Reading list for med students (non-school books), part 2

Adding to the list from before (Arrowsmith, Complications, When the Air Hits Your Brain), here are three great more titles to check out, just in time for winter break.

  1. Do No Harm: Stories of Life, Death, and Brain Surgery by Henry Marsh
    Marsh picks up where Frank Vertosick left off in When the Air Hits Your Brain‘s description of the painfully underfunded yet clinically astute practice in Merry Old England. Marsh is a somewhat curmudgeonly, seasoned surgeon who is deeply human despite his gruff-sounding narrator in the audiobook version. He recounts incredible stories of his work in England and in communist Eastern Europe. This is a very entertaining read! Complementary to Vertosik’s book, it is more thought-provoking about the medical system but less thought-provoking about brain surgery and humanity.
  2. House of God by Samuel Shem
    Although it recently came under some criticism in the New Yorker, this book is a classic chronicle of life as an intern with some unforgettable characters. This book chronicles intern year at a Boston hospital for a graduate of BMS (Best Medical School) and is an absolute must-read for interns. It features an unbelievable cast of characters and several immutable Laws of the House of God. Some of these laws are useful (Age + BUN = Lasix dose)*, others just funny (Show me a BMS (Best Medical Student, a student at The Best Medical School) who only triples my work and I will kiss his feet;
    If the radiology resident and the medical student both see a lesion on the chest x-ray, there can be no lesion there;
    The delivery of good medical care is to do as much nothing as possible.)
    All specialties should read this book.
  3. The Puzzle People: Memoirs of a Transplant Surgeon by Thomas Starzl. Dr. Starzl was a softspoken and incredibly hardworking surgeon who — nearly singlehandedly — invented the field of transplant surgery. He was hardworking to a fault (his secretary found him crawling to his desk to finish a manuscript when he was having a heart attack, and he sort of neglected his family), as you’ll see in the book. This book, however, gives you an incredible window into a great man’s life and career, and is highly recommended! We have come a long way since the first effective immunosuppressants were discovered. Starzl not only had incredible surgical technique that he perfected in groundbreaking surgeries, he also tirelessly worked to optimize immunosuppressant regiments in animal models and ultimately in the brave patients he took under his care.

*Med School Beast does not provide medical advice and is not responsible for the consequences of any medical decisionmaking you make. However, a good nephrologist I spoke to once said this formula actually works pretty well most of the time

The three best non-school books for medical students

Physicians have spilled plenty of ink over the years on matters academic and nonacademic. During (and before) the long slog of medical education, the following books provide telling insights into the practice of medicine and surgery, the psyche of patients and physicians, and – in a larger sense – what it means to be human.

  1. Arrowsmith by Sinclair Lewis. Written by Nobel laureate Sinclair Lewis* in 1925, some of the science and the idioms are getting to be dated, but the timeless conflicts our protagonist Martin Arrowsmith faces are still relevant today.Arrowsmith follows the education and life of Martin Arrowsmith, an all-too-human Midwestern doctor as he grapples with medical school, his love life, and a career as a physician and scientist. Along the way, he grapples with local politics and with positions that force him to shove his passion for research to the back-burner and sell out for profits. In the end, he must grapple with being a good scientist and live up to his mentor’s admonitions, or trying to help as many people as he can. Arrowsmith’s personal flaws make him an eminently relatable protagonist, and Lewis’s writing effortlessly ties together scientific fact with expert storytelling. I stayed up until 4:00 AM finishing this book; once it picks up, I doubt you’ll be able to put it down. Despite its age, the conflicts Arrowsmith faces in his profession are perennially relevant, and you will think about this story long after you put down the book.It was adapted as a film in 1931, but the reviews say that this one’s a dud! It may be the moustache that does this one in.Arrowsmith_poster
    I’d like to once again give a shoutout to Ian Drummond’s excellent podcast, The Undifferentiated Medical Student (featured here on MedSchoolBeast), as Dr. Bryan Hambley mentioned this novel on the first episode, and I otherwise would not have heard about it.*With lots of help from microbiologist Paul de Kruif, who received 25% of the royalties but isn’t mentioned as an author!
  2. Complications: A Surgeon’s Notes on an Imperfect Science by Atul Gawande. Gawande, a surgeon at the Brigham, has become famous for his excellent, simple writing (four books and pieces in The New Yorker). Though it’s his first book, Complications is the most engaging; he reflects on his most intense cases from residency in it. His later books, while good, lack the rawness of Gawande post-residency. Better: A Surgeon’s Notes on Performance gets an honorable mention. Being Mortal: Medicine and What Matters in the End is an illuminating and thought-provoking look at geriatrics. I have not read The Checklist Manifesto.
  3. When the Air Hits Your Brain: Tales from Neurosurgery by Frank T. Vertosick, Jr., MD. This one came recommended to me by another MD/PhD student. Books by surgeons are a dime-a-dozen. Most feature hard-hitting, exciting stories about cases and seldom reflect on anything more profound. Vertosick, however, is a deep thinker. As he works through medical school and a grueling seven-year residency (with a detour to England in the middle), Vertosick considers the meaning of his work and what patients really want out of their surgeons. This one will stick with you.


The 3 best podcasts for medical students

When commuting, working on chores, or waiting in line, listening to podcasts will keep you productive and will unleash hours you never knew you had. Here are three of my top pics to get you started.

