Some of my: Inventions | Magazine interviews | Sheds | Favorite ER memories

Information for people contemplating
a career in emergency medicine and
other medical specialties

By Kevin Pezzi, MD

 

Advanced studying tips

Q: I desperately want to be an ER doctor or a surgeon. I watch ER and Grey's Anatomy, etc. but am completely aware that these shows are nothing like the real hospital. I am competitive and have been doing surf life saving for many years and am not grossed out at all by blood but get thrills when someone needs help.

Last year I was getting all A's and this year I'm dropping to a few B's and even a C! I was wondering if you had any ideas on ways to study as I know I need better marks to even think about becoming a doctor.

I was also wondering what else I could do to prepare myself for becoming a doctor. Any books I could read? Even some on human anatomy that would help me in the future?

Thank you,
Tayla

Answer by , MD: First, congratulations on pursuing a challenging career that requires a willingness to work hard and put the interests of patients ahead of your own. Both take dedication and maturity. Your parents should be proud of you.

I thoroughly answered most of your questions in my two ER websites (this one and ERbook.net). I'll give you some advanced tips to improve studying, but let's begin with the basics by reading what I previously wrote on this subject.

www.ERbook.net/even_more_er_questions_part2.htm#studyhabits

www.ERbook.net/many_more_ER_questions_and_answers_part3.htm#concentrating

www.ERbook.net/moreqanda-ERdocQ_part%202.htm#studying

Now for relevant pages on this site:

A smart student looking for ways to boost her chance of becoming a doctor

How to increase motivation

1. Questions about becoming a nurse practitioner
2. How to make studying (or other boring things) fun (everyone should read this)

1. “My sex drive is affecting my ability to concentrate.” (Reading this topic might change your career plans from becoming a doctor to becoming a leader.)
2. When will adults grow up, or wise up, regarding sex?

1. Is she ER doctor material?
2. The futility of worrying
3. What can you do if a 100% effort isn't enough?
4. How to increase intelligence

I updated and expanded some of those topics in response to your question, so anyone who previously read them may wish to scan them for the additions.

By the way, the above links are just the tip of the iceberg. To maximally benefit from my advice, you should read all of it. My ER websites contain the equivalent of several books jam-packed with info.

Next, a comment about getting “thrills when someone needs help.” Yes, indeed! It is very pleasurable to be able to help someone in need or, best of all, save his or her life. Some patients expressed gratitude in ways that made my heart melt, such as the waitress who unexpectedly paid for my meal. I described that and other cases in some of my favorite ER memories.

Now for the new information:

Outside-the-box ways to improve studying

Ever wonder why 99% of people never earn a doctorate degree?

It is not because of the expense of higher education, because my family was once so poor that we ate food found on the side of the road, yet with student loans and lots of work, I became a Doctor of Medicine.

It is not because of the time required to attend the thousands of lectures for the classes that lead from a high school diploma to a Doctor of Something degree. You can learn the information on your own in much less time, because lectures are an inefficient way of acquiring knowledge. Most professors don't care if you show up for class, only the exams, which add up to only a few hundred hours. You'll spend far more time brushing and flossing your teeth during your life, so time is not the primary impediment.

Then what is? The pain of studying. Humans are innately wired to prefer pleasurable activities, and few people think that studying is fun. This is especially true in the 21st century, which is filled with so many enjoyable temptations: movies, music, television, video games, the Internet, shopping, traveling, dining, dating and friendships—the list is endless.

People intuitively know that every hour spent studying is one less hour available for fun, which is so addictive that few students can resist the impulse to pursue it. I know of some people who aren't doing too well in medical school yet find plenty of time for their thousand Facebook friends. When posting another hundred pictures is more important than studying—yikes!

I know the pain of studying all too well. Even though I love learning, I hate studying. I'd much rather wash dishes or mow my neighbor's lawn than study. I wanted an education, which is the end-product of studying. Most people love living in homes, but few love building them. Even most carpenters won't pick up a hammer unless they are paid handsomely. While the rewards of advanced education are available to everyone, almost everyone metaphorically throws in the educational towel long before they learn all of what they should learn to maximally benefit themselves and others. Why? Because studying is a pain.

Can you make studying less arduous and more efficient? Yes. Here are some outside-the-box ways to do that.

