Re-Learning to Learn

I’d like to think I’m good a learning. I have two degrees, surely this is evidence that I am pretty good at learning? Since I’ve started at Warwick and medical school one thing I have realised is my previous methods of learning and revising were not adequate for medical school, not adequate at all.

One thing that I got to grips with is that learning here is more about memorising facts rather than understanding concepts. This is quite different to what I have previously experienced and I have been slightly disappointed with. Inquisitive doctors are surely better doctors?

To exemplify this, one of the questions in our end of year exam was what is the probability of contracting Hepatitis C from a needle stick injury from a patient with the disease. Quite specific right? The answer is 1 in 30 by the way, which luckily I got correct.

I have been disappointed in that being inquisitive and wanting to learn more than what is being taught, whilst useful for your career, is potentially detrimental to your grades and ranking within the year. I would like to spend time reading through textbooks, however this is just not worth the time compared to going through lecture slides for, what feels like, the fifth time.

I think that part of this is that medical school is largely about memorising facts like symptoms, incidences, treatments, and so on. The other part of this is that I am studying for a four year graduate entry medical degree, cutting a year from the traditional British medical degree. In order to fit everything in a little fat must be cut and all the material must be concentrated and fine tuned.

I’m hoping that this changes throughout my latter years at Warwick when things (I’ve heard) become a little less hectic. Which I hope they do as I don’t think I could handle another three years as hard as the first one.

In my next post I will go through a number of different learning/revision methods that I think could be useful for those starting medical school.

Induction Week

The first year at Warwick is split into five blocks each five weeks long. However this all kicks off with an induction week. This is pretty much a meet and greet where you have a number of welcoming lectures explaining what will happen during the year etc.

This week also starts with a number of lectures that are largely introductory to ‘science’ lectures for those without science backgrounds; including things like DNA, proteins and simple pharmacology. The idea of these is to get everyone up to the same level of these things given that Warwick also except non-science graduates.

Coming from a science background, and having studied both biology and chemistry at A-level, I found some of these lectures OK (and a little boring in places). However, some of the non-science graduates, understandably, found this quite difficult. The pace that things are delivered is quite fast which, I imagine, would be hard to grasp at any meaningful level of you have never studied any of this before. Before the course starts everyone is sent some optional pre-reading material that includes relatively simple chemistry and biology, which, if you have time I would strongly recommend going through if you don't come from a science background.

I don't want to scare any non-scientists potentially reading this, it is hard but it just means that in the first few weeks you'll probably need to put in more effort than the 'scientists' in the cohort. This does ease up and everyone comes to the same level and after Christmas it's quite difficult to tell those who have studied science subjects to those who haven't.

There is some more medical material covered during this week including lectures of the physiology of diabetes and the thyroid gland. This includes symptoms of disorders, for instance, hyper and hypothyroidism and type 1 diabetes mellitus. All material covered is potentially examinable, a few example questions you should be able to answer following his would be:

1. Which cells release thyroid hormone?
2. What is the mechanism of insulin release from pancreatic beta cells?
3. Give three symptoms of hypothyroidism.

The Friday of this week is the first day at the hospital. Every Friday during the year we were based at UHCW covering both anatomy, via the plastinated specimens in the surgical training centre, and clinical skills teaching. The day typically starts with a lecture at 8 am so you'll be getting up early!

The UKCAT

As part of all applications to medical school normally some sort of entrance exam is required to be taken in order to rank and score the applicants. The two most common ones in the UK are the UKCAT and GAMSAT. Having never taken the GAMSAT I don’t have too much knowledge of it. My understanding is that the GAMSAT is a tough exam of basic science amongst other things and takes a long time to sit.

My decision to sit the UKCAT was largely based on the fact that Bart’s and Warwick were my two top choices and that it looked slightly easier to prepare for, which was important for me given that I was studying at the time for my degree.

The UKCAT is a five-part exam testing verbal reasoning, decision making, quantitative reasoning, abstract reasoning and situational judgement. When I first sat the exam it was stated that you don’t need to prepare for this exam and that however many times one sat the exam they would always get similar scores. This is absolute bobbins, having sat the exam four times (!) I can categorically say preparation and practice definitely does help. Now, there is a preparation page provided by those who produce the exam which can be found here.