  1. Goljian (late MS1-MS2)

Time listening to Poppy is time well-spent. You’ll pick up lots of high-yield pathology information and you’ll hear some old-school Brooklyn English. I previously covered this podcast here. Here’s the link to the audio files… …and a backup in case the first one goes down.

Dr. Goljan about to snap the wrist in an armwrestling match with an overconfident student.

2. Emergency Medicine Cases (EM Cases) (MS3-MS4)Screen Shot 2018-06-24 at 7.28.34 PM.png
As an MD/PhD student in grad school, I’m always hunting for ways to stay on top of my clinical knowledge so the transition back to med school isn’t too rough. EM Cases gives a good mix of “Best Case Ever” episodes with bone-chilling tales from the ED combined with longer overviews of a topic. They bring in top guests from all over Canada, and have excellent discussions and quality production.

3. The Undifferentiated Medical Student (TUMS)

As the match loomed closer, rising MS4 Ian Drummond was feeling overwhelmed with the decision about which of the 160+ specialties to pursue. He took some time to get an MBA and think about it. To help him out, he is on a quest to interview a practitioner from all 160+ specialties.

Ian sits down with physicians from tons of specialties on his show. Most of them practice at Case Western (his home school), though he has been branching out and recording interviews with top physicians and surgeons from around the country. His interviews follow a well-prescribed format in which he asks questions culled from surveys of twenty MS3s and MS4s. The interview consists of three segments:

  1. About the specialty
  2. How did they choose their specialty
  3. Long-term career advice (irrespective of specialty).

Ian is a thoughtful and effective interviewer who draws out valuable pearls from his guests, though I’m not sure I’ve ever heard anyone say “thank you for that” so often. His production quality is quite good, and you can see that he’s dedicated significant time and money (for a medical student at least!) to record a quality podcast. He sends the questions to the interviewers in advance, so they bring well-thought-out answers to his questions. He’s also a pretty interesting guy himself, having been a semi-pro hockey player in Sweden before starting medical school.

A few episodes take on other formats (including two episodes with advice from three MS4 buddies who matched into top specialties), making it a dynamic and well-rounded show.

Ian Drummond and his matched MS4 buddies (Roy and Marco Swanson, Dana Canfield) sitting down to record an episode in his “studio.”

Coming soon: 3 more podcasts to check out!

Review: “How I got a 260” USMLE Step 1 Advice Podcast

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I recently came across a well-done episode of the excellent Surviving Medicine podcast entitled “USMLE Step 1 Advice – How I got a 260.” Frank Cusimano, the medical student and PhD candidate who hosts the show, deviates from his usual interview format to read a letter from a colleague who scored a 260. The letter, though quite dense, brings up a number of good points that are worth reiterating. Here’s a summary of some of the take-home messages (with my own advice sprinkled in, marked with MSB>), though I highly recommend checking out the podcast via the above link (or via iTunes/Google Play/other Android apps).

  • Other people may have come up with study plans that worked for them, but you need to tailor one that will work for you.
  • There is no substitute for quality time spent studying.
  • There is no substitute for learning the material correctly the first time! A recipe for failing Step 1 is trying to make up for not learning the material in the first place. Step 1 study resources are review resources. If you don’t learn the material properly during your MS1 and MS2 years, there’s nothing to review.
  • The difference between a 220 and a 260 is random facts from your courses that are not in First Aid. That’s why it’s important to learn the material in-depth the first time (see last point). Further, that’s why it’s important to relegate First Aid to its proper place. You may wind up with four detailed questions on urinary incontinence (as the letter-writer on the show did), MSB> or four on chronic granulomatous disease (as I did).
  • That said, First Aid is an essential reference, and it’s important that you know about every topic listed in it.
  • During MS2, familiarize yourself with your Step 1 resources during the courses. Get a feel for what material is important for the boards. Also, by learning your way around the books you’ll be using to review for Step 1, you’ll be able to hit the ground running. Don’t go overboard though. Relegate First Aid to a quick 30-minute perusal during each course. Pathoma can be used much more thoroughly during the organ block courses; MSB> I recommend at least going through all the videos. If you have extra time to listen to podcasts (after listening to your medical school coursework and then to Goljan), you can listen to Pathoma‘s audio files as well.
  • What you shouldn’t worry about:
    • How you score on UWorld questions (it doesn’t matter until ~7 days out).
    • Finishing UWorld. Quality use of UWorld (post forthcoming) is more important than sacrificing depth so you can finish all of the questions.
    • MSB> What your classmates are doing.
  • Apparently you must get ≥6 months of UWorld in order to have the option to reset the Q-bank (question bank). MSB> I personally never reset my Q-bank though.
  • UWorld is the most useful Q-bank, and I didn’t like Kaplan. MSB> Don’t buy any other Q-banks. You won’t have time to use them if you’re going through UWorld carefully and using a variety of books that most of your classmates will have overlooked to review (as I recommend). I also tried Kaplan and didn’t like it. None of the other Q-banks write questions anything like the test, nor are their figures and explanations as good as UWorld. They are not worth your time.
  • The NBME practice exams (with the score reports) are the most useful predictors of your score and provide crucial practice for test day. They don’t let you review all the questions though, MSB> but there’s a good method I used to help get around this (post forthcoming). Also, to predict your score, you can combine NBME tests with your UWorld data
  • Don’t take a practice test within the last 5 days.
  • Do lots of UWorld questions with mixed material the week of to keep yourself fresh and prime your brain to answer USMLE-style questions quickly.
  • Plan some half days and some full days off of studying to do something you enjoy (MSB> preferably something that won’t cause a massive hangover).