Nutrition – 1 unit
This two-week nutrition class was not
difficult. You do not need any additional material other than the
two packets provided. Your grade is based on one exam. I thought
this class would provide an understanding into the fundamentals of
nutrition and various ways to tailor nutrition for
patients...sadly…this was not my experience.
The class was broken up into two
sections. You will learn about nutrition in health and diseases
during the first week. Topics covered include host response to
trauma/infections, inflammatory responses, and various nutritional
needs throughout our lifecycle, pre-/during/post- pregnancy, fetus in
utero, and the basis of a healthy diet. Most of the information you
will learn during this first portion is pretty common sense (eat
fruits and veggies, limit intake of saturated fats, folic acid
supplementation to prevent neural tube defects, benefits of omega-3
fatty acid).
I found the second portion more
informative compared to week one. Topics covered included nutrition
during intensive care, under-/over-nutrition and associated diseases,
malnutrition, and the relationship between vitamin D to bone health. Studies were included in each lecture topic to highlight certain
points. We were not asked any specifics in regards to the numbers
found in these studies. Knowing the general results/conclusions of
each study for the second portion was sufficient for our exam. However, you do have to memorize specific numbers for the first
week’s material.
This class offered a chance for
recuperation after the microbiology final. The exam for nutrition
was not too challenging and I personally found most answers pretty
easy to pick out (Find the odd one out: Eat a well-balanced meal,
increase omega-3 fatty acids, increase fiber intake, increase
saturated fatty acids).
Communication and Physical Diagnosis
– 3 units
I personally found this class
disorganized and quite frustrating. Most lecturers read
word-for-word from PowerPoint and did not offer any additional
insights into the material. Most students in my class felt that
lectures were mundane, a waste of time, and only went because of
mandatory attendance via clickers. I believe we needed to attend 16
lectures to receive full credit for professionalism (5 percent of
grade).
You are required to bring your PD kit
during each laboratory session. Lab groups that consisted of 6 students (assigned based on first names) met twice a week with a different
clinical tutor every few meetings. Your group will meet either from
1-3 or 3-5 and will switch after the microbiology final. The change
in time threw off many students studying routine they developed
throughout the first half of the semester. My experience with the
quality of instruction from the various clinical tutors ranged from
10/10 all the way to 1/10. Some clinical tutors had magnificent
teaching skills and could properly introduce the material to the group in a cohesive manner. Other tutors sat and kept
silent the entire time offering no additional guidance and told our
group to read the manual for explanation. The most frustrating
portion of lab sessions was that different clinical tutors would
teach different techniques on performing the exact same physical
examination. This inconsistency was also represented in the physical
exam videos that we watched at the beginning of each lab session (15
to 30 minutes).
You will receive a total of 14
laboratory manuals covering topics from vital signs, global
assessment, head and neck, ENT, eye, heart, peripheral vascular
disease, respiratory, abdomen, musculoskeletal, CNS, breast, and
female/male genitalia. This was the sequence we were presented with for the
course materials. Each lab manual presented topics starting from
relevant anatomy, followed by physiology and/or neurology, then
ending with proper techniques needed to perform the given physical
examination. I would highly suggest reading each packet before going
to lab as some clinical tutors will teach improper techniques. You
will be graded on the OSCE based on the specific manner in which you
perform a physical exam according to the manual, not according to the
lab videos or clinical tutors.
There were two in-lab quizzes and one
case write-up. You will pick the quizzed physical examination from
an envelope and perform it in front your group. The clinical tutor
will then ask two questions based on information found in the
laboratory manuals. You will have a real patient for the case
write-up. Your group will interview the patient and perform the
necessary examinations.
The Objective Structured Clinical Examination (OSCE) I and II will represent
approximately half your grade. The first OSCE will have three
stations: one interview, one major, and two minors. The second OSCE
will have four stations: two interviews, one major, and two minors. You will have a total of 8 minutes to perform the skills asked in
each station. Your clock will countdown from 10 minutes during the
first OSCE but not the second OSCE. This threw off many students in
their first station because exam time ended when 2 minutes were still on
the screen. Feedback was given during this remaining period.
