“Hello everyone, please take the chart. Read the patient’s info. Knock and walk in.”

Name: Frank Bepidis

“After you introduce yourself, go ahead and take a history of present illness… Easy as pie.”

Have you ever made a pie?

“Go ahead whenever you’re ready.”

Just focus… You have a minute. How am I going to introduce myself?

Hi. My name is Irvin Bussel.

Ehhh…

Hello. I’m Irvin Bussel.

Hmm…

Hey. Future Doc Bussel. What’s up?

Not happening.

Vast analogies can be drawn in regards to the process of speaking. I’ve been known to make comparisons to coloring. We are born with an amount of color crayons and draw with what we got. There are ways to improve your proverbial coloring, but having a stutter curses you to never being able to color within the lines. I was fortunate to realize that even coloring outside the lines can be considered art.

“Come in” replied Mr. Frank Bepidis as I knocked on the grey office door.

Every thought was ricocheting in my mind between past experiences of stutter-prone words and fear of judgment. I was accepted into medical school. This had to show some level of competence. Yet, it could all be popped with a single verbal speed bump.

Stop ruminating! Does ruminating make it worse?

Well studies show that…What the fuck is wrong with you! Get out of your head.

Telling someone you stutter is always an odd and awkward moment. I do it as a pre-emptive tactic. Few things make me more anxious than noticing the immediate moment someone realizes I stutter. Our species is programmed to spot flaws and facial language changes when someone becomes aware of one.

“Hi Mr. B-B-Bepidis. My name is Irvin Bussel… Before I begin I’d like you to know I stutter.”

Supposedly it’s because I have excess dopamine. Or is it a defect somewhere on chromosome 12? I like to believe it’s because I think faster than I speak.

“How would you prefer to be addressed Mr. B-B-Bepidis?”

“Frank is fine.”

Did he actually prefer Frank or did he think it’s easier for me to say?

Stutterers experience breaks in fluency at various points in the flow of speech. My problem is getting started– equitable to juggling; I just have to get the balls in the air to keep them moving.

“I’ll be taking a history of your present illness today then we can discuss any questions you may have.”

The exchange goes well. Frank had abdominal pain that got worse with… Wait… I’ve been sworn to patient confidentiality… I promise you it wasn’t that exciting– It never is.

This exercise was supposed to be an educational experience, but what did I learn?

You play the cards your dealt. You work with what you’ve got. You color with your crayons.

You attempt to speak without a stutter.

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An aside regarding therapy options:

I have attempted to assess the difference between spoken words and stuttered words. Mental algorithms and attempts at finding patterns were of no help. Neither was therapy. It was constantly one big act of attempting to show how much effort is being put forth to help with my stuttering: the illusion of progress.

“Have you sought out therapy?”

Yes. Yes I did.

You know what’s the best that therapy had to offer me?

Take a deep breath and speak slower.

That’s right folks… Breathe more. Talk less.

But wait… there was also a consolation prize!  No it is not an affordable Korean mid-sized sedan; it is a metronome hearing aid. I don’t know about you, but I’d rather stutter. Someone is bound to think it’s a cute quirk.

As a facilitator for the Department of Physiology, I want to help students appreciate and succeed in their medical physiology course without stress. There is a unique best way to study for each course/professor. I aim to have you study less but in a better fashion because nobody wants to study endless hours and still not score as high as they hoped.

Medical Physiology is a unique course because it is not about memorizing facts but rather building a mind-set and framework for thinking about the function of the human body. With that in mind, realize that you are not taking medical physiology to become a doctor– you will learn that by doing. You are a medical student. There is no M.D. after your name… yet. Study for the exams and all else will fall into place.

Even though everyone inherently understands that they have to study for exams, they still study to be a doctor. You are not studying medical physiology to become a doctor. You’ve been studying to become a doctor since three years of age when you were learning your alphabet and numbers.

Get the difference?