Study in different, unusual, and fun places. Forget the incorrect old advice about studying in a specific spot, such as the desk in your office or bedroom. Recent research demonstrated that you learn better when you study in varied locations. Besides that, if you study in one spot, before long you will associate that spot as Boring Central—unless you're one of the few people who enjoy studying.

You don't need a desk for most studying. In college, I'd sometimes drive our tractor into the woods and study while sitting on it. I love tractors and the woods, so just sitting on a tractor helped me meet my MDR (Minimum Daily Requirement) of pleasure. Sure, you can try the ascetic approach and not spice up your studying, but your mind will likely revolt and seek fun by wandering to pleasurable thoughts: daydreaming, in other words. I've also made studying more tolerable by driving to an unusual location and sitting in my car, a park, or beach.

Don't try to make studying more fun by playing your radio, TV, or iPod. This has been shown to distract even people who think they are immune to distractions.

The hours I've spent generating this reply have been almost torture because it kept me cooped up inside on one of the few gorgeous days left this year. The obvious solution is to use a laptop to untether me from my inside desk. That brings up a relevant point: for me, studying outside (even in one of my sheds) is enormously more fun than studying inside when the weather is nice.

Here are two sheds I built that I love to study in (the text will continue below the images):

shed to study in
another great shed for studying

Both sheds have a second story that give a fantastic view of the surrounding area. The joy of being in one of those spaces fulfills my need for pleasure, thus making it easier to focus on studying or thinking.

Studying can also be made more tolerable if you do it with someone. In medical school, I dreamed of dating a fellow classmate, who certainly would have studied more than the college (not med) student I later dated, but a moment of inattention caused me to blow my chance.

couple studying together

Substances that may help you study

Creatine (pronounced KRE-ah-tin, not KRE-ah-teen as so many people say) is often used by athletes seeking to increase muscular power, but it can also enhance mental energy and thereby lessen the “I’m too pooped to do anything” blahs that may keep you from studying—or make your mind wander while you do it. Researchers at the University of Sydney and Macquarie University in Australia have shown that creatine can significantly boost memory and general intelligence when given to vegetarians (whose diets supply less creatine) in a dose of 5 grams per day. Even carnivores and omnivores may benefit, because ingesting 5 grams of creatine per day from food would involve eating an impractically large amount of meat. The average dietary intake is about 1 gram.

Creatine is naturally present in meat and fish. The richest natural source is herring, which supplies 3 grams of creatine per pound (in contrast, salmon and beef have 2 grams, and tuna has 1.8, grams per pound). To obtain the optimal doses for augmenting concentration and muscle growth, the only practical option is to take a creatine supplement. Since their intake of creatine is poor, people who eat little fish or meat are especially likely to benefit from creatine supplementation. Studies have shown that vegetarians have lower baseline levels of creatine and thus obtain better results from taking supplements of it.

Personally, I noted a benefit even though I eat meat at most meals. The mental boost delivered by creatine is not like other neurostimulants like caffeine. Instead of feeling immediately peppy, I do not notice any effects for several hours. At that time, I can keep going, and going, and going, just like the Energizer® Bunny. I never feel sped up or “wired” (as I do with caffeine), but on the other hand, I realize that I am working noticeably faster and more efficiently than I otherwise would. While performing a task requiring intense focus, I am usually ready for a break after about five hours, but creatine can more than double this time. Thus, creatine may be useful for soldiers, racecar drivers, students, doctors, and others engaging in prolonged activities in which mental focus is crucial.

Users are often advised to take a loading dose of about 20 grams of creatine daily for five days (divided into four equal doses), then 5 to 10 grams daily thereafter as a maintenance dose. I’d recommend taking no more than 2 to 5 grams per day after the loading phase. The necessity of the loading dose is debatable, and some researchers claim that it is unnecessary. However, taking the loading dose may give you better results sooner. Physiologically, it makes sense, and it is consistent with the strategy that physicians often employ when they wish to expedite the action of a particular drug in the body.

Creatine seems to work better when it is taken with carbohydrates, which trigger the release of insulin, and with whey protein (The effect of whey isolate, creatine and resistance training on muscle fiber characteristics, strength and body composition. Cribb PJ, et al. Experimental Biology 2003 meeting. April 11-15. San Diego.)

Studies suggest that caffeine may negate the beneficial effects of creatine.

