Fifth and Sixth Terms

This is a good term.  Everything is simpler: smaller campus, two places to eat (it seems every island has its version of “The Ladies”), one lecture hall.  The seats are more comfortable but it is harder to nap in them.  The library is very small and if you made use of the one in Grenada, then you are about to appreciate what a fantastic facility that was all along.  The technology here is a better with every single lecture available online with audio synched to the slide progression.  If you regularly miss the lectures (8am to noon, everyday) they will save you.  Some lectures stick to the notes, some wander around, but it has always been that way.  This is the end of second year, you are all seasoned medical students, and nothing is going to surprise you.  Congratulations, you are almost done.

            Some caveats.  This really is a harder term.  Whereas in Path you might cover two full topics in three weeks, you will now cover three whole topics in two weeks.  Twice a week you will spend three hours downtown in a hospital, once a week you will have a Pharmacology small group for an hour, and once every other week you will have a three hour Clinical Skills session.  You had things eating up your afternoons in Fourth term, but not in the same way.  Whereas before you were getting constant review of the material in Path Lab, now it is simply less time all around.  To fit all of the material into the term, things get much tighter.  You will not have a “grace week” in Path leading up to an exam the next Monday.  You will not have an easy week leading up to the Micro test that same Friday.  You will not have any ‘review’ days at all, and the term can feel relentless.  Relax with a sailing trip. 

PATHOPHYSIOLOGY (14cr)

            Boy, are you in for a treat.  This course covers twenty-seven different lecture topics ranging from Cardiology to Urology, comprising 14 credits for 223 hours of lecture.  Fun stuff.  The great thing is that this course is taught by specialists: a radiologist with lecture about radiology, a surgeon about surgery, and so on.  There are three exams, each worth the same amount, but the last exam covers much less material (so there is a chance to finish strong).  Pathophys is not Path or Phys.  In Path, everything that was going to go wrong pretty much did and you were left to memorize buzzwords.  In Physiology, you were an idiot trying to understand the magic of breathing.  PathoPhys is much more clinical and could have been named “What do you do with a patient’s chart?”  In other words, if you learned Path and Phys, we can assume you know a lot already and can skip the easy stuff.  You will be given stacks of notes for Renal, Cardio, etc.  There is no need to buy a surgery textbook for the surgery lectures, or the Atlas of Diagnostic Imaging for the radiology lectures, and so on.  I recommend…

First Aid for the USMLE.  The new version is organ-based as opposed to systems-based.  Bring whichever you have for review.

 

Merck Manual.  Wow.  Description, signs and symptoms, pathology, diagnosis, treatment, prognosis.  And all of it is well written.  I am thinking about reviewing for the USMLE with First Aid, Merck, and a toothbrush.

 

Pocket Robbins as a reference only.

PHARMACOLOGY (6cr)

            Pharm is to Pathophys as Micro was to Path: disproportionately difficult for the credits.  Most students spend 85% of their study time with this 5 credit class.  The beginning is tough because you are learning a new language.  The course itself is a review of Neuro, Physio, Micro, Parasitology, Path and Biochem…so that you can understand the drug’s actions in the first place.  You also end up understanding how Prozac, Digoxin and other drugs work which, lets face it, helps us all sound a little bit more like doctors.  Never mind that if you were asked to prescribe any of them, you would kill someone.  Get some practice before the tests at Tulane’s pharmacology website (the pharm version of WebPath).  As a little aside: Hans Baer will email you every single day for silly little things.  He means well.  You will learn to love him.  Onto the books…

Golan’s the Pathophysiological Basis of Drug Therapy. Well-written book that, in each drug section, gives a review of the Phys, Path, and Biochem before going into the drug actions. There are patients-vignettes at the beginning of each chapter (less cartoonish than Al Martini), little blue boxes that discuss the most current research, and usually a paragraph or two about the history of a drug’s discovery. I am won over by this book. There are no review questions at the end of each chapter which is a minus if you like that.