Once this is clear, you can actually use your exams for what they are– directions for how to do well in your medical physiology course.

If you just study medical physiology without looking at past exams, you will not do as well on the actual exams as you would like. The course is just too broad for you to base your studies of what you assume to be important. As long as you went to lectures or have even a remote idea of what material you covered, you should take a look at the past exams that are available. Record what topics are addressed most often in questions and hyper-focus your studies to those high-yield areas. You should review all of the material presented but be sure that you have a thorough understanding of the high-yield concepts.

Do not wait to take practice exams days prior because you are not as ready as you would like to be. You will never be fully ready– ever. Nor will you achieve perfection. You can however strive to be excellent. The very act of taking the practice exams will better prepare you for the actual exams and will provide further direction regarding your weaknesses. During your study sessions, you should be in a constant state of awareness that there are critical points you still have not learned.

When taking the practice or actual exam, always do the easy problems first. Additionally, on multiple choice sections, your attention should be devoted to finding the wrong answers. Since there is only 1 correct answer and 4 wrong answers, it is not only easier to eliminate wrong choices but it also increases the probability of having to make a guess if necessary. While you are eliminating wrong answers and picking the correct choice, it is crucial to briefly write out your rationale for each decision. This redundancy not only ensures you didn’t misread but also primes memories that may be advantageously accessed for later questions. I stress proving wrong and right answers because answer choices on exams are repeated more often than entire questions. More importantly, questions are often changed while answer choices are not.

After any exam, a post-mortem type of analysis must take place. What went well? What went wrong? Stupid mistakes? Lucky guesses? Constantly evaluate performance, analyze trends, and implement improvements.

On a final note, do not waste time engaging in debates on minutiae and rationalization battles. The reality is that most rationalizations are based on faulty assumptions and unless evidence can be provided, these communications are a complete waste of energy, air, and time.

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While all courses will promote various text books, I think the best sources, if you need them, are the following:

1. Ganong’s Review of Medical Physiology by William Ganong
2. BRS Physiology by Linda S. Costanzo

The alarm was set for 7am. I awoke at 6:36am with intensity. I haven’t thought about it much but today we are going to “meet” the bodies that we will be dissecting in anatomy. All med students wait for this moment with enthusiasm. But what is everyone feeling this morning?

Curious? Anxious? Excited? Scared?

I couldn’t even tell you what is going on between my two ears.

I think this will be brutal. Does it matter what I think– probably not.

2nd week into medical school and we are about to cut open a recently dead but well-preserved human body… hope it sounds worse than it actually is.

During Anatomy Lecture…

Sitting through the didactic lecture before the hands-on lab, words like lubricating and skinning are used in relation to the human bodies.

The professor reminds us that bodies are donated and once the anatomization is complete there will be a ceremony to honor and respect the bodies that were donated to science.

After Anatomy Lab…

It was like seeing kids break for recess in elementary school. Everyone ran to get the best tetherballs and scalpels first.

Standard uniforms: scrubs, crocs, and gloves. There was no fashion rebel calling others sheep… at least not in this setting.

Having been split up into groups with about half a dozen individuals to a body the familiar med school phenotypes became apparent.

They jock/future surgeon fixated on being first to cut.
The hyper-competitive girl with something to prove.
The shy guy that hovers and whimpers if he can help.

Time and time again… these roles never change.

As we unzipped the white body bag revealing the cadaver, everyone’s honest visceral reaction was clearly the same….

“Oh shit… What. The. Fuck. Am I doing here?”

Too bad their outward signaling didn’t match…

Comments regarding the similarity of dissection to various meals and cold cuts were put forth:

“Just cut it like your cutting a steak.”
“Wow… it looks just like roast beef.”
“Doesn’t this feel like your skinning a chicken?”

No gasps. No shock. No awkward silence. Just silent acknowledgement that we are all thinking the same thing.

