Those darn pre-med requirements – are they really necessary?

When I was in college, I could never understand why I needed to know where to draw the little arrows and dots for the Baeyer-Villiger reaction mechanism in organic chemistry, or why I would ever need to know circuits or hydrostatic pressure from physics.  After all, I wanted to practice medicine one day, and I couldn’t see the reason why these were requirements to get into most medical schools.

As an first-year medical school war veteran, I can now understand to a certain extent, why these pre-med classes were important, and why so much emphasis was (and continues to be) placed on the undergraduate science GPA.  I thought I’d share some thoughts with you on the matter, concerning first-year material that I have come across.

Physics – Circuts and hydrodynamics are extremely important in understanding the basic physiology of the human body.  Circuts are important in appreciating cell physiology, where it’s comparison to cell membranes is highly valuable.  This includes setting up resting membrane potential, ion fluxes, and the Nernst Equation.   Hydrodynamics is essential in understanding cardiac physiology.  When they say “measure blood pressure,” you will come to understand that there are many different blood pressures, and depending upon how the catheter or monitor is positioned in a given stream (of blood?), the measured pressure can differ.  There’s so much more involved in understanding cardiac physiology: velocity, gravity, the individual’s height, wall tension, wall thickness, viscosity, flow, flow lines, pressure curves, etc. to name a handful.  In addition, renal physiology requires an understanding of fluid dynamics.

Organic Chemistry – Biochemistry in medical school has a lot of information.  There are many organic reactions that take place in our bodies, and without having heard terms like “aldol condensation” and “oxidation/reduction”, I would have had a very tough time in medical biochemistry.  Organic chemistry, even though I hardly remembered much at the time of graduation, exposed me to such terms before medschool – even though I didn’t remember much, I knew they existed, and I’ve seen these terms before…giving me some morsel of confidence.  Although I have not experienced M2 year yet, I gather that Pharmacology requires some understanding of the chemistry behind the drugs you will one day prescribe patients.  I walked into a seemingly empty classroom one day, hoping to find a place to study; but I had accidentally walked in on a TA reviewing Pharmacology with some M2 students – he was pushing arrows and dots on the blackboard.  I almost fainted.

Genetics – This was a required class in my pre-med curriculum.  I knew that genetics was important, but little did I know how much would be covered in biochemistry and the level to which we delved into such material in our Medical Genetics class.  We learned that cancer, inherited diseases, mutations, forensic uses, etc were some of the applications of genetics.  You will have to understand how small RNAs work, what SNPs and Snurps are, what the genetic mechanisms are behind diseases like Huntington Disease, different types of cancer, Phenylketonuria, etc.  You will have to understand the genetics behind how B-cells rearrange certain genes to produce their receptors.  All these, among other things.

In conclusion, I sincerely believe that those “ridiculous” science classes in undergrad will serve to benefit you once you start medical school.  Try to learn as much as you can now, so you’ll have an easier time learning the basic medical sciences.  You will also find it MUCH easier studying for the MCAT if you work hard now – in college coursework – to understand physics, general and organic chemistry.

Food for thought: If those pre-med requirements are useful in understanding normal physiology and biochemistry, imagine the level and extent of knowledge you would need when things go wrong with the human body.  Medicine is about fixing human beings whose bodies deviate from the normal workings of life – only if you have a solid framework in the normal basic sciences can you think about how to revert things away from the abnormal.

Study Strategies: Gross Anatomy

There is no secret way to study for anatomy, than to get your hands dirty and just do it.  However, I have realized that there are ways that can help you retain and reinforce the material consistently.  This post will describe how I go about studying anatomy.

Studying anatomy is all about organization.  The material itself is not all that challenging, however the first unit (it was Upper Extremity for our school) is always hard because you are still trying to get used to the terminology.  The way to overcome this is by breaking down the words into its Latin/Greek derivatives, and doing a little research about the root-words online.  Take for example, the Lateral Antebrachial Cutaneous Nerve of the Upper Extremity.  At first, the name seems daunting for the new medical student.  However, you can break this down the following way:

Lateral (toward the outside, when compared to Medial, which is inside)

Antebrachial (antebrachium in Latin means “forearm”)

Cutaneous (“cutis” in Latin = skin; So, Cutaneous = relating to the skin)

Nerve (clarifies structure category)

So, as you can see, the Lateral Antebrachial Cutaneous Nerve provides innervation to the skin, on the lateral (outside) surface of the forearm.  

Another way to keep these nerves organized is to have a visual representation of which cutaneous nerves innervate which aspects of the limbs/body.  Many atlases and textbooks usually give you a colored representation of, for example, an arm and forearm, showing which side of the arm/forearm is innervated by which cutaneous nerve. 

