Well, I've stirred up the hornet's nest, dear readers.
I'm answering questions over at reddit.com (hey, reddit!) for anybody who is interested in jumping in on the discussion. Apologies if the blog crashes, they're sending some pretty heavy traffic my way.
Happy 4th of July!
Every so often I dig into my treasure trove of things I need to write about. I actually wrote this draft 4 years ago, fresh into medical school, and finally decided that it's high time to help some bloodthirsty sycophants ingratiating suckups eager young premeds out. And so, without further ado, I present...
How to get into medical school... advice from someone who's done it.
Medical school is tough to get into - everyone knows that. One of the reason it's tough is that many people simply don't apply smart. They get mediocre grades in college, bomb their MCAT because they stayed up all night cramming for it, don't have anything interesting on their CV because they were too busy studying, and get a recommendation from a prof who teaches Intro Bio to 650 students. Sound familiar?
Lets start with the basics. These are the things you would hear from your premed advisor, if you had one. Not just because "that's the way it's done", but because each thing I'm about to talk about has a very specific purpose. There are huge books on this subject, but frankly, all you really need to know is crammed on this one page.
For the sake of argument, I'll be your admissions committee member for the next few minutes.
You need to do volunteer work. You need to do volunteer work. You need to do volunteer work. If you do not do volunteer work, you will never get into medical school. Ever. Don't do "volunteer work" with your doctor father at his plush plastic surgery practice. Dole out food at a soup kitchen somewhere and moonlight at a retirement home with batty old ladies. Or, even better, find a scribe position - this is what I did, and it puts you FRONT LINES with patient care. I firmly believe this is why I got into medical school.
Why are you doing this? Because it gives your application weight - you've dabbled in the morass that is modern medicine, and you still know you're interested. Perhaps more importantly, it tells me that there's a shred of human decency in you. A caveat to the "need to do volunteer work" rule: it doesn't have to be volunteer if you find something else medical-ish (want to be a pathologist? Work for the county coroner. Emergency minded? EMS/paramedic is always a great route. Cardiology? Do research with the local university).
Seriously. It cannot be emphasized enough how important experience is. The average age of matriculating medical students is 24. That means that MOST med students took time off, and MOST of them will have some sort of experience with the medical field. If you don't, I will wonder why on earth you're applying, and how you know you aren't going to lose interest. Because people do. And then they become washed-up asshole surgeons, only in it for the money. I'm not kidding.
Groovy personal statement
Aside from volunteer work (actions speak louder than words!) this is the most important thing you've got. Write your personal statement about something you find interesting, and read it like a bored admissions member. You need to be so convincing that I - as your admissions liason - cannot bear to live with myself if I do not accept you. I need to think to myself "Hey, this girl really sounds really interesting, and seems like she's got a good head on her shoulders. Plus, that anecdote about helping grandma find her dentures... oh man. Rolling on the floor with that one."
Along those lines, don't lie. Don't pretend like you found deeper meaning in emptying bedpans. I know you didn't. You know you didn't. When you write your whole personal statement about how awesome it was when ol' rheumy-eyed Agnes shat all over you while you were helping her to the toilet, I will roll my eyes, say "bullshit", and mentally cross you off my list. I'll also make fun of you when the committee meets. And the last thing you want is the admissions committee laughing at you.
Along these lines, remember one thing above all. You are not applying to a faceless institution. There is a person on the other end of that electronic application, and that person is me. If your personal statement is boring, I will not care if you get in. Your personal statement is the one part of this application that you have generated yourself. It is your voice. It is the explanation of WHY you are forcing me to spend 30 minutes reviewing a file with your name on it.
Here's where we start getting into the murky stuff. If you can get all A's, great. Assuming that you didn't (I didn't!), know that I care because good grades show that you can work within a system. Getting A's and B's means that you can handle whatever workload has been thrown at you in college. You can be the nicest person in the world, but if you aren't able to pass Anatomy, you can't graduate. At my med school we took 6 years worth of graduate-level coursework crammed into 2. This is why you need to be able to pass in college.
