Will you survive the second year of medical school? Or more importantly, will you learn? Will you enjoy it? I think you’ll find that the answer is yes to all of the above.

Despite anything you may have heard, you will have the strength to survive. At the same time, you’ll live and learn pathology and public health. You might even decide that medicine isn’t for you. It’s okay. You’ll enjoy it all the same.

The Dreaded YL6

In the Ateneo system, we call second-year medical school “YL6”. But it’s more popularly known as “YHell6“.

Every year, medical school gets tougher and tougher (don’t let anyone tell you otherwise). Increasing capacity means increasing challenges. But if you ask older medical students what’s the hardest year to conquer in terms of medical theory, they’ll answer second-year medical school 99% of the time.

(The latter years of medicine will test other skills: social and emotional intelligence, physical stamina, mental dexterity, will to keep going.)

1. Information overload

Human beings rely on gradation to learn. Before we can analyse, we need to know how to comprehend. Before we can comprehend, we need to know how to read. We build on the knowledge we learned in the past to make new information more digestible.

The first year of medical school is chock-full of linear building blocks. Students start with a visual model –the cadaver– which we dissect in bite-sized pieces. Here’s the chest, then the lungs and heart, then the abdomen. Here’s morphology, and then function. Morphology, physiology, repeat.

(Oversimplified, but that’s basically first year medicine.)

Pathology is trickier. Unlike anatomy, you can’t always link diseases to one another based on proximity. There won’t always be a way to logically build upon information you just learned; sometimes you just have to accept the way diseases are presented to you.

In second year medicine, you’ll be given literally dozens of diseases to grapple with each module. For any organ system, diseases can be sorted by epidemiology, etiology, pathophysiology, or symptomatology. Instead of a nice table on origin-insertion-action-nerve supply for muscles, you’ll have to create flowcharts. Lots of flowcharts.

 

On some days, you feel like you’ll have to leave out diseases because you just can’t process everything. You’ll feel like crying because it would mean a disservice to your future patients. And you probably will be crying when the exact info you skipped out on comes out of the exam.

Dealing with what seems to be information overload is not impossible. But it does require a conscious shift in perspective.

There’s no way around having to memorize and deal with hundreds of diseases throughout the year. But pathophysiology in itself –the process of the disease– tends to be reasonably easy to understand.

If you really try to digest the information instead of just memorizing off-the-bat, you’ll find a method to it. Signs and symptoms don’t come out of nowhere. You have to imagine the process that stretches from cause to the manifestation, from the insect bite to the inflammation and then to the redness and swelling.

For incoming YL6 students, there are many things that can help deal with information overload (which I can now only say in hindsight):

1. Get inspired. Remember that you’re not the only second-year medical student struggling. Look to your seniors, your batchmates, and people across the globe vlogging their study styles.
2. Value the introductory courses. Principles & perspectives 2 seems like an abrupt transitionary module from summer to the rest of the year; don’t be shocked. And don’t take it for granted. Done correctly, principles & perspectives 2 gives you the framework you need to understand the flow of the year’s curriculum. Likewise, Basic Pathologies 1 and 2 are more than just stressful modules. They’re the foundation you’ll be building on for the rest of the year.
3. Open your books. Robbin’s and Harrison’s are your friends. The way they organize content is pretty much the most reasonable way to systematically tackle diseases. It usually goes Epidemiology – Etiology – Pathophysiology – Morphology – Clinical Features/Manifestations – Treatment. It’s never too early (or even too late) to read the books.
4. Listen in class. This is ironic, because I was only fully awake for 50% of all YL6 lectures. But I realized that good lecturers are able to really communicate which information are vital, and which aren’t. Transcriptions simply can’t convey that kind of emphasis.
5. Repetition is key to success. There are a lot of terms you’ll encounter during P&P2, FCH, BP1 and BP2 which will sound foreign. Some of these terms will come completely or relatively unexplained, and lecturers will tell you not to worry about it, it’s just nice to know. Take the initiative to research on these terms as soon as you encounter them, even if you know they won’t show up in the exam next Monday. Why? Because these terms will definitely come up in some module down the road, in a few months’ time, and it’s better to have some groundwork already covered. In second-year medicine, familiarity is still key.

