Don’t Look Stupid…

I have been reading a lot of med student blogs recently, so I am inspired to share my “Just Don’t Look Stupid” Study plan. I still use it regularly when planning my surgical study. I also browbeat any students I come across to try to make them into disciples of the plan. It is my main medical soapbox, so I am surprised it took me so long to share it.
Medical School Teaches Poor Priorities
Medical school is usually taught by clinical experience. Students get exposed to a wide variety of medical cases, and varied, interesting and rare cases get exposure. This is also a huge downfall of the system. “Unique learning opportunities” mean that bread and butter cases get de-emphasized – they are just not interesting enough.When medical school is over, you suddenly have to deal with COPD, pneumonia, cardiac failure, and diverticulitis. The “exciting cases” happen maybe once a week or once a month, and will be treated by more senior doctors.Your overall ability as a doctor will be based on your knowledge of simple every day cases. If you know them back to front, you will shine. If your seniors are busy, you should have the ability to initiate appropriate investigations and treatment for these common conditions. Failing to know details of histiocytosis X or Wilsons Syndrome will not lead to bad reports. But failing to know the best antibiotic for community acquired pneumonia will.
Just don’t look stupid
1)Stupidly common
Every time you start prep for a new rotation, list the 20 conditions that are most common, and therefore most important.
* Learn them back to front.
* If you are doing clinical rotations, see at least 5 cases for each. If you can’t find 5 cases, you have chosen the wrong 20 conditions.
* Learn all the details of the cases including meds and doses, even though that might not be required at your stage. For these common conditions, you need to know all algorithms without looking it up.

2)Stupidly important
Once you know those 20 topics back to front, then choose 5 conditions that are uncommon, but life-threatening or catastrophic, or easily misdiagnosed, and therefore important. Learn them back to front as well. See if you can find at least one case to see on each of these five. If you can’t find an inpatient case, then look up a historical patient and write a summary of their illness, and review their investigations.
3)The rest
Once you have your 25 conditions committed to memory, then you can select another 10, and work through them. These are extra-value. Try to avoid seeing rare cases on your own time as much as possible. The structure of med school will make sure you see enough of the rare stuff. Study to the beat of your own tendon-hammer and concentrate on the important.If you are clever, you will end up studying most of the stuff you would have anyway, especially if you have multiple rotations in one discipline. This system simply makes sure you learn it in the right order, and you don’t miss something really important.
4)Selecting the stupidly common
It is not always easy to select the best topics to cover, and they will vary a bit depending on your location. I favor the survey approach.
* Survey all the consultants of your unit, and the registrars/residents you trust. They will each be unable to restrict their list to 20, but compile the suggestions anyway.
* Check the admission diagnoses in your ward for three consecutive mondays.
* Survey the ED presenting complaint lists for three days in a row, and pick any cases that relate to your current rotation.
* Compile all these lists and you should find lots of conditions on multiple lists.
* Choose the top 20.
5)Continue to avoid looking stupid
As you progress through training, the stupid cases will change. Interns who don’t know really common cases look stupid. Residents or registrars need to know less common conditions to avoid looking stupid, but they need to know them in more depth. Consultants or Fellows need to know really uncommon cases, but only in a very limited field. This is how I plan my study, and you may not agree. However, you should choose whether you are studying to pass exams, or to be a good doctor. They are different purposes.

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