Dissecting homework

I finally finished with all of my med school board exams (barring failure of course, which I won't know about for weeks or months) yesterday.  I was planning on blogging about that first, because I don't think that many people understand the brutal beasts of becoming a doctor- otherwise known as the Step exams.  More on that later.

While trying to relax after my 9-hour exam last night, I stumbled across an article: Homework overload gets an 'F' from experts.  Ironically, this has recently a point of contention between me and my fiance (mostly because I keep bringing it back up).  We both had very different childhoods: he did his homework between classes and played outside after school; I had 3 hours of ballet or music lessons and then 4 more hours of homework (this is MIDDLE school).  We both agree (I do, at least) that there's probably a middle ground that's healthiest (mentally and physically, highlighted by the article "High school kids don't exercise enough, CDC reports" which was posted near the other article).  Four hours of homework in middle school is excessive.  My high school homework experience was even worse.

The other problem with making kids competitive academically is that the parents become crazy as well.  See article: Police: Mom hacks school's computer system to change kids grades.  She changed her kids grades from like 98 to 99, WTF?

I had a unique experience with schools; while in kindergarten, my parents researched top high schools in the area, and figured out I had to go to a certain elementary and middle school to get into that (yes, public) high school.  So I did the "academically gifted" classes, making rhomboicosidodecahedrons (see picture) out of construction paper in 2nd grade instead of doing connect-the-dots. My first grade science fair project compared the efficacy of using dish soap on dishes rather than just water (I swabbed them and plated them on petri dishes, and found that using dish soap didn't reduce the number of bacteria growths- probably a reason why I slack at cleaning these days).  I was in Key Club, Battle of the Books, National Honor Society, All-State honors bands- you name it.

And as predicted, I'm now in medical school.  No big surprise.  I attribute some of my success to the ridiculous measures I was put through early on, but a lot of it was pure drive.  I wanted to be a doctor, so I did everything possible- and 99% of it was just stupid hoops to get where I needed to be.  Sure, you learn good study habits.  But 4 hours of homework does that just as well as 2 hours.  And busy work just results in burned-out children who lose the energy to follow their dream.  Had school been longer than 13 years I probably wouldn't have made it this long.

I would like to point out that some work is definitely necessary.  No work means no structure, essentially.  The article points out that requiring homework "takes the fun out of it."  That lady was obviously smoking pot.  Homework has never been fun, required or not.  If not required, it wasn't done.  Even if your career doesn't require an ounce of academia, having been forced to sit down and complete a task as a child sure sets you up to be more successful (unless you smoke pot and don't have a job, like the aforementioned woman probably does).  It's all about responsibility.

Just a summary of modified milestones to shoot for if you want the next nobel prize-winning offspring:

My experience preparing for Step 2 CS

Note: this blog was written 2 weeks ago before I took Step 2 CS.  I'll eventually follow up with a brief reflection on the exam and how this worked for me, but things are hectic as my CK exam is next week!

As I'm winding down to the final few study days, I thought I'd share some of my study tactics.  No guarantees, but I guarantee it's better than the usual advice of "just go in, introduce yourself and wash your hands" and "speak English."  I ALMOST fell for those!  I realized about two weeks ago that there's a lot of preparation needed for this exam- not because my skills aren't adequate, but because the exam is overly structured.

A few reasons why you should prepare:
-You lose points for washing your hands at the beginning and not in the middle right before the physical exam
-You will probably have a phone call scenario- this could be as crazy as a mom calling about her sick child which isn't even with her
-You must drape the patient. It seems that doing it in the beginning results in fewer people forgetting.

Important things to go over:

-Physical exams: you need to have them down cold.  Memorize each set (HEENT, cardiovascular, pulmonary, abdominal, extremity, neuro), and be able to pick and choose or prioritize maneuvers because you won't have time to do them all.  My full neuro exam takes over 7 minutes (this includes a fairly thorough set: cranial nerves, motor/sensory, reflexes, cerebellar exam, and mental status exam), but you only have 15 minutes for the entire encounter.  Know what's critical. Also know what maneuvers pretty much need to be done on all patients (listening to heart and lungs).

-Difficult questions: most scenarios will require you to address a difficult question.  "Do I have cancer?" and "I can't afford to come in for an exam, can't you just send in a prescription of pain medication for me?"  There are long lists of examples, but it really boils down to 3 or 4 general questions, meaning just have a few sentences ready (usually something like, "I don't know what is causing your symptoms, but I can't rule out cancer and I'd like to order some tests to make sure").  These aren't something you would be prepared for if you hadn't read the prep books (not that you can't answer them, but it seems CS wants some pretty specific answer types).

-Counseling: you're expected to catch and address "bad" health behaviors, like smoking, alcohol abuse, medication non-compliance, etc.  At the end, in your "closing," you need to make a statement or two about why it's bad and that you're there to help quit (list some resources).  This is an easy one to forget.  In practicing, I try to make big boxes around the topics while taking notes during the interview so I know which one(s) to address later.

-The "closing:" this is pretty insane.  You need to summarize the history and physical exam findings, then give a few differentials.  This is a good time to then ask for questions. Then give a general overview of your planned workup (labs, imaging, etc), in LAYMAN'S terms!  Even "thyroid" isn't a good word to use!  Patients will jump on the medical terms and make you explain them.  For example, instead of chest x-ray, say "take a picture of your lungs or chest."  Then you should make sure they don't have questions (this is usually when the difficult questions happen).  Also arrange for follow-up.

The format of the progress note and grading have changed subtly in the past month; do your research!!

I think a week of intensive studying or two weeks of moderate studying is plenty; I wouldn't start early, as a lot of it is rote memorization and will be quickly forgotten.

Two good books so far:

First Aid for the Step 2 CS
Kaplan's USMLE Step 2 CS: Complex Cases

Good luck!

Update (12/28/12): I forgot to mention that I passed!  I don't know the exact percentiles but I scored at the top of all three categories!