At that moment, standing with 5 other class mates, we were assigned this body for the next 9 months. We were supposed to share the body in our anatomizing experience… 1 Body. 6 Students.

16.6% cadaver per student.

Are these reactions perverse and twisted?…Yes.
Are they in any way wrong and inappropriate?… No.

There is no right or wrong way of dealing with the anatomy experience. We are all just thrown into the ether of formaldehyde and dissection tools.

Sink or swim.

Cut or get out of the way.

I hate both of those mindsets but they are part of the process.

1. Those who think they like research – Type A
2. Those who want to like research – Type B
3. Those who truly like research- Type X

The type A folks, just as their name implies, are usually perfectionists with aggressive and assertive behavior patterns. They have excelled in clearly defined school work their whole life and usually derive much of their sense of self from those accomplishments. Since the research process lacks instruction and involves thoroughly evaluating the apparently mundane and trivial with an original purpose, the type A camp is constantly in an unsettling state of mind. They are bothered by the lack of strict guidelines and the flexible fluid mindset that is required to persevere. They will do as told and will do an excellent job no doubt. However, they will rarely question the process let alone what other people in the lab are doing. Research is not much more than formalized curiosity, yet these types are constantly waiting to be handed the next project that will earn the Nobel Prize. They have a poor understanding of the research process and believe they are entitled to a project. They lack the insight to realize that a successful research project is achieved through countless hours exploring possibilities, failing constantly, and evaluating efforts in hopes of finding a truly novel piece of information.

The type B group has a clearer understanding of the process and genuinely wants to like research. However, there is a deep-seated feeling that their efforts could be better spent elsewhere. Research, while a noble pursuit is not for everyone. Realizing this about oneself is not a detriment but rather a blessing. There is no better realization in life than finding something is not a fit for you- that you can’t square a circle. It is a valuable and mandatory detour on the road to finding what you truly have a passion for. While anything is possible with enough work, allocating time and effort should always be looked through the frame of a cost-benefit analysis. Is it worth the tremendous time and effort to become mediocre? Everyone should strive to be the best at something they have a passion for. Does a type B go to sleep being dead-tired doing what they love? If not, why keep doing it?

Type X. They can’t imagine doing anything but research. No matter what they do, all their mental exercises come back to the process they are so comfortable with. Similarly to how writers write, musicians make music, researchers research. They toil in the trenches of laboratories, sit behind the glare of their computer monitors, and are incessantly writing in their research notebook. This notebook is but the fifth extremity- losing it would cause a visceral reaction equivalent to loosing an actual limb. I do not mean to paint the picture of an introverted hermit. Quite the opposite, the type X usually has a wide range of interests outside their own work; a necessary source for the stimulation of new ideas. Discovering original data or untangling a puzzle is their nirvana.

Let me be clear: I do not think there is any correlation between what category you fall into and the success you can achieve. However, I do always wonder about the distribution of Type A, B, and X throughout society’s various industries.

It is not an effective tool in studying for exams except in dire circumstances. Ultimately, it is the Hail Mary approach to studying- the bottom of the barrel of tactics.

This cram session should be avoided since it not only results in diminishing returns as time progresses, but also further inhibits your cognitive efficiency and mental acuity. However, no matter what evidence is presented, many students will still feel the need to resort to this approach.

The point of this is not to absolutely advise against the use of an all-nighter, but rather to mention the value of the pre-emptive all-nighter.

Rather than resorting to pulling an all-nighter out of necessity, you do it prior in order to hedge the risk of having to endure one as the exam approaches. This anticipatory judgment should be a planned decision rather than a forced one. Granted, some individuals resort to all-nighters out of habit and anxiety-induced decisions.

Respect your brain’s need for sleep. On various levels, your sensory systems become overwhelmed- you become psychologically and physiologically depleted. In my experience as well as those around me, the feeling you get can only be described as “fried”.

The goal of this preventative technique is to avoid the detrimental effects as the exam date nears- a time when your mental capacity is most crucial.