Studying For Tests: My Two Decades of Evolving Study Techniques

Last week I took the PRITE exam.  (Psychiatry Resident In Training Exam)

I still have more tests to take in the future: Child Psychiatry Board Exam, General Psychiatry Board Exam, etc...
I may be a doctor, but I only got here by becoming an expert test taker first.  Which means I had to learn how to study.
I am not the smartest or best test taker by far.  I did not glide through medical school, and I was not in the top of my class.  I worked hard, constantly evolving my study skills to meet the latest challenge.  Here is my journey.

ELEMENTARY SCHOOL

 - I almost never studied.  It was so bad that when there were spelling tests and two words were pronounced the same (red, read) I'd have to ask the teacher to use the word in a sentence because I had never looked at the list.
I only studied when there was a competition.  When I was in a Geography competition I spent hours and hours at home memorizing all the countries.

HIGH SCHOOL

 - I studied a little for classes, but I knew there was one test that mattered most: The ACT.  I checked all the colleges I wanted to go to - and figured out what ACT and GPA I would need for a scholarship.  My GPA would take consistent work - but the ACT was a single test with HUGE results.  That's why I needed to figure out how to take it.  I took it my freshman year - I didn't get the score I wanted.
I took a review course and took it my sophomore year - still too low.  I took it again my Junior year - too low.  I took another review course and then took it again my junior year - 1 point too low.
I took it for the fifth time my Senior Year - NAILED IT!

I earned the scholarship I needed to be able to pay for college, and off I went.

COLLEGE

 - This is where I learned the necessity of study groups.  I walked into a physics class and quickly discovered - I didn't get it.  I could go to lecture and read the book and it still made no sense.  So about the 2nd week of class I paid attention to who was bored, but always knew the answer.  Two guys in the front (Jake and Pete) were always joking together, but when the teacher called on them - they answered everything right.
I walked up to them after class and asked if I could study with them. 
They already had a study room reserved 3 days a week at the same time for the whole semester.
All 3 of us aced Physics.
I then took Calculus.  I couldn't find a good study group so I went to the math tutoring center.  I sat there every afternoon for 4 months.  I used the same tutor every time.  He got paid by the school, I learned calculus, and thanks to him I aced that course.
Then came Genetics, Anatomy, Physiology, Organic Chemistry, Evolution, Pathophysiology, etc...
That's when I found my perfect study partner - Kyle.
He was more "bookish" than I was.  I knew the lectures.  I knew what the teachers liked, what topics they cared about and what lecture facts they were most likely to test.
Kyle new the book.  He knew the concepts, the underlying theory.  We sat in study rooms and wrote on white board for hours and hours - recreating metabolic pathways and memorizing names, equations, and formulas.  If not for him, I never would have passed those classes.
For a "pre-med" there is one test that determines the rest of your life: The MCAT.
It is the test to get into medical school.  I couldn't just take it 5 times to get the score I needed, because med school's don't just get your top score, they get all your scores.  They want someone who took it once and nailed it.
So - I decided to study for 1 year with a group of eight guys.
We took the formal practice exam nine months before the real thing.  We all scored too low.  We then met EVERY Saturday and practiced.  We reviewed practice questions, took practice tests, quizzed each other, wrote practice essays.  We worked, and worked, and worked.  One year later - I had my high score, and I was accepted at multiple medical schools.

MEDICAL SCHOOL

 - This is where I learned the art of note taking and an exact / never changing schedule.  By this time I was married with a child and I would have two more children before the end of medical school.  I needed family time, and I needed it to be dependable and predictable.
So I car-pooled with three classmates.  We left at 6:30 a.m. and came home at 5:30 p.m.  Whether we had classes or not - we were at school for 11 hours a day.  Saturday mornings I spent at the library from 9-12... always.
I learned that there was WAY too much material to review.  I needed one place to put all the pertinent information.  ONE page of notes for each test.
My first year the page looked like this:

By second year it looked like this:



I had to have a faster way to review, and to know what was important for the test.
We had study groups every day.  We always got together the night before a test to review again.  We always invited our friend Joel (the smartest guy in the class who lived near us) to join us.  He would give us the info we never thought to learn.  He would know the answers to questions no one had asked, and no one cared about...except the professor.  I learned enough to pass from my study group, I learned enough to do WELL from Joel.
When the 11 hours got too boring - I found a way to make studying more fun.  When studying anatomy I purchased flash cards with every muscle, bone, artery, vein, and organ labeled.  I'd place the cards all around the edge of  a pool table - and start a game.  Every shot I took - I'd memorize everything on the card under the cue before I took the next shot.  My games of pool took a long time - but I aced my anatomy tests.
I also learned to relax and recoup.  After EVERY test, we'd play basketball.  About 15 guys showed up every time, and we'd play for an hour or two. (you have to do something to stay sane.)

In medical school, there is a test that MUST be passed to go to residency -  the General Medical Boards.(USMLE or COMLEX)  It's actually three tests, each about one year apart, hundreds of questions, hundreds of dollars to take each.
I studied for each one for six months.  I bought the books, I listened to the review lectures, I took the practice tests.  I spent thousands of dollars on review materials, travel, hotels, and the tests themselves.  I didn't get the highest scores, but I passed every single test the first time. 

RESIDENCY

 - It finally happened.  I got to the point where I can read a book and understand the material and remember it.  I now have 4 kids and a very busy position in my church.  I really don't have time to get together for study groups.  So I read.  I have a book with me EVERYWHERE.  I have one at work to read between appointments.  I take one to the DMV while I wait in line, read it on my lunch breaks, and keep one on my night stand to read before going to bed.
That way I can always play with my kids, and when they move on to something else - I can read. 

Why do I mention all of this?  Today I spoke with a sophomore in college whose grades are slipping.  He told me "I've never had to study and I just don't really know how."

This is what I told him.  You start by looking for new solutions.  You go to the tutoring center, you ask people if you can study with them, you make routines and schedules, you find a way.

I didn't make it through school unscathed.  I never had a 4.0 in high school or college.  I almost failed a course in med-school (the week after my 2nd baby was born).  I am not the smartest, or the brightest.  I'm smart "enough," and I learned how to study.  That is the "secret" of my success.

Book Review: Long-Term Psychodynamic Psychotherapy

First – I’m really curious to see if ANYONE reads this review.  I mean really – with a title like that – how many people are really going to find this on a google search?  This isn’t exactly a popular topic. Hunger Games and Honey Boo Boo it ain’t.

But – I read it – it helped me, and here’s what I thought.

The author did a good job writing about a topic that few would read past the first page. 

The first topic?  MISCONCEPTIONS.

They explain that it isn’t about the stone faced therapist, sitting mostly in silence and only speaking to say “mmm-hmm” or to ask about the patient’s sexuality.

It’s about the relationship between the therapist and the patient.  They’re both real people – both have backgrounds and upbringings and biases and conversation styles and patterns and soft spots and rough edges etc…

The author explained Klein, Freud, Kohut, Bolwby, Stern and others.  But none of them are God; none should be followed precisely.  They are people who had theories, and their theories taught us something.

This book helped me the most by teaching me what NOT to do.  Don’t over analyze, don’t interpret too quickly.  If the patient says I remind them of their father, just leave it alone.  If they mention a past experience, just listen.  Once they mention the same subject 3 or 4 times, once a pattern is readily apparent - then bring it up.  Don't assume to know what it means - just bring it up.  Sure I'll have idea and theories, but not push them on the patient or they'll pull back.

If they mention a dream - don't try to interpret it.  If they give an interpretation - fine.  If it reminds me of a recurring thing they've brought up many times - ask if there might be a connection.

I learned to slow down and avoid jumping to conclusions.

This book teaches how to do psychotherapy, how to deal with resistance, when to interpret and when to just listen.  It taught the good and the bad of transference and countertransference - when to bring it up and when to just acknowledge it and move on.

It explained the goals, the purpose, the meaning behind it all.  It gave me another useful tool to use with patients.  I think that's the point, if you learn lots of medications, lots of therapies, and lots of ways to help - you'll have a better chance of picking the right one.  "If all you have is a hammer, everything becomes a nail."