 

 

Lippincott’s Pharmacology. If you liked their Biochem book then you will probably like this book as well. Everything is simplified (so it is easy to study from and memorize), there are a few review questions at the end of each chapter, and the pictures are funny. Some sections in this book (pharmacokinetics and antimicrobials) are not as strong as others are and had me looking in Golan for straight answers. While this book is an easy read and helped me get into some difficult sections, I would not recommend it as a stand-alone.

 

Katzung’s Pharmacology. As the required text, there is little that is talked about in class that this book does not cover. The graphs from this book are used in class, in the notes, and in the First Aid book. It seems to be the standard-bearer. It has all the detail you could ever want, and this makes it a difficult read. There are several review questions at the back of each chapter.

 

Lange Pharmacology Flash cards- Some students find these helpful as a way to learn the drugs.  If you are an index card person who found the Netter flash cards helpful, you may enjoy these as well.  They are good because they have the relevant information about each drug along with a clinical vignette. 

ADVANCED CLINICAL SKILLS (4cr)

             More of the same.  Every other week your group will listen to an hour lecture about the Abdomen, Chest, etc.  These lectures are a nice supplement to the hospital rotations to help stay current.  Your grade and attendance in St. Vincent is worth 25% of your overall grade, your performance in Fourth term is worth 50%, and the OSCE is worth 25%. 

            The OSCE is the culmination of your being.  Did you learn anything in Clinical Skills over the past two years?  Do you know how to inspect the abdomen, read and interpret an ECG, write a prescription?  Well neither did I!  The clinical tutors in St. Vincent’s will break you off into groups and give you a handout for the whole thing.  It serves as a script, which is appropriate, because the OSCE is about acting like a doctor.  Set up is basic with seven stations.  Four stations are for patient interviews (two of which include an exam) and three stations are for the EKG, X-Ray interpretation, and Prescription writing.  You are given ten minutes at each station, which is plenty of time, except in the patient interviews where three minutes is blocked for feedback.  It may not sound like a lot of fun, but people leave this test beaming and everyone is left to wonder, “Why wasn’t Clinical Skills always this much fun?”

HOSPITAL ROTATIONS

            Twice a week you will be in the hospital.  You need a stethoscope, two pairs of scrubs, one person in your group to bring a PD kit, a white lab coat, some doctor clothing for underneath the white lab coat, and maybe the Pocket Bates.  You will be pimped from time to time where the physician will ask you to report the patient’s history, offer differentials, and explain the physics behind an under-water sealed drain for a chest tube (true story).  The goal of this course is for you to leave the island capable of taking a patient history by yourself, carrying out a general and systems-based physical exam, reporting your findings while offering differential diagnoses, and not embarrassing the school.  One book is helpful for all of this:  CS Essentials: A complete guide to the USMLE CS by Jennifer Rooney.  For the nuts and bolts of what questions to ask in which order and how to report to a physician, I found this book very helpful.  Overall, you will go to the hospital twenty-two times in fourteen different specialties, you will see surgeries and autopsies, maybe watch a birth, and learn to suture.  The experience is what you make of it. 

HOSPITAL PLACEMENTS

            Every term the students become all hot and bothered over their hospitals.  They wonder which hospital is better for research, for surgery, and so on.  If you talk to anyone in the clinical years, they will say that, “None of it matters.  Every hospital is the same.”  And they are right.  You will be working with Residents, Attendings and other students.  These people will be responsible for teaching you and will determine whether you love a rotation or hate it.  They also change every year.  So if the thing that makes your experience good or bad is luck of the draw and has everything to do with the people and nothing to do with the hospital, then the hospital cannot matter.  If you do not believe me, then wait for Dr. Weitzman to come to St. Vincent to give his talk.  He will make believers out of all of you.  Surveys from students and what they thought of each hospital can be found in the DES office on campus.