Best advice I can give is to practice
with a partner or in a group. It helps to watch somebody else perform
various exams while you try to catch the mistakes and/or omissions. First learn the proper techniques then begin timing each other for 8
minutes. Some physical exams (eyes, ears, mouth, abdomen, peripheral
signs of various systems) require you to memorize a list of things to
inspect for. You need to have these memorized for the OSCE because
the examiner has a list and checks off specific things you mentioned
during inspection. Make sure to practice your interviewing skills in
various clinical situations.
The written midterm covered
introductory materials to respiratory and the final was cumulative
with an emphasis on the second portion of class. Both examinations
did not include any materials from lectures that were not in the
laboratory manuals provided. The only exception was for Intro to
communication skills, the difficult patient, patient education,
physician anxieties, and the glossary. WARNING: Our examinations did
however ask questions that were not found in the lab manuals but
introduced in other classes.
OSCE examples
(This list was meant to give you an idea of how OSCE instructions are written and is by no means complete. You should create your own list based on your version of the laboratory manuals.)
Major:
Examine CN
5,7,9,10,12
Percuss and auscultate the heart including special
positions
Examine joints of wrist and hands
Inspect, palpate,
and percuss the posterior chest
Central visual acuity and
peripheral field testing
Examine the parietal cortex and
cerebellum
Examine external ear and perform the 3 hearing
tests
Examine and palpate the abdomen, including tests for
ascites
Examine lower limbs for peripheral vascular disease and do
special tests
Minor:
Examine peripheral signs of the thyroid
Examine
epitrochlear and axillary lymph nodes
Perform the 4 tests for
extraocular eye muscles
Fundoscopy (verbalize what you are
looking for)
Evaluate lumbar spine, special tests sciatic nerve
pain
Peripheral signs of abdominal disease
Tests for acute
meningitis
Test meningitis, hypocalcemia
Peripheral cardiovascular (excluding fundoscopy) and
examination of internal/external nose
Perform vital signs
Examine the
oral cavity
Examine the salivary glands
Examination lymph
nodes of head and neck
Superficial and abnormal
reflexes
Superficial and deep tendon reflexes
Test for motor
power
Test fluid in knee and collateral ligaments
Test for JVP
and hepato-jugular reflex
Perform Allen's test and Buerger's test
Palpate and percuss the liver and spleen
Interview scenarios:
Hint: Don't only focus on PAIN! "SOCRATES" will NOT work in every scenario (Severity, Onset, Character, Radiation, Associated symptoms, Timing, Exacerbating/Relieving factors, and Severity). I personally did not like this acronym because it does not follow a natural progression of asking questions. I preferred using OPQRST which stands for Onset, Palliative/Provocative, Quality, Region/Radiation, Severity, and Timing. However, try to use more open-ended questions (Tell me about your XYZ, Can you describe your XYZ) when possible instead of close-ended ones like the acronyms above. Think of various common situations for doctor visits and time yourself for 8 minutes when practicing.
Nausea and vomiting
Colicky pain in
LLQ that fainted
Burning urination and increase urinary urgency,
herpes
Infertile female because of PID with previous history of
STD
Diabetes
Thyroid disease with associated symptoms
Throat
infection with associated symptoms
Menopausal women
AIDS with
severe diarrhea and cramping
Acid reflux
Lower GIT
infection
Stomach ulcer and dark tarry stools
Sexually
transmitted disease
Ruptured ectopic pregnancy
Benign prostate
hyperplasia
Urinary tract infection
Headache
Vision issues
with arm numbness
Possibly pregnancy
Healthy patient
Microbiology – 5 units
Microbiology was an intense ten week
course. Some students recommend getting Clinical Microbiology Made
Ridiculously Simple. I believe this was a great book but many
students did not have enough time to read through it. Pre-midterm consisted of
general introductory material into microbiology (microorganism,
parasite, fungi, virus), lifecycles, classifications, methods of
control, pathogenesis, and diagnosis followed by a list of
microorganisms to memorize. Post-midterm information was presented
by organ systems (CNS, respiratory, genitourinary tract). I found
this method of teaching microbiology extremely ineffective because
instead of learning about a specific organism in its entirety, we
were introduced to that microorganism in various organ systems with
one or two slides pertaining to it. This fragmented approach in
teaching microbiology made learning the material extremely difficult.