Here are a few of my favorite quotes:

"When in doubt, be human." - p. 57

"The young therapist - fearing spontaneity, human engagement, and a naturalness of response - is overly rigid and formal." - p. 71

"Therapists are privately passing judgments on the patient all the time." - p. 72

"We might regard resistance as a way that patients show us who they are...resistance is not 'bad' behavior on the part of the patient." - p. 117

"Patients are boring for different reasons...the art of therapy includes making the boring patient a fascinating subject of study." - p. 161

Blog Post #100

I created this blog in April 2010.  It began as a book blog to post my book reviews as I read throughout the year.  I broke form on Independence day when I posted the Declaration of Independence.  Then a few months later I posted my first off-topic post - about Conservatives not being close-minded.
I posted a total of 13 times that first year.

In 2011 I didn't do much.  I posted 11 times, mostly about books again and also one really LONG post comparing two of my favorite father figures - Tevye and Jean Valjean.
Then in February of this year I decided I wanted to get more serious about writing.  I also decided that I wanted a forum to share my thoughts.  I've now written 76 posts this year.
I knew that to have a popular or successful blog I would need a specific topic - some niche or genre to draw people to my blog.

I failed.

I didn't want to be limited to discussing politics, or religion, or psychiatry, or medical research, or books.  I wanted to discuss EVERYTHING!  I wanted a venue where I could write anything too long to put on Facebook.
(maybe that's why my blog only has 4 followers after 100 posts?)

I don't know everything, and I am not THE EXPERT on the topics I blog about.
 - I really am a Simple Citizen who is just trying to make a difference in this world.  Someday I hope to write something important enough that it gets referenced from some big news source and thousands of people end up reading my writings.  I'll never monetize my blog - because that's not the point.  I'm not here to make money, I'm here to make a difference.

For now I'll practice on all of you.  Most of you are Facebook Friends who follow one of my links here.  The rest of you - I have no idea how you landed here.  But if you have feedback, critiques, encouragement, corrections, or even topics you'd like me to research and write about (because I'm nerdy like that) - just ask.

Also - on the off chance someone else wants to try writing a blog post - I'd be happy to have my first "Guest Blogger."  I guess we'll see. 

Thanks for reading.  It's nice to know at least a few people are reading what I write.

Defensive Medicine - What Makes Psychiatry Even Harder

When most people think of "Defensive Medicine" they envision what physicians do to cover their backsides rather than really help patients.

I think of being a medical student working in the ER when a drunk patient comes in complaining of chest pain.  My attending physician asks - "what does that patient need?" I answer - "He needs a rally bag, some food and a place to sleep for about 12-18 hours."
She then says - "but you know what we're going to do right?  He's going to get a CBC, CMP, UA, BAL, Chest X-ray and an EKG - and that's just for starters."

And that's how it goes.  We know what's wrong - or least we're pretty sure.  But we have to cover ourselves legally - because what if???

Can a drunk guy with chest pain be having a heart attack?  YES

It's like they say: "Every Hypochondriac eventually dies from something."

My residency director often said: "A man with diseases can have as many as he pleases."

Just because someone uses drugs and has a personality disorder doesn't mean they can't have epilepsy.  Yep - just because someone has pseudoseizures doesn't mean they can't have real seizures too.

And that's why we do it.  Yeah - we don't want to get sued - it's true. 

We would probably be correct and save thousands and millions of dollars if we treated people how we REALLY think they need to be treated.  But we don't get to make that call.

Psychiatrists have it even worse.  I wish I could just look at a depressed patient, or an anxious patient, and give them what they need.  I could give them the medications that are most likely to help them and get them the therapy that is most likely to have a lasting effect - but I have to do more than that.

Every patient I see - I have to look at their medication list and ask myself - "If they took every pill in their medicine cabinet - would they survive?" "If they tried to kill themselves - have I given them the tools to do it?"

I always have to worry about suicide.  Always.

I can't just treat symptoms, or even diseases.  I have to practice defensive medicine - meaning I have to defend the patient from themselves.