Compartmental organization will make learning anatomy so much easier as well.  In your limbs, you can group muscles based on what their general function is…extensors, flexors, adductors, etc.  Also, the limbs can be divided into anterior or posterior (front, or back) compartments.  These large categories can help you memorize muscles in groups, and formulate mnemonics if necessary.  There are 2 other significant advantages to learning muscles in groups.  First, it is very common for a certain nerve to innervate a “compartment.”  For a very simple example, the Radial Nerve provides innervation for all the muscles in the posterior (back side) compartment of the arm. So, if you can remember which muscles are in the posterior side of the arm, you will automatically remember which nerve innervates it.  The second advantage is that you will begin to notice that muscles grouped into the same compartment will seem to insert into very similar locations on the bones.  This can be extremely useful to deduce function from muscle-bone attachments.  As you can see, organization plays a huge role in studying anatomy.

Next, how do you deduce function from structure?  Our medical school does not require for us to memorize each insertion and origin of every muscle.  However, they want us to have a ‘general idea’ of where they start and end, so that we can infer function of each muscle.  The way I learn function from structure is by the following way:  I first learn the major landmarks of the bones (for example, Greater Trochanter, Lesser Trochanter, and Intertrochanteric Crest of the Femur – thigh bone).  Once I know these major landmarks, I try to close my eyes and visualize what these landmarks look like on the bones.  I don’t take the trouble to note all the little bumps, etc on the bone – just major landmarks (beacause the majority of muscles will attach to major landmarks).  Be advised that for some bones, you have to go over them multiple times before getting a spatial representation (the Pelvic, or Coxal Bone is a prime example).  You must be able to rotate the bone in your head and see how the major landmarks look from every angle.  Next, I learn muscles organized into compartments, and slowly start discerning their attachments on the major bone landmarks.  One by one, as I add muscles to my mental spatial representation, I can see how the bone will move as I mentally “pull” on a certain muscle.  Next, for a bunch of muscles that attach to a huge landmark, you have to realize that they all dont do the same thing – how is this possible? Because they start from different areas, and even though they attach to the same landmark, they attach to different sides of it.  Then, rinse and repeat.  

Repetition is key in anatomy.  You have to go over structures, functions, attachments numerous times before you can get a good understanding of the anatomy.  I also use flash-cards heavily for Anatomy.  Our course is presented with a grand-organization scheme: There are 7 regions of the body: Upper Extremity, Lower Extremity, Thorax, Abdomen, Pelvis & Perineum, Superficial Head/Neck, Deep Head/Neck.  I use the lecture notes and atlases to make flashcards online (I use flashcardexchange.com), and I either print these out or upload them to my phone.  When I’m on the bus, or waiting for the bus, on the train, or standing in line for lunch, etc, I just go over these flashcards over and over again.  This is very helpful because you learn the anatomy and have a functional representation in your head before going into anatomy lab.

Anatomy Lab also requires a lot of organization.  Our school has anatomy set up the following way: There are 6 people assigned to each cadaver, and are each responsible for dissecting one unit (one of the regions mentioned above).  Since there are 6 people, but 7 anatomical regions, we all help dissect one unit.  Each week, the Anatomy Staff give demos on pre-dissected bodies.  Also, each week, our fellow-student dissectors responsible for their regional dissection, will give us demos of the new structures they have found.  This way, we teach the dissectors stuff about the anatomy, while they reveal the structures for us in the cadavers.  In addition, the instructors try to cover the same material in the lectures, along with Clinical Correlations to help us understand the anatomy.  Once all the dissection is complete, we usually have about 4 days before the exam to review in lab.  How do you go about doing this?  Systematically.

We are given a structure-list for the Lab portion of the exam.  So, everyday for these 4 days, my friends and I would come in and identify all these structures, grouped by categories like: Bones and Joints, Ligaments, Arteries & Veins, Muscles, Nerves, Fascia, etc.  Please understand that studying for these ~4 days is not enough.  This is the review phase of studying, AFTER we came in regularly for the weekly demos.  We made it a point to look at the majority of the bodies in the lab, because these are these are the same bodies used for tagging structures for the practical exam.

Another useful way to systematically study Anatomy, is to understand the Embryology behind how the structures developed.  For example, the developmentally dorsal side of the thigh is actually the ventral side on the adult human.  The reason for this is because the lower limbs go thru a heavy medial rotation (compared to the upper limbs’ lateral rotation).  Have you ever noticed that flexing your forearm about your elbow is “opposite” in direction to flexing your leg about the knee?  

Study Tools I use for Anatomy, that I highly recommend for future medical students:

• Netter’s Anatomy Flash Cards – VERY useful
• Netter’s Anatomy Atlas
• Gray’s Anatomy Textbook – gives you nice charts for muscle innervation, function, organization, etc
• Gross Anatomy by Rohen – these give you actual dissections, instead of drawings like Netter; VERY useful
• BRS Gross Anatomy – Good for practice problems, and maybe reviewing some material
• University of Michigan Anatomy Department – they have AMAZING tutorials and HIGH-Yield practice questions with fully complete explanations for right and wrong answers.  Here is the link: http://anatomy.med.umich.edu/courseinfo/mich_quiz_index.html
• Flashcardexchange.com – great for making flashcards and reviewing them, AND browsing other people’s flashcards too.  Best part of it all, I can access my flashcards from any computer with internet access, anywhere in the world.

Once again, there is no secret way to study anatomy, other than to just sit down and plow through it all.  However, organizing your material will surely save you a lot of time, and will help you study effectively.