Things You May or May Not Need: Part 1

Save Your Money

As you can imagine, medical school is a fairly expensive undertaking. It will also consume huge quantities of your time. With this in mind I’d like to go over a few things that you do and do not need either because they are expensive or because they will complicate your life rather than simplify it.

Just my opinions, of course. Your mileage is going to vary considerably depending on your comfort level, your school, and your financial resources. I will endorse some products but I am not being paid to do so (not that I wouldn’t like to be, you understand). Please don’t post angry comments.

First and most important, you really don’t need textbooks. Good Lord. Why would you sacrifice huge quantities of your study time parsing closely packed text for the few important facts buried therein? Of course you need study materials but like everything in medical education, you want them to be “high yield.”

The typical Biochemistry textbook, for example, is an 8-pound 1200 page behemouth full of essentially useless trivia. Not only that but you could easily drop 150 bucks for it, barely open it, and then lug it around from residency to fellowship to your first job before you get the courage to throw it away.

The first thing you need to understand that in a lecture based-curriculum, the tests are based on the lectures. In other words, essentially all of the questions you will be asked on any test will come from either the material presented in the lectures or from the course syllabus (Oftentimes a packet of handouts and notes). Occasionally you will get a list of “required reading” from the approved textbook for the course but this is usually just wishful thinking on the part of the professor.

I suppose a professor could enforce the required reading by taking his questions from obscure details only to be found in the textbook. In two years of lecture, however, this never happened. Occasionally the professor would throw in a few trivia question from the textbook but, as medical school tests usually run into the hundreds of questions, the potential to miss a couple of questions is not much of an inducement to miss potentially forty or fifty questions through wasting time studying trivia.

The key is to have access to good notes. Notice I didn’t say “take good notes” because it is almost impossible to take notes during a medical school lecture. Unlike undergraduate education where the courses proceeded slowly, dwelling over the subject matter and allowing time to digest and annotate, medical school lectures are a study in information overload and there is just no time to take decent notes.

But don’t despair. Usually one of the first orders of business of your newly elected class officers will be to set up a note taking service. There are many variations of this service. Some classes divy up the lectures among the students who are each responsible for preparing the notes for the lectures they are assigned (usually by transcribing from a tape after the lecture) and then emailing them to the class.

Our class hired a professional note-taker who sat in on every lecture with her tape recorder and then emailed the finished product to the people who subscribed to the service. I never bought the notes because my school posted the lectures (Power-point presentations, mostly) on our class web site and I studied directly from these. I though the note-taking service was redundant as it usually just recapped the Powerpoint presentations.

So don’t sweat it. With a few exceptions, eschew the textbooks. Instead, judiciously acquire review books. High Yield and BRS are the most popular and they have them for every subject. You will probably pay 20 bucks for a good Biochem review book which will have only a small fraction of the information in it’s bloated cousin but since you will actually read it and only the relevant information is covered you are going to come out way ahead.

With all this being said, you probably need to get a good anatomic atlas. Netters is the gold standard and you cannot go wrong buying it. A photographic atlas is also pretty useful. I liked my Rohan’s Photographic Atlas and still use it. Avoid buying a big pathology or physiology book. First of all they have them in the library or on line and if you really need to read them you can find them their. Second the review books will cover the things you really need to know.

Remember. Medical school is all about time management. Use your time efficiently and effectively.

How about diagnostic equipment? What will you need and what can you avoid buying?

You will need a good stethoscope. Most people get the Littmann Cardio 3 or one of similar quality. Not only is auscultation of the heart an important diagnostic skill which should be an inducement for you to get a good quality stethoscope but your stethoscope is kind of de facto badge of authority. You will probably end up wearing it around your neck and your patients will recognize this as your license to stick your finger in their rectum pretty much at will.

In the old days a rolled up piece of paper sufficed as a stethoscope. There are still old-school cardiologists who insist that they can hear just as well with the el-cheapo Rite-Aide stethoscopes but for my part I like to be able to hear the heart and any technical advantage I can get I will take. I would unashamedly get one of those new electronic stethoscopes except I am a resident and can’t really justify the expense. By all means look on line for a good deal but don’t skimp here. You will probably use this thing every day for your entire medical school and residency career.

Otoscope? Opthalmoscope?

Save your money.

I know. I know. It is on the “required equipment list.” Maybe you can’t avoid buying them but buy the absolute cheapest models you can possibly find because you will probably only need them for standardized patient exercises where it doesn’t really matter if you see anything or not. The patients are pretending to be sick and you can pretend to look at their retinas and into their ears.

When you start seeing real patients in third and fourth year you will find that every clinic will have an otoscope and an opthalmoscope on the wall. You will never, ever bring yours to work with you for several reasons.

First, even if they are not lost or stolen if you bring them invariably somebody will want to borrow them and in a matter of days they will somehow wander away and become common property somewhere in the hospital. The only way to prevent this is to exercise constant vigilance which you will not have time to do. You may have paid 400 bucks for them but to a causual user they are just like a pen or other “freebie.”

Second, they are heavy and bulky and you will already invariably be carrying around a white coat “combat load” which would make a Marine wince.

Trust me. Nobody carries them around. If you must, look on line for the really, really small otoscopes which fit in your pocket like a pen. They run around 100 bucks and are all you will need for a pediatrics rotation.

Blood pressure cuff? Don’t make me laugh. I suppose you’re going to carry all of this stuff around in a little doctor’s bag. (Neurologists who need a lot of tools actually do carry around little bags.) Nurses usually take blood pressures and measure other vital signs. You may occasionally want to verify a blood pressure but the cuffs are on the wall in most clinic and hospital rooms.

Reflex hammer? Why not. You can use the bell of your stethoscope of course but a nice reflex hammer will only set you back a few bucks and it will fit in your pocket.

A penlight is indispensible for examining the eyes and for looking into the mouth and other body cavities. These also fit in your pocket and are cheap. Knock yourself out.

To Be Continued…