It's an impossible task.  I don't control their free will.  I am not their parent or their conscience.  I am merely their psychiatrist.

Yet somehow - when I get that call - the one where some ER doctor tells me that my patient just attempted suicide by overdosing on the pills I gave them - I'll feel responsible.

Maybe I can get used to it.  Is that what makes a good shrink?  Being able to handle things like that?

Maybe that sinking pit of guilt, despair, and regret at having facilitated a patient's suicide goes away?

Maybe it should.

Maybe it shouldn't.

Does Faith = Ignorance?

Sometimes I am treated like I must be an ignorant, uneducated moron because I believe in God, follow my religion, and try to live my life according to the teachings of God as I understand them.

I walk in very well educated circles - and sometimes people think "Once you're smart enough you don't need a belief in God anymore, you know better."  They can reason their way past a need for faith.

So I decided to do a quick check on the leaders of my church; a group of 15 men.

Is it possible they are just blind faith followers?  Are they just well intended sheep who blindly follow and do what they're told? 

Or is it possible they are well educated, intelligent men who despite (or likely because of) their education believe in God and have made him the center of their lives?

Here is what I found on a quick, cursory search:

Among the 15 men there are:

3 lawyers
1 surgeon
7 masters degrees
6 doctorate degrees including Nuclear Engineering, Business, Religion, American Studies, etc...
4 University Presidents
3 Harvard Graduates
1 Stanford Graduate 
1 Yale Graduate

These men are smarter than me - but even if they weren't, I would still follow them.

They don't need all those degrees, but it's nice to know that very VERY educated men can still humble themselves, get on their knees, and admit that they would be nothing without their creator.

Source of Information: LDS Church News

Les Miserables Predictions:

Yes - I am one of THOSE people.  I love Les Miserables.  I mean REALLY love it.
Due to lack of funds and time I have only been to see the stage musical twice - but here are a few examples of how much I love the story:

I have read the unabridged book 3 times.
I have read 3 abridged versions.
I have abridged my own version because I don't think anyone else "did it right."

I own the 10th Anniversary "In-Concert" DVD
I own the 25th Anniversary "In-Concert" Blu-Ray even though I don't own a blu-ray player. (I refused to buy the DVD because I wanted higher quality)

I watched the 25th Anniversary concert in a movie theater in Reno because I didn't want to wait to buy the blu-ray.  (which I still can't watch)

I can recognize and name everyone from the original cast, the 10th Anniversary cast, and the 25th.

Get the picture?  I'm sure I'm not the biggest fanatic out there - but I might make the short list.

WITH ALL THAT SAID - Here are my predictions:

Prediction #1 - The movie will be a huge success - and not because of people like me.  I see this movie kind of like the JJ Abrams version of Star Trek.  There are fanatical Star Trek fans around the world - but that isn't the reason that Abrams version succeeded.  His version made over $350 million while the last Star Trek movie before his made just $60 million.
Why?
He made it for the masses.  He left enough classic trek material and enough fun inside jokes that trekkers could love it - but even if you had never even heard of Kirk or Spock - you could still love the movie.

That is what Tom Hooper is doing with Les Mis.  He didn't cast Lea Salonga and Alfie Boe, or even Michael Ball (amazing singers from the show) - he cast Anne Hathaway, Hugh Jackman, Russell Crowe, Sacha Baron Cohen, and Helena Bonham Carter.

He cast film actors.

He also included enough classic Les Mis to satisfy fans like me.  The original ValJean (Colm Wilkinson) is playing the Bishop.  Samantha Barks is playing Eponine.

Which brings us to...

Prediction #2 - The name that will be on everyone's lips will be Samantha Barks.

Yes - people will say that Anne Hathaway gave a beautiful and heart wrenching performance.  Hugh Jackman held his own as ValJean, no one knew Russell Crowe could sing and he actually did fairly well. 

They will say that Helena Bonham Carter was perfect in her role - the freaky and intimidating but funny Madame Thernardier.  Her husband, Sacha Baron Cohen will also get some good reviews.
Cosette (Amand Seyfried) will be mediocre.