Supplements are available as creatine monohydrate or creatine citrate. The latter is more soluble in water (creatine supplements usually come in powder form, which is dissolved in water), but the former is more palatable, and more concentrated. Creatine monohydrate (and perhaps the citrate, too) appears to slowly degrade when mixed with water; one researcher found a 64% reduction when a creatine solution was stored for two weeks at 77° F.

Ingestion of large doses of creatine (whether from foods or from supplements) reduces the endogenous production of creatine by the liver and kidneys. Some experts advise creatine users to maintain natural creatine production by using it for no more than a month, followed by two to three weeks of no supplementation.

Creatine should not be used if you have diabetes, kidney disease, or are pregnant or lactating. Creatine may predispose you to dehydration and cause muscle cramping, especially if you exercise in hot weather. It may also heighten the risk of muscle strains, mildly accelerate hair loss, and impart an unpleasant body odor, primarily axillary (armpit). The effects of long-term creatine supplementation are not known, so it is prudent to be cautious and not use it for a prolonged time.

Spice up your studying

I've found many herbs, nutrients, and foods that improve concentration, including ginkgo biloba, ginseng, flaxseed, lecithin, choline, salmon, and fava beans. Besides creatine, one of the most unusual ones is ginger, which is especially effective when concentration is hampered by mild anxiety or depression. Ginger acts as a mild euphoriant. Stated another way, ginger can rapidly give you a slight buzz while enhancing alertness and attention span, unlike most drugs that trigger euphoria, which typically make people dopey. Ginger can make people feel more confident, optimistic, content, and in control. Ginger also seems to make me somewhat more creative. I suspect that the antidepressant/euphoriant effect of ginger is due at least in part to its stimulation of endorphin release.

Surprised that a spice can do all that? Don't be. Most people equate spices as flavoring agents and nothing more. Wrong! Many spices are chock-full of chemicals that can affect brainpower, mood, sleep, libido, and sexual sensation. In fact, if the spices were not naturally occurring and grandfathered in under the FDA's GRAS provisions, many of them would be banned or restricted as controlled substances. In The Science of Sex, I discussed spices that can substantially improve libido and sexual pleasure by affecting the brain's neurotransmitters. Properly timed and dosed, nutmeg and related spices spike my creativity and cure writer's block.

Anything that affects neurotransmitters won't help everyone, and the correct dose for one person may be too little or too much for others. In The Science of Sex, I explained why tweaking neurotransmitters helps some people more than others. For every mental function, from concentration to libido, each of the neurotransmitters should be in optimal concentrations. Some people may have too much of Neurotransmitter A, while others have too little of it, and so on. Hence, taking a substance that boosts Neurotransmitter A won't help everyone. Hence, to use a car quip, your mileage may vary.

The correct dose of ginger for me is ½ to 1 teaspoon mixed with 4 to 8 ounces of water, repeating as needed in 4 hours. As you will undoubtedly notice the first time you mix ginger with water, ginger does not dissolve in water. Mixed rapidly, it forms a slurry or a suspension. I discovered that different brands of ginger vary in the ease with which they suspend in water; the best I've found is called Trader's Choice.

Pregnant women should avoid ginger because it blocks the formation of some prostaglandins.

Cycling neurostimulants

I've repeated exhorted prospective doctors not to use caffeine until they are in medical school and really need it, but most kids lose their virginity to caffeine in elementary school or before. That's bad, because chronically using caffeine lessens the response to it.

What can you do if you're not a caffeine virgin? Stop it entirely for a year or more and substitute other substances (such as the examples given above) when you need a mental boost. Continue this cycling of stimulants (not just caffeine) throughout your life, except for nutritional ones such as lecithin, choline, and salmon.

Caffeine trivia

Brad Pitt uses carbonated beverages “to get his kids moving in the morning.

Improving long-term memory

To help cement memories, study information a few days after you first learn it. For example, in medical school I studied every weekday, and on weekends I reviewed everything covered in the past week. Doing that helped consolidate memories into long-term memory.

By the way, there is no one strength of long-term memory; some are things you “kinda” know and might forget five years later when a screaming mother deposits her blue baby into your arms, while others are things you know cold and will never forget.

I've heard some people (most notably Rush Limbaugh) disparage emotions, but they are critically important. Smart people can capitalize on them to enhance learning, as I discussed in other articles (Can intelligence be improved? and Increasing intelligence, memorization, and creativity–Part 2).

I have thousands more study tips, but no time to discuss them now.

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