The Complete Guide on How To Study Medicine in Fourth Year MBBS

It’s only been two weeks since my medicine rotation ended but it already feels like it was only yesterday and yet also, a lifetime ago. It’s kind of confusing to describe. I also can’t believe we’re almost halfway through fourth year! Getting into the clinical side of medicine is pretty scary. Even though we were introduced to things in third year, it’s hard to keep everything under my belt while simultaneously trying not to let everything I’ve studied in the past evaporate out of my ears, which I seem to be very good at doing.

I spent my eight weeks in medicine in a very scattered sort of mindset and I think that if I knew beforehand what exactly I was getting myself into, I would have been able to give myself better study goals and also be able to facilitate myself between the clerkship and USMLE studying. Which is precisely why I’m writing this post- so that you don’t do any of the mistakes that I did, most of which consisted of mismanagement of time.

One of the first thing that the teachers stressed upon was to study topics beforehand. I’m so sorry to say this, but I have never been able to keep up with studying this way. For some reason or the other, I never sit down with the books the night before the class and most certainly never read up on the topic. I think most of it stems from the fact that when I do study the topics, it usually turns out that I didn’t read exactly what I was supposed to read, or the discussion turns out to be something completely different from what I expected. With these kinds of outcomes, it’s hard to keep up with the “pre-study” schedule when it feels like studying and not studying gives the same result in the end.

I also want to tell you that this is stupid. Don’t be like me. It doesn’t matter if studying beforehand feels useless, just do it. You don’t even have to read the topic from the assigned textbook, just go through the background basic science content related to the topic selected for discussion. You might not get the output that might be expected from pre-study, but the discussion will be the perfect excuse to go skim through your basic science subjects and it would be super helpful when it comes to the USMLE. Besides, medicine is all about application. How can you understand clinical conditions and presentations without having a strong grasp of anatomy, physiology, biochemistry, and pathology?



Anyway! Let’s get back to our “complete guide” format. If this is the first time you’re reading this series, be sure to check out my complete guide to studying microbiology, pharmacology as well as pathology. The structure I use is pretty simple. We’ll be discussing books and apps as well as some study strategies that you should use to stay on top of your game. Please remember that everyone has different methods of studying and the tips and advice that I’m sharing are all based on my experience and self-analysis of my own performance. This is basically the blog post I would have liked to read before I entered my medicine clerkship. It would have definitely helped me and while it’s a little late for me, it’s not too late for someone else!

Books

Oxford Handbook of Clinical Medicine. I cannot even begin to explain what a fantastic book this is. It’s the pocket dictionary of medicine. If you see something in the wards, it’s definitely in this book. It’s definitely handy to carry around in your white coat during rotations and to consult it as you go over patients and various presentations. However, it’s a handbook, so everything written in it is very short and concise. It’s not a good book to study from. It’s merely a sort of companion guide to help jog your memory of a disease and to list out important things from it. While it doesn’t teach you medicine, it certainly enhances the experience in the wards and I highly suggest that every medical student should purchase it.

Step Up To Medicine. This was the main textbook that everyone was using for the theoretical side of the rotation. Again, it’s a book of medicine so it doesn’t really explain pathologies- it merely discusses clinical presentations followed by imaging and treatment. It’s the imaging and treatment part of the section which is super important. Gone are the days of pathology- medicine asks you to fix the patient, not figure out what’s wrong with them. Here it would be a pretty good idea to revise pharmacology to help augment understanding of the treatment regimes. Again, it’s a very concise book and I personally felt that instead of spending time on reading it, I should have added the imaging and treatment sections into my copy of Pathoma. You see, reading all the pathology again, in a different format from what I’m used to (Pathoma, Anki) was a little jarring and I felt that it threw me off my study balance. It would definitely have been a far better use of my time if I had just taken notes from Step Up into Pathoma.

