I feel some kind of scarcity mindset, but I felt like I didn’t want to complete my Amboss or USMLE qbank and since SGU has a discount with kaplan, I bought this one.
The interface isn’t the best compared to the other two and the ability to pick out certain topics isn’t there, but a pretty recent bank to get used to Step style questions.
Sketchy
In my eyes, this is a necessity. I used and loved Sketchy micro, pharm, and path. I would transfer all the sketchy-tagged cards for a certain topic and go over them the day they were introduced. Adding that to watching it a second time helped me consolidate it. However, reproductive pharm is not it or not even there but physeo and pixorize do have videos for this topic.
Pathoma
Also a necessity, the way he teaches path is just so organized and concise. Simple as that.
What would I do differently
I loved my end-of-term routine. It was way more useful to dedicate more time to consolidating information than learning it.
DERS is so long, it felt like digestive content was the last module so I wish I had implemented it more strongly throughout the module.
Lastly, I found the ITI stop points about two weeks before the end of the module and it was so helpful to use as a workbook to test what information I had retained
Okay the beast of Term 4 is dead. See you in my last pre-clinical term y’all!