Thursday, January 18, 2007

Cost of MD

As I look at the HSDN forum I see so many bright eyed idealistic premeds. How many of you have thought about the costs associated with medicine. Some are easy to quantify monetarily direct costs are 4 years of foregone income after college. That works out to $200,000. There are the additional costs of medical school an instate schools will be 20,000 per year, OOS or private will easily be 40,000 per year. Living costs are 15,000 per year for bare bones in a low cost area, higher cost areas like New York can easily top 25,000. The average medical student graduates with $150,000 of debt from med school on top of whatever costs you have from undergraduate assuming average debt from undergrad that's an additional $20-40,000 with the interest clock running. In addition you will be paid horribly for the 3 to 7 plus years of residency and fellowship. This is merely the economic cost. There are huge intangible costs to attending medical school or any other professional school. In college you will study harder than most to maintain the 3.45 average for Osteopathic or 3.65 for allopathic medical school. While your best friends party, you will study. You will do research and ECs that may be tangential to medicine merely because they are expected not out of any abiding love or desire to do them. You will be forced to take a proscribed set of courses. Once all of this is done you sit for the MCAT, a difficult exam requiring months worth of preparation, a low score may mean 3 years of hard work were all for nought. After all this you apply you have a 50:50 shot of getting accepted anywhere. If accepted you will complete 2 years of basic sciences, you will study all day and night. You then sit for the COMLEX or USMLE which will help determine what caliber of specialty you will match into. Then come clinicals, long days and pimping questions characterize this time. You then do the match and find out what you will spend the next 3-7 years doing in residency. Residency involves long days and nights, lack of sleep and horrible pay. If you do a fellowship you will be paid even worse during this. 11 to 15 years after your high school diploma you will finally practice. Starting pay is not wonderful PCPs may start as low as 75K specialists in the mid 200s. You will have had to delay marriage and starting a family most likely. Pay in real terms is falling. Medicare continues to cut pay in both real and relative terms. PCPs are making 150K 20 years out of medical school, not bad, however with your exceptional debt load and taxes you won't see most of it. Preexisting relationships will be strained throughout medical school and many will fail.

The point of this is not to dissuade you from going for your MD or DO, but to give pause. Contemplate how committed you are. From a financial perspective avoid as much undergrad debt as possible and eschew expensive private med schools for cheaper state schools. If you will be graduating with 300K in debt you will be forced into choosing the best paying specialty. Medical school costs have really been hiked up when my father went to med school in the mid 70s the cost was 20k or in todays dollars $80,000 and this was at one of the most expensive private schools in the US. Today it is 172K for four years not including the additional 25 or 30K in living costs a year. With the coming changes and continued cutting of reimbursement consider this. Also consider the cost emotionally being a physician is disruptive, you will get called and paged at all hours. Think about this carefully. Medicine is no longer accesible to the poor and is quickly outstripping the ability for the middle class to pay for. Even if you take out loans they will cost you 2200 a month assuming 10 years at 6% interest. However this is artificially low. You will most likely be forced to defer payment through residency and the interest will continue to roll on.

Wednesday, January 17, 2007

Examkrackers

1) Your individual scores and composite score

Total: 39R
PS: 13
BS: 13
VR: 13
WS: R

2) The study method used for each section

A) SELF STUDY AND WORK FROM THE EXAMKRACKER BOOKS. I actually signed up for the Examkrackers course (www.examkrackers.com) at Columbia University. The course was taught by Jon Orsay (one of the founders of the company and the main writer of the book). He is a phenomenal teacher, but his lecture style was EXTREMELY similar to his books. In the interest of time, I ended up skipping the classes while still following their schedule