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The Big Picture


How do we know what we need to commit to memory when it comes to studying for an exam or for the boards? What are the things we can gloss over? Well, you should focus on the big picture. You should focus on things that are testable (ie. Standard of care and non-controversial). What do I mean by this?

Let’s take cardiology for example. Anatomy and physiology are things that are known without debate, and are a pre requisite to your understanding of the various disease processes. Therefore, you should know these like the back of your hand. I would spend as much time as possible understanding these concepts. What are other things that are tried and true? You should know that beta blockers, aspirin, and PCI improve mortality in those patients with an MI. These are not things that are debatable, but rather are the standard of care. An example of something you might not need to know is that a recent study was published stating that morphine might reduce the efficacy of clopidogrel. Why? This was one study, this is not going to be accepted by everyone, and does not change the fact that the standard of care in MI patients is to give morphine for pain, followed by clopidogrel.

Your exams will not test you on things that are controversial or debatable. Looking at this another way, if there are two diagnostic tests to choose from, that are equally effective, they will not have you choose between the two. I know I would get hung up on this fact during my studies. But the truth is, they will only have one of those options on the exam, so do not spend all of your time trying to figure out the nuances of when to order each of these (unless it’s the standard of care – CT in CVA, not MRI). The same goes for treatment options. Now, you should be aware of certain contraindications to treatments. Contraindications are NOT debatable, and will present on your exam. They might give two correct options, however, one medication will have a contraindication and the other will not. This will be the case when students say, “well they are both correct”.

Medicine is a large and complex subject. There is an infinite amount of knowledge to retain that is impossible to do in the short two years you are in school. You need to familiarize yourself to all organ systems and the basics of each disease. Now, if you go deeper into this, within each organ system is a substantial amount of disease. Do you need to read up on all of them? No. Focus on the blueprint; this is what your school and boards want you to know. How do they choose what goes on the blueprint? Well, these are the most common diseases within each organ system. Another thing to keep in mind is to know common presentations of common diseases. This is what you will see in practice most, and is what you should prepare for. An example of this might be to know that classically pericarditis will present as sharp and pleuritic chest pain that is relieved when sitting up. However, there are a subset of patients that can present with a dull or pressure like sensation. The latter is something to know clinically, but not for your boards. This is where things can get tricky, because the boards won’t expect you to know all variations of all disease, but in real life, your patient doesn’t read the textbook on how they should present to you. Which brings me to my next point: passing exams does not correlate to how well you will practice medicine, and visa versa. Now, would I commit that variation to memory if I were a student? Probably not. Why? Like I said, you should focus on common presentations of common diseases. After you have these basics down, then focus on the details (ie the various way this might present). If you don’t approach it this way, you will get over whelmed with all the information thrown at you; because in the end, anything can be anything.

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Founder of PA BOARDS