· By Michael Goldberg
Studying In The Clinical Years
Hansel and Gretel luck out.
It is interesting that in medical school there is no course in medicine; you have to learn it through patient contact and deciding on your own what to read. It is a different kind of studying than in a course, where the instructor assigns a specific number of pages each day.
How should you study?
One way would be to set aside a certain amount to read each day in a large textbook, such as the excellent 4000 page reference book, Harrison’s Principles of Internal Medicine, reading it a little each day progressing from beginning to end. Or you could read journal articles. However, it can be difficult, particularly when tired, to come home and focus attention when the literature does not pertain specifically to the patients you just saw.
It is more effective to prepare a number of questions each day that relate to the patients you encountered that day. What is the differential diagnosis? What are the diagnostic tests? What are the treatment options?
There are a number of advantages to focusing study on the patients you encountered that day:
1. You will be more attentive when looking up specific information that relates to the patients you have just seen than to read material that, however important, does not relate to the patient at hand.
2. When presenting at rounds the next day, you want to appear sharp and informed. You can do so by reading up on the patients who will be presented at rounds.
3. Over the long run, by studying this way each day you will accumulate a knowledge of the most common presentations in the hospital. You can’t know everything. You can, however, know the most common situations.
In the old days, before computers and the Internet, one had to rely on reference texts, which could be out of date, and journals. One could also go to the library and take out the voluminous Index Medicus and search out papers that pertained to your subject of interest. Frankly, I was too tired to go to the library.
Now, with Internet access and medical search engines, it is relatively easy to quickly find the specific information that interests you. Despite the explosion of new medical information, this is balanced by easier access to that information, and access continues to improve.
Which do you prefer - eBooks or print books?