I don't mean that you need to get a 42. Don't go getting 12's and assume you'll get in, though. The beauty of the MCAT is that it's a standardized test. It's an objective way for me to tell how well your grade-inflated school (Harvard, I'm looking straight at you) has prepared you. Get a 45 and theoretically you can handle medical coursework. Your classmates will make fun of you for being a nerd, though. It's a tradeoff.
This is the least important thing you will submit. When I write you a rec, it will say "Premed undergrad blah blah blah has worked in my lab for blah blah blah and is a good student blah blah blah I like him blah blah blah". Everyone has nice recs. Yours don't mean anything special. Oh, and don't submit 10 letters. I will be required to read them all and will get PISSED at you.
How To Get Into Med School: The Conclusion
My parting words of wisdom are about the application itself. I know it's hard to do, but always keep in mind your audience. I try to do that every time I write something. In your case, your audience is me. You are trying to befriend me through the pages of your application, and convince me that you:
a) want to go to medical school
b) are smart enough to go to medical school
c) will be a doctor that I will want to work with - and can trust
d) are not going to lock yourself in the library and live next to Frankie the homeless guy for the next 4 years
You get one shot. Make sure everything fits together - if you mention you like to prepare sushi, put it in the personal statement. "When I'm not at the hospital, I come home and make sushi for my friends". Really? Well that's pretty cool. Sounds like you'd fit right in.
I'm not a statistician by any means, but I will say an example from High Yield Biostatistics by Dr. Glaser really caught my attention. This stuff is pretty confusing, so I'm going to simplify his numbers a bit further.
There was a study called WOSCOPS that treated obese men with statins. WOSCOPS was a huge study, involving 6,000 men for 5 years. 3,000 of them were given the statin, and 3,000 were given placebo.
Over the course of the study, about 75 men in the placebo group died from heart attacks, while only 50 died in the statin group. We calculate the mortality rates for each group as 50/3000 = 1.6%, and 75/3000 = 2.5%.
Calculating the relative risk reduction is easy:
1 - (risk in the population of interest / risk in the population as a whole)
1 - (1.6%/2.5%) = 33%
Therefore, the WOSCOPS study reported an incredible 33% reduction in cardiovascular mortality from statins. Amazing! Cardiologists everywhere rushed to put their patients on statins, right?
Not so fast.
The absolute risk reduction is calculated by subtracting the 2 percentages. 2.5% - 1.6% = 0.6%. We then calculate the number needed to treat as 1/ARR. This comes out to 166... which means we would have to give 166 men statins for 5 years to prevent one of them dying from a heart attack. This reflects the fact that the heart attacks happened at a relatively low frequency in the study.
Multiply 166 people x $100 a month (the cost of the statin) x 60 months in the study... and you get roughly $1,000,000.
It costs $1,000,000 to buy enough statins to save one life over a five year period. This is why healthcare costs so damn much.
Sorry for the absence†, I've been a bit more stressed out than usual. A few quick things:
General Antibiotics for the USMLE Step I
(Almost) Any Gram +: Penicillin
Respiratory Problems: Erythromycin
Big 3 Meningitis(es): 3G Ceph
G.E.T. & anaerobes: Metronidazole
Random stuff: TMP/SMX
___Worms: Mebendazole / Pyrantel Pamoate (round, hook, whip, pin)
Tapeworm: Albendazole (for cyst form only)
A few notes:
Penicillin for community acquired pneumococcus (gram+), 3G Ceph if nosocomial.
TMP/SMX is a random catch-all, including Nocardia (Gram+ but acts like a fungus).
Doxycycline can be used in renal patients, unlike Tetracycline.
1G Cephalosporins are often used pre-op in a surgery suite.
Ampicillin is most often used as prophylaxis before dental work in RHD.
Diethylcarbamazine works for Onchocerca too, but it itches like the dickens. Preferred Tx is ivermectin.
