25 July 2013. Historians did not mark anything significant in their record books about this day as nothing special happened on this day, according to them. That day just like any other day holy Ganga donated tens of billions of liters of water to the sea. Same would have been the case with me also, but fortunately I saw a post by one my friends on Facebook because of which I came to know that my first year professional exam results were out. It took just seconds to open a new tab in Google Chrome and open the website and enter my roll number. But life is not that simple as we think. My net setter stopped working. Adrenaline and all other stress hormones had a nice time inside my body. After half an hour, I got internet connection back. Again the same steps i.e. open Google chrome and enter the roll number. A white sheet with black letters appeared on the computer. 70% marks and passed all subjects. My mother who came to me with a cup of tea asked why I was laughing. Even if I explain well, she wouldn’t be able to appreciate the depth of relief that I was experiencing. So I just said I got the ticket to enter second year classes. The burden of household works forced her to leave the scene without asking further questions. My experience would be helpful for the first year medical students as someone rightly said when you plan to take a path about which you don’t have a good idea, do ask the footprints of the adventurers who went through that path before you proceed. So let me share my first year MBBS experiences with you.
Before reaching the college itself, I had an impression that anatomy would the most difficult subject to deal with and first year MBBS syllabus would be very difficult. Later it was proved true. Initial days didn’t trouble me much as the portions were simple (general anatomy and physiology). Sleepless nights and nightmares started with the commencement of upper limb part completion test. I thought only bones and attachments will be asked in the theory examinations. No seniors were there to advise me. I still remember that evening when its answer sheets were distributed. I got only 12.5 out of 40.I couldn’t even score 50%. Physiology department conducted one open book examination out of 50 marks. Albeit having an open book in front of me, I couldn't score 50% marks in that also. Later I improved bit by bit and performed fairly well in the final exams.
Our dissection started after a small delay as our cadavers reached late. I was little apprehensive when I reached the dissection hall for the first time. The smell of formalin was eliciting nausea.One of my friends fell down because of that pungent smell.He later wrote the article "Cadaveric Nightmare". But later I understood that the smell of the cadaver is better than the smell of some human beings. The mistakes that I made in gross anatomy were so funny. I gave so much importance to cutaneous nerve supply because it was coming in the startup pages of each chapter. Neither the teachers nor the god himself gave me any idea about the examination pattern. What to study and what to be skipped????Always this was in front of my mind. Later I realized that cutaneous supply is just 10% important as far as examinations are concerned. Nerve supply, actions and clinical applications of large, prominent muscles are very important, like Pectoralis Major, Sternocleidomastoid and Trapezius.I observed my teachers repeatedly asking certain clinical terms. Those clinical terms are well explained in the BD Chaurasia textbook of gross anatomy and the Vishram Singh text book of gross anatomy. One of my teachers told me without Cunningham anatomy is incomplete. Later I realized that advice is valid for a PG student and rather than UG. For an undergraduate B D Chaurasia or Vishram Singh is sufficient. Certain diagrams of these textbooks are weird. For diagrams I used Gray’s Anatomy Student’s version. If you want to read Cunningham, well and good. But don’t get disheartened if you are not able to follow it. Attending the dissection classes is very important. That will give you a fair idea about the total anatomy. But you cannot see all the structures that have been described in your textbook. That requires time and a magnificent dissector. So it will be good if you collect dissection videos of Auckland or any other. Video of upper limb itself costs around 3000 INR. Don’t worry. It is available on YouTube.
I still consider histology as a boring subject. The reason for this aversion is the headache that I felt while observing slides under microscope for long. But you should practice diagrams by drawing because a diagram will be asked to draw and explain in the final exam. I feel Di Fiore is the best textbook to study histology for an undergraduate. But to build good theoretical knowledge about the microanatomy InderBir Singh textbook of histology is good. For osteology no need to purchase a separate textbook as it is well given in the gross anatomy text book. Do give more importance to those bones which are used to identify the sex of a person. Holding the bone in anatomical position and its attachments are very important. Try to learn the ligaments attached on each bone. Don’t forget to learn the relation between nerve and bone if any because injury to the bone at that site can cause the damage to that nerve which can ultimately lead to muscle paralysis (ex. Radial nerve in spiral groove). Ossification is not that important, but still ossifications of certain bones are the favorite questions of professors, especially those ossifications which can give a clue regarding the age. Those who are more interested in osteology can purchase IB Singh textbook of osteology.