The name that will be talked and talked and talked about - will be Samantha Barks.  Why - because she is amazing, and she is relatively unknown.

She has never been in a movie that wasn't a recording of Les Miserables.  Her T.V. appearances were on a reality show - auditioning for the lead female role in the musical "Oliver!"
She can act, she can sing, she's gorgeous, and she is going to be the best singer in the movie - and people will notice.  This will be her breakthrough to the masses.

Prediction #3 - More musicals will follow suit with the "live recording of songs." Very few musicals use vocal recordings from the set - they're always recorded in a studio and then the actors lip sync on the movie set.  Les Mis is one of the first in a long time to try it - and I think they'll succeed and start a trend.  They'll have to clean up some of the tacks, and some will have studio recordings mixed in (Amanda Seyfried) - but most will be live recordings, and audiences will love the change.

Hugh Jackman explains it here:

Prediction #4 - SPOILER WARNING! The Bishop (Colm Wilkinson) will be in the last scene. 

The musical really screws up one scene - the last one.  In the end, Valjean is dying. 
In the book it goes this way:

"Do you want a priest?"
"I have one," answered Jean Valjean.
And, with his finger, he seemed to designate a point above his head, where, you would have said, he saw some one. It is probable that the Bishop was indeed a witness of this death-agony.

In the musical Fantine and Eponine appear to ValJean  They sing a beautiful duet and take him to heaven.  It's nice, but it doesn't make sense (I've written an entire blog post about why)
In the film this will be fixed for two reasons. 

1. It makes sense.
2. They want Colm Wilkinson to have one last moment at the end of the film - one last goodbye to the role he defined.  He was the original ValJean, and they'll let him end it.

oh - and here is a screen shot from the trailer that shows ValJean and the Bishop - and ValJean is NOT dressed like a convict.  (hint hint)


The film opens Christmas day.  Enjoy.

Book Review: The Confession

The Confession reminded me of two books I have read before. 

The first is Michael Crichton’s State of Fear.

State of Fear was basically Michael Crichton’s well scripted argument against global warming and it’s bogus research.  Crichton studied so much and cared so much about the topic of global warming that he testified to Congress on the matter. (Read his testimony here)   

The Confession by John Grisham, is not about Global Warming.  It is about Capital Punishment.  It’s the story of a young black male, who was questioned for hours and hours and hours about the death of a white female classmate, then  coerced into giving a bogus confession which led to his conviction and death sentence.  The young man is innocent, and is sitting on death row.  His appeals have been denied and all hope is lost until days before the execution, the real killer 9who is dying of a brain tumor) confesses his crime to a pastor.  The pastor then works like mad to get the killer to drive to Mississippi, confess, and stop the execution of an innocent man….

This book is Grisham’s referendum on the death penalty.  Which brings me to the second book it reminds me of:

An Innocent Man, also by John Grisham.

An Innocent Man is THE TRUE STORY about a young man coerced into giving a bogus confession, convicted of murder, sentenced to death, and then left waiting on death row for appeals or execution.  It is rather obvious that writing An Innocent Man had a strong impact on Grisham.  He is now on the board of directors of the Innocence Project in New York, and is chairman of the board of the Mississippi Innocence Project. 

In preparation for writing “The Confession” Grisham made frequent visits to death row at the Mississippi State Penitentiary. He got to know the guards, the inmates and the stories of some of the convicted killers' victims, he said.

He even let guards strap him in the death chamber gurney to get a feel for it.

This book does not go how you expect.  It is not predictable, and it is a good read.  But more importantly it makes you think.  While reading the book I had two strong feelings.

1.       “They have to save the innocent man, and the death penalty shouldn’t be allowed.”

2.       “They should convict the real killer and put him to death immediately for the rape and murder of an innocent girl.”

Grisham makes you think of both sides.  The pros and cons of capital punishment.  He shows the ridiculous politicization of the issue, and the people who are hurt or killed because of it.

I had lost faith in Grisham as a writer – this book brought me back, and reminded me why I enjoy his novels.