HLA Subtype mnemonics††
Di4b3tes (DR3, DR4)
Steroid Responsive Nephrotic S7ndrome (DR7)
Random side note: Type I diabetes is twice as likely to develop in infants who were not breastfed.
† treat with ethosuximide.
†† by the way, I apologize profusely to those of you readers who AREN'T taking the boards in a week. I'm sure this stuff is pretty obnoxious. It'll get more fun REAL soon, I promise. I start wards in June.
Interesting Fact #1
People suffering from Celiac Sprue used to be barred from the Catholic priesthood. Don't believe me? A priest taking communion is an integral part of Catholic mass - not only for their own salvation but for that of the congregation.
Unfortunately, since the communion wafer must be made from wheat (according to Roman Catholic doctrine), and there is no leeway for use of rice wafers, the Congregation barred people suffering from Celiac sprue from the priesthood, as they could not complete the sacrament. Luckily, through the miracles† of modern science, a new ultra-low-gluten wafer is available and the ban on Celiac Priests is lifted.
Interesting Fact #2
Ever wondered where the name Maalox came from? The most common antacids are made from Magnesium, Aluminum, or Calcium. Maalox is a combination of Magnesium Hydroxide and Aluminum HydrOxide. MaAlOx.
For all you USMLE studiers out there, this combination allows for regular bowel habits by combining the diarrhea-producing Magnesium antacids with the constipating Aluminum ones.
A few fracture types:
Greenstick Fracture: Similar in appearance to a green twig that has broken only halfway through and then splayed out. More common in kids.
Chalkstick Fracture: Looks like a piece of chalk snapped clean in half. More common in Paget's Disease of the bone.
Sorry it's short... I'm exhausted!
We were studying SBS today at our local pizza place, and the waitress figured that we needed a break from studying. After making sure that we wouldn't be offended, she told us the following joke:
What's the difference between Jesus and a pictures of Jesus?
Only takes one nail to hang a picture.
Most interesting thing I learned all day.
Best mnemonic I've heard yet (as long as we're still stereotyping): NAACP.
National Association for the Advancement of Colored People, you say? WRONG! NAACP actually stands for Neoplasia, Asthma, Allergy, Collagen Vascular Disease, and Parasites... all the things that cause "colored" cells to increase in number. Oh... by "colored", I mean "red". As in eosinophils.
And the award for Most Misplaced Section In First Aid (drumroll please!) goes to the section on Psammoma Bodies. If you thought you'd find it in endocrine (papillary CA of the thyroid), reproductive (serous cystadenoCA of the ovary), neuro (meningioma), or respiratory (mesothelioma), you'd be wrong. It's in hematology, on page 307. Why, I have no idea... psammoma bodies are a far cry from a blood-based disease.
Earlier on, when I was talking about my golden rules for SBS, I mentioned that you shouldn't stereotype... openly. The USMLE is your chance to practice. Nobody ever needs to know that the instant you see lawyer you immediately think scumbag who sleeps with prostitutes and therefore has gonorrhea, syphilis, chlamydia, and herpes. It'll stay our dirty little secret.
Stereotyping for the USMLE:
How To Discriminate Your Way To The Top
African Americans have sarcoid and sickle cell.
Africans have Burkitt's, malaria, sleeping sickness, or worse.
White kids have cystic fibrosis and can't dance.
Jewish girls have ulcerative colitis or crohn's.
Eastern Europeans have glycogen storage diseases (oy vey!).
Gorgeous Mediterranian men have beta thalassemia.
Japanese people have stomach cancer and ninja skills.
Peruvians have huge lungs, hypoxia, and polycythemia.
Native Americans are obese, have diabetes, high cholesterol, and gallstones.
Indians (from India) have TB and oral cancer from chewing Betel nuts .
Immigrants all have a disease that we can prevent with a vaccine.
Central Americans have Chagas and can dance the tango.