2. Running out of time

Losing out on extracurriculars and personal time is only half a myth when it comes to second-year medical school. It’s true that you won’t have as much time as before, but it’s definitely untrue that you’ll be all work and no play.

With long exams every Monday morning, papers for SGDs and patient encounters, and other fun learning activities cooked up by ASMPH, life’s just too busy. It’s even worse when you have to think about information systems and financial accounting at the same time as medical exams. (I’m not hating though, I love MBA).

Always prioritize your mental and physical health, and that includes having social, creative and physical outlets to enjoy yourself. Sleep. It might seem like the end of the world if you don’t study tonight, but some things are more important than getting a passing score (even if it doesn’t feel like it, I promise).

To balance personal time and the feeling of wracking guilt because you’re not studying, the solution is….. time management. It’s the solution that business consultants, guidance counselors and leadership coaches have been pushing for years, and it really works. You don’t always have to miss birthday parties and clan reunions.

1. Study everyday. The reason why I can personally not study during the whole weekend, or why I can go to a dinner with old friends on weekdays, is because I’m never afraid about falling too far behind. I learned to form the habit of studying material daily, even when the Monday exam still feels far away. You can consolidate your notes from the morning’s lectures, or read ahead for tomorrow’s. Either way, you lessen your anxiety about having to cram everything during the weekend.
2. Engage in other commitments. It’s easy to let studying become an excuse to stay disconnected with the rest of the world. Before you can consume yourself in a tide of work and no play, commit to other things. ASMPH culture is full of initiatives that can help you relax or be more productive in other ways.
3. Accept failure. We always feel anxious because we feel like we haven’t studied enough. We always push ourselves to study more, or study better. While competition with one’s self is important to improve, it’s not always healthy. I learned to accept that I really won’t be able to study everything, cover to cover, even if I had all the time in the world. It’s just how human brains are designed. Limited, until next time.

3. Comprehensive exams?

Entering YL6, the year-end comprehensive exams seemed like a dream. Kind of a nightmare, really, but still too far away that it doesn’t really make a difference.

We’ve all run the numbers. The year-end module exams don’t really matter much when it comes to your final grade, unless you’re on the brink of pass-or-fail, so don’t stress out on it. The best way to prepare for the back-to-back lecture and laboratory exams is to listen to lectures throughout the year, and to actively engage all learning opportunities.

For the Grand Patient Encounter, trust in your groupmates. Assign responsibilities beforehand, and rely on what you’ve learned through the many patient encounters in the past. Be honest with your preceptor if there’s a task you haven’t learned to do yet (like DRE).

The OSCE (objective structured clinical examination) and the Revalida (oral integrative exam) are the two most dreaded exams come May. I also felt a lot of anxiety over the Microbiology Laboratory Exam (Unknown Determination). 

But honestly… it’s over before you know it. 

Know why you’re taking the test. As I said, these tests don’t really impact your final grade. But the Grand OSCE and the Revalida are key to whether-or-not you pass the whole year. The oral exam is meant to test the breadth of your knowledge and the rationale behind your decision-making process, which are things you’ve ideally developed in YL6.

You’ll be given a case, 30 minutes to prepare, and 30 minutes to discuss the facts with your preceptors. There will be questions to prod you along. I ended early, so I got the privilege to see one of my grading sheets; there are bonus questions, and some questions where you’ll only get a maximum of 1 point, no matter how many factors you list out.

The best bet for both OSCE and Revalida you’ll have is to know the most common diseases. These are the diseases that often come up in exams, integration sessions, SGDs and patient encounters. These are also the disease entities that keep cropping up in different modules, because they tend to involve multiple systems and have a wide range of clinical manifestations.

Trust in Bates and Harrison’s. Watch YouTube videos which simplify everything. Don’t panic. 

xxx

It’s not all a big scramble to meet the challenges of a tough year. There are plenty of things to look forward to. I’d start featuring all the fun I had throughout the year, but I’m already at 1700 words and I may or may not be tired.

I need to gather all the introvert energy I need to survive YL7. Let’s go!!!

Thank you to everyone who helped me through YL6. :)