Embryology is interesting. If you learn it well then you will find it easy to understand the gross anatomy also as both are closely linked. Models are very useful to understand embryology. Take help from teachers to understand certain portions like folding and formation of the peritoneal cavity. IB Singh’s text book of embryology is sufficient for an undergraduate. Lanngman is also good. Radiology also comes under anatomy. No need to go in depth because you will be dealing with the same in the coming years also. Just learn to tell whether the given x-ray is a P-A view x-ray or A-P view and some more basic things. Surface marking needs practice. Group study is helpful here. Practice in friend’s body those questions given towards the end of the gross textbook.
Without diagrams anatomy answers won’t be complete. Don’t waste time by drawing diagrams for 2 mark questions, but do remember to draw diagrams from 3 mark question onwards. Some teachers consider the size of the answer also. So elaborate your answer and ask for discussion of the questions after each exam. That will make you understand how to write an answer. Don’t forget to write clinical applications for each long answer question which can fetch more marks.
Physiology is very interesting.Without understanding the concepts of physiology properly it is almost impossible to learn second year subjects like Pharmacology and Pathology. Immunity and respiratory physiology were my favorite topics. The only problem that I faced in physiology was everything for an undergraduate was not given in one textbook. Endocrinology was well given in Gannong but for respiratory physiology and immunity Guyton was better. The style of illustration in Gannong is not student friendly rather teacher friendly. Guyton is one of the best textbook I had ever seen. So simple that even a kid can understand. Students may face little problem in understanding the complementary system of immunity chapter. But don’t get disheartened. The same will become clear when you sit for microbiology chapter. In medicine everything will get repeated again and again. Immunity is very important as it is one of the branch in which a lot of researchers are going on and if you search more you can see that so many Nobel laureates did their research in immunity. Best and Taylor even though is a PG book is good for UG also.Understand the physiology of glands well because the number of patients coming to the hospital with hormonal problems are huge especially thyroid and Insulin. Play with BP apparatus, spirometer, ECG instrument and other instruments of physiology lab and try to become an expert. After all, medicine is not a theoretical profession. You need skills and should know how to deal with these instruments. Those skills will come only with practice and experience. First time when I used stethoscope I couldn’t even get heart sound (obviously I didn’t get lung sounds also). Give more importance otherwise equal to physiology practical against theory.
Biochemistry was my most favorite subject out of the three. For me, the molecular basis of the diseases was the most interesting thing to learn. Do give more importance to those hormones and metabolic pathways which you would encounter more in clinics like Insulin,Gout,Glycolysis etc. Understanding the molecular basis will help you a lot to understand the disease and to become a good clinician.Many hereditary diseases that you study in biochemistry will be repeated in pathology next year. I used Harper and Vasudevan during my first year for biochemistry.Both are good books and I rate Harper ahead of Vasudevan. Cholesterol synthesis pathway and LDL, HDL metabolism are very important, especially in this era of atherosclerosis and other coronary artery diseases.
Since the time is short and the syllabus is vast, the best way to understand each subject is by paying maximum attention to lectures. This will help to build an image about the important topics and the decrease the time needed to spend for each topic when you revise it. But life is not very simple. For me it was the most difficult thing. Even if you couldn't understand some topics or concept, don’t get disheartened because you have plenty of time to understand it. Group study is an effective tool. You may think it is a wastage of time because group studies usually end up in group talks.But believe me, you will remember more those sentences and facts which your friend taught you during the group study time while you are in the exam hall. Second year medical studies are much more interesting, courtesy to early clinical exposure. Seniors will be a great helping hand especially in a medical college. Never hesitate to take help from them because their advice at times can be more useful than your teachers’ advice.
Before concluding, I would like to tell the first year medical students one more thing. Don’t forget to enjoy your life. Don’t hesitate to bunk a class once in a week to watch a movie, but don’t miss a practical class. Do contact me if you need any help. firstname.lastname@example.org and also ready my Final year MBBS Experience.
My website: www.tinyphysician.in