Mexican Kids have lead poisoning (lead-laced candy was a bad call, vatos).
French people - particularly from Paris, that dirty, dirty city - have toxoplasmosis.
Asians have alpha thalassemia, Takayasu Arteritis, and asian glow.
Americans are fat. Actually, thats just an observation of mine.
"Urban" patients present to the ER with knife wounds that conveniently test your knowledge of anatomy.
Lawyers have STD's (gotcha now, suckas!).
Dentists and aerospace workers have Berylliosis.
Explosives experts / Explosives plant workers get "monday morning headache".
Coal miners have CWP, TB, and Rheumatoid Arthritis.
Cave explorers have cryptococcus.
Sheepherders have echinococcus and a dog named Lassie.
Radiologists have any blood cancer but CLL.
Nurses and pharmacists have factitious disorder.
Football players, wrestlers, and weight lifters are taking anabolic steroids.
Young athletes have osteogenic sarcoma.
Kids (0-14) who are tired have ALL.
Young Adults (14-40) who are tired have AML.
Adults (40-60) who are tired have CML.
Elderly (60-?) who are tired have CLL.
Kids with Downs have a VSD, Hirschsprungs, ALL, and Alzheimers.
Transplant patients got CMV in addition to their shiny new organ.
Diabetics have life-threatening mucor infection. Every freakin' time.
HIV patients have toxoplasmosis, if it's a multiloculated brain cyst.
Moms who lose their first baby have type O blood.
Women are always pregnant. No matter how careful they were.
Alcoholics have HCC, B12 deficiency, Klebs pneumonia, and Wernicke-Korsikoff.
IV drug users have right sided endocarditis and multiple parietal strokes.
Smokers have both COPD and lung cancer (+ mets to the organ system in question).
Coke Addicts had an MI (don't smoke crack, kids!)
Travelers get giardiasis, amoebiasis, yellow fever, dengue, hepatitis.
Kids swimming in lakes get Naegleria Fowleri.
Kids playing in the sandbox have cutaneous or visceral larva migrans.
People who look tan either have skin cancer or hemochromatosis.
Patients with a swollen knee are female, young, hot, and caught gonorrhea from their last boyfriend.
Quinine: Stereoisomer of quinidine: antimalarial agent (Fun fact: also prevents shivering. Next time you're cold, drink a Gin & Tonic!)
Quinidine: Stereoisomer of quinine: class Ia antiarrhythmic.
How do you tell the difference? Easy: be an alcoholic. That way, you know that you always order your G&T with gen-u-ine quinine. Ooooh look! It rhymes!
Here's my personal favorite mnemonic, ever (and I am not, by any means, a mnemonic person). 100% of the credit goes to Peas:
The 5 Right to Left Shunts (The T's):
0: Total Anomalous Pulmonary Venous Return (0 connections back from the lung)
1: Truncus Arteriosus (1 big-ass trunk)
2: Transposition of the Great Vessels (2 switched vessels)
3: Tricuspid Atresia (3 fused leaflets in the tricuspid valve)
4: Tetralogy of Fallot (c'mon, you should know these 4 cold by this point)
Last one, then I'm done, I promise. It's HARD to have Cardiomyopathy:
Hypertrophic: Basketball players who drop dead during a game.
Arrythmogenic: Right Ventricular Dysplasia. Thin-walled right ventricle.
Restrictive: sarcoid, amyloid, radiation, endocardial fibrosis (high eosinophil count for >6 months), hemochromatosis.
Dilated: Most common. The ABCCDs - Alcohol, Beriberi, Cocaine (don't smoke crack, kids!), Chagas, Doxorubicin.
First Aid Mnemonic That Sucked The Hardest Today: REd = REperfusion. Guys... this is like, the most basic of all pathology concepts. I believe I can safely say that this is not mnemonic-able (braces for hate mail).
I should mention that I always write in pencil in my book, unless I'm crossing out stupid mnemonics. That's done in black pen... with a vengeance.