Microbiology lab was only during the
first week of class. It was not mandatory to attend the two lab
sessions. Students learned various plating and culturing techniques
throughout the two days. We had the chance to go around campus to
take sample swabs of doorknobs, handles, and various other objects. You will be shocked with what was cultured should you do decide to
join the two-day lab session. I will never look at a water fountain
the same ever again.
Some students printed out the note
version of the handouts instead of using the slides to study. I felt
the notes were easier to read and seemed more organized (especially
in the GI portion where you must associate the clinical symptoms,
types of food, time and duration of presentation with the agent). Many students neglected this class until the weeks prior to
examination. The pathology exam is usually on Monday and
microbiology exam on Friday. It’s very tempting to put off
studying because you see that three day gap in-between. But trust
me…there is simply too much information to cram in that short
window if you want to do well.
The best advice I can give is to make
sure you study microbiology at least an hour or two each day before
starting on pathology. EVERYTHING said in lecture and written in the
handouts is fair game. Make sure you know the specific categories
and shape of each microorganism. You must also learn the mode of
transmission for each one. Knowing the clinical presentations often
narrows the answer choices down to two. Knowing the exceptions
and/or stains along with specific environments and/or drug
sensitivity/resistance needed to culture the microorganism often
narrows the answer choices down to one.
There were 5 in-class quizzes that
consisted of reading journal articles with topics ranging from
influenza vaccine, hand-washing, and various other microorganisms. To the best of my recollection, each quiz consisted of 5 questions. The lowest of all your quizzes will be dropped. Quizzes are an easy
twenty points so make sure you study the articles and know them down
cold. A unified exam was given during the first few weeks of the
semester with questions on microbiology and pathology. Microbiology
was more heavily weighted (6.8 percent) as compared to pathology
(2 percent). Microbiology questions were not nearly as difficult
compared to pathology. The material at this point was not too dense,
but you must know the different plating techniques, mode of
transmission, and shape of the organisms that you have covered thus
far.
I am afraid that I cannot provide any
more insight into this class because I contracted dengue fever
post-midterm and was unable to concentrate for a month. I still
can’t fathom how I passed the microbiology final given that I only
studied for one night. Our class of approximately 600 students had
roughly 20 A’s, more C’s than B’s, and a few dozen students
failing the course. Anyhow, I wish you the best of luck for this
one. Let the bug parade begin!
Pathology – 13 units
I personally felt that pathology was by
far the most interesting topic…right alongside with physiology. With that being said, this pathology course was the most challenging
and frustrating experiences of my life. Challenging because you
cover so many diseases in such a short period of time and frustrating
because of the department. You must have the required textbook,
Robbins Basic Pathology (baby Robbins), or an electronic version to
use as reference throughout the course. Robins is a reference book,
not something you read from cover to cover throughout this course. The
book goes into too much depth at a level that is not required to do
well and may perhaps hinder your performance.
Pathoma was THE MOST invaluable resource
that I used throughout this course. I cannot overemphasize this
enough. Dr. Sattar does such a magnificent job at simplifying
concepts in pathology. I would suggest reading through the relevant
chapters and watching the videos in Pathoma PRIOR to attending
lectures/sonic. Pathoma does not go into as much detail compared to
class but does a superb job in laying the groundwork needed to
understand pathology.
You will have a different visiting
professor each week throughout pathology. Quality of professors
ranged from being truly exceptional all the way to downright bad. Some will take the time to explain concepts while others will read
off their notes verbatim. The pathology department took down the
slides on sonic halfway during the semester due to copyright issues
and/or HIPAA violation. This made it very difficult to sonic for
obvious reasons. There were three equally weighted exams along with a
unified exam in this course. The first third of class covered
general concepts and the remaining two-thirds dealt with system
specific pathologies with each midterm reflecting said materials
respectively. The pathology portion of the unified exam was worth 2
percent of our total grade. I felt the questions were more difficult
in the pathology section as compared to the microbiology portion.
Pathology lab sessions were four times
a week from either 1-3 or 3-5 and switched after the microbiology
final. It drops to three times a week towards the end of the
semester. A maximum of 12 people are allowed in each lab group. I
believe you submit a list of group members during third-term. It is
better to have the maximum allotted number so that workload is more
distributed than would be otherwise. Your group will receive a set of
slides each weekend and each member will present a given amount
throughout the week. It typically took me about two to three hours
per slide…sometimes four… which I think was a bit excessive. This was the biggest mistake I made during pathology and I urge you
not to repeat it. Looking back, I personally felt this was not an
efficient use of my time and would suggest that you try to spend no
more than an hour and a half for your slides. The only benefit I
received from taking that much time was that I knew my slides inside
and out and could focus on other topics come exam week.
Print out the pathology slides
beforehand (4 or 6 slides per page) and take notes on it during
sessions. These slides (or some variation) were on our exams…I
think it was 35 image questions on each test that were from the slides. Pay special attention to EVERYTHING the clinical tutors say because
some information they highlighted were not found in the lecture notes
but were on the exam in some form. You will have a different
clinical tutor every week and again, the quality ranges from really
good to okay. Clinical tutors arrive about 30 minutes after lab has
started. Try to ask your clinical tutor if there is anything they
feel is important for each slide.
Focus ONLY on the general principles
(cell adaptation, necrosis) for slides you receive during the general
pathology section. DO NOT focus your time researching/presenting the
specific pathologies (benign prostatic hyperplasia, esophageal
cancer). You will revisit those during the systemic pathology
section. Make sure to learn and understand the general concepts in the first third
of the course because all pathologies stem from those
very concepts.
I think reviewing normal histology
helped me prior to starting pathology. I say this because I believe
knowing what normal looked like allowed me to better differentiate
abnormal. You need to understand what is happening at a cellular
level to appreciate pathology at a macro level. This is especially
true for the second midterm since it focused heavily on the
histological aspect of various diseases. Not only will you need to
learn the buzz words (monospot positive, M-spike, target cell, Heinz
body), but more importantly, you MUST learn what those words actually
describe. This is very, very important because most questions on the
exam will not mention buzz words specifically but rather describe
them histologically.
I felt constantly pushed up against the
wall throughout this semester. I did not have much steam left in me
after the microbiology final (even more so because I contracted
dengue fever). However, I remember the last two weeks of material
(childhood pathologies, forensic pathology) for the third exam was
not dense.
You will need to turn in 10 concept
maps throughout the semester. A concept map is like a brainstorm
covering a specific topic (necrosis, cytokines, cancer) of your
choosing. You need to connect each word to as many topics as
possible (draw many interconnecting lines). This will make sense
after the lab tutorial on how to draw concept maps. There are also 5
clinicopathological cases (CPC) that you are required to turn-in each
week near the end of the semester. Your group will discuss the case
and go over the answers with the clinical tutor. You are not graded
on whether the answers are correct but rather on participation during
group discussion. I mostly used the Robbins pathology book and
Wikipedia to answer CPCs.
My advice for this course in a nutshell
would be:
1) Get Pathoma – read and watch the videos BEFORE
lecture
2) Don’t spend too long on lab slides and assignments
3)
Learn the histological changes for every disease
4) Learn the buzz words and what it actually describes
5) Focus on your notes rather than using too many resources
6) Form an awesome group~!!!