My advice for the exam are primarily to focus on timing. The questions themselves are not too complicated and if you have a degree or are doing well in you A-levels you shouldn’t have a problem at all with the level of difficulty. What most people struggle with is doing the questions in the time provided. Doing timed tests is what you should practice when preparing for this exam. There are a number of books available the foremost of which is ‘Get Into Medical School. 1000 UKCAT Practice Questions.’ I personally wouldn’t recommend this book. When I used it I found the questions were more difficult than the actual test and it doesn’t help you practice the timing.

When I practiced I used, Medify, an online resource which costs £40 for a month. This has the test in the correct format and has timed options available. I spent about 2 hours per day for approximately two weeks and was reasonably successful with a score of 730 average, which was enough for a number of interviews.

I have quite mixed views about this exam as a whole. Having been based previously in a dental school and knowing the admissions team there, their admission was that they know a good score in the UKCAT does not reflect on how someone will be as a doctor (or dentist). However, with thousands of applicants all with perfect A-levels or a degree how else can these people be sorted through?

My tips for anyone taking the UKCAT would be:

• Practice using timed questions so you are aware of what time you'll have for each question. 
• If you think a question will take you a long time to answer, then mark it and move on. There is likely to be questions later on that are faster to work out and answer.
• Practice quickly using the calculator and preforming the simple calculations. 
• If you have more than a year before you plan to sit the exam, then sit the exam the year before you intend to apply in order to give you some practice of what the real exam feels like.

Work Experience Part 2

My work experience started very well, the dispensary manager, Jane, picked my up from my house, as she lived near me and took me with her to the practice.

The GP practice I was working at was located in a fairly large village next to the town where I lived. The practice was a converted house where the partners used to live, living upstairs, with their consultation rooms downstairs. They had eventually moved out after the practice expanded and moved upstairs, moving to a house across the road.

It was summer when I started and the practice looked inviting, with flowers in the garden and ivy growing on the front wall. The dispensary in this practice, where I was primarily to work, was fairly small and not staffed by a pharmacist but by two dispensers. They would receive all of the scripts from each consultation which the dispensary would then prepare while the patients waited in the waiting area.

The practice manager had obviously gone round and told everyone that I was starting and that my name was ‘work experience boy’, so everyone knew my name. However, Jane, the dispensary manager, seemed to believe my name was Liam and introduced me as such. Being nervous and wanting to make a good impression I didn’t correct this. The problem with taking an approach like this, I later found out, is that its very difficult to correct a mistake like this later on. Awkward questions come up, like “Why didn’t you correct me yesterday?”. Leaving that day, I thought what’s the worst that can happen?

Being called Liam for two months, while all the other nurses laugh, knowing that’s not your name, is apparently the worst that can happen. On my first day when I was introduced to the other dispenser, Yvonne, who furrowed her eye brows when Jane said my name. The second day, when jane was out of the room, she asked my what my name was and I told her.

“So why is Jane calling you Liam?”

I shrugged and told her I was too nervous to correct her. She obviously found this hilarious and from then on whenever Jane was in the room would say my ‘new’ name whilst slowly winking at me. The rest of the staff soon found this out and would continue to do the same. This got to a point that whenever I was checking a script and writing my initials, I was actually using the new initial I have been given by Jane.

This continued for two months, until one day my mum came into the practice to pick me up. I was in the store room and heard my mum say to Jane “Is ‘work experience boy’ here?”. I walked through into the main office to see Jane staring at me puzzled, then realisation suddenly dawning on her face. Not a single word was said about this between me and Jane, but from that moment on she used my actual name. She must have thought it was very strange that I had so willingly accepted this name, going so far as to change my initials.

My overall time at the practice was very useful and much less eventful, I got to see how the practice operated. The GP’s even let me sit in on a few consultations which was very interesting and I learned more about how consultations were structured to facilitate patient-doctor communication.