In 25 years of teaching medical students, I found that Biochemistry is the course that students have most difficulty relating to for clinical relevance. While Biochemistry has much clinically relevant information, the material students are taught often does not reflect this.
I think this is because there is a big difference in what is important to PhD students and what is important to medical students. For instance, ALT and AST are liver enzymes that are vitally important to the function of cells. Their detailed biochemical reactions are important to the PhD student, but not to the medical student. It is more important clinically to know that these enzymes leak out of damaged liver cells and are useful as markers for liver damage.
As another example, creatinine is a waste product of muscle biochemistry. It is not so important to the PhD student, but very important to the medical student as a marker of muscle and kidney damage.
It would help to have more clinicians teaching the basic sciences and providing a more clinical focus.
Of course, if your instructor emphasizes topics of greater interest to PhD students, you need to learn that, as well as facts that are asked on the USMLE. But teaching would be improved by emphasizing clinically important areas.
There is a problem with just rote-memorizing isolated facts. Somewhere along the line it would help to understand Biochemistry as an overall whole, particularly in a clinical context, for future practical use. For instance, there is much discussion about the value and side effects of HMG CoA reductase inhibitors (“statins”) in suppressing cholesterol synthesis. It helps to see this enzyme in the context of a broader Biochemistry map to understand the pathways involved in cholesterol synthesis and what may be affected by suppressing it.
In Clinical Biochemistry Made Ridiculously Simple, I have tried to do just that, present the clinically relevant points in Biochemistry (particularly the metabolic pathways and the diseases that affect it) on a single map that can be grasped as a whole. It is not a reference text, which disappoints some readers. I suggest that readers also acquire a good reference text, bearing in mind that it can be very difficult to see the overall picture in a reference book. The best way to study Biochemistry is to first grasp the overall picture in a small book, but also have a reference text and your class notes to fill in on other details.
The Goldberg Files
The Goldberg Files is based on the struggles of Dr. Goldberg as well as those of his many students which he observed while teaching medical school for 25 years. This extensive blog is dedicated to assisting students in dealing with the stresses of medical education. Want to learn more?