Clinical Medicine (P J Kumar). My clerkship director would recommend this book every single time he had the opportunity to recommend books. Unfortunately, this is a very big, very fat book. I think it would give Guyton a run for its money. I am personally very averse to buying thick books since I know that I will not be reading them again. You see, I like to have things clear and concise. If I have to study a thick book (like Guyton, for example) I make summary notes and try to squish several pages into a single page of my personal notes and the goal of my note taking is simple: I should never have to open the book again. As a result, I prefer to just read these types of books during school hours in the library. However, P J Kumar was not one of the books I read. Nevertheless, I am mentioning it here because it was the book used by my clerkship director for the revision classes held before the exam.

Davidson’s Principles and Practice of Medicine. This was the fat book I DID read. Only two or three chapters though. Again, it’s super thick and I opened it with a notebook ready to cram the entire chapter into a couple of pages. Needless to say, it’s an exhausting exercise and while there was definitely some active learning going on, I don’t think it was worth it in the end.

MacLeod’s Clinical Examination. This was the book I used for the more practical aspect of medicine. Some of my classmates used Bedside Techniques, which is a much slimmer book with less detail than MacLeod’s. I didn’t use the book as much as I thought it would, but it’s still a pretty good book since it explains what you’re looking for and why. However, some aspects of the examinations are missed out and probably should be supplemented with the videos.



Other Resources

Medscape. I didn’t even know this app existed until recently. Oh boy. The greatest app ever. My favorite part about it is that it saves so many things offline. Even if you don’t have internet, there is a fairly decent amount of information you can still access. This is the perfect app to actually study on when you’ve got spare time. In fact, I could even argue that it rivals the usefulness of the Oxford Handbook since it’s much more detailed and gives a better insight into a disease. Of course, some background knowledge and grasp of basic sciences is necessary to fully understand, but even if you don’t know anything, Medscape can provide just enough for you to be able to make sense of what’s going on.

There are some other general resources you can use (like my favorite, Anki, you saw that coming, didn’t you?) but I think just Medscape is sufficient. I tried looking for an app where you could enter in symptoms and get a list of differential diagnoses (because medicine is almost entirely about building a list of differentials) but I haven’t found any such app yet. I installed one called DxSaurus but I didn’t find it very helpful and it’s not free either.

Strategy

During the middle of medicine, I started keeping a small notebook where I would write in important topics after reading up on them on the internet. I feel like I started this habit way too late and that it should be something that medical students should be doing right at the start of their rotation.

Basically, I would write down a topic or two on my own during the day based on the patients I saw. For example, my first patient that I tried to take a history of was a patient with dyspnea. My history was pitiful at best and it was almost mortifying when I found out that the attendant with the patient was also a doctor. Fortunately, she was a nice person and she sat down and explained the entire history to me and told me to take presenting complaints and build up a list of questions for each complaint, as well as a list of differentials and possible complications. So that day, I went home and started doing exactly just that and I personally found it to be very helpful.

It helps a lot when it comes to history taking because now not only do I know what specific questions to ask, but also what the differentials might be. I’m also carrying this method over to surgery.

A new thing I’ve started doing in surgery (which I would also recommend doing in medicine) is to write notes while in the wards. A senior advised me to keep scraps of paper on hand and to note down all the things I saw that I needed to read up on later, either immediately on Medscape or later at home. Instead of carrying a notebook, I now keep a blank page in my white coat (folded twice) and I take notes on it. At the end of the day, I take a highlighter and mark out what’s important that I need to go over again. Once I’m done, I put a checkmark next to it. I feel like it’s a great way to study on the wards.

Medicine is all about repetition and having things on the tips of your fingers. I feel like it was the perfect rotation to study for the USMLE in, however, two months was not enough time to get acquainted with the rotation, the study methods, and the wards. I hope this post helps you out when it comes to organizing your schedule. Please don’t waste this clerkship, when the time comes.

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Author: Kanra Khan

I'm a Pakistani American student of medicine, or more precisely, an almost-graduate of MBBS Class of 2019. I like to write about my experiences in med school and my adventures in life, which range from traveling, to art, to blogging and photography. Like what you're seeing so far? Consider exploring a bit more! The Lunar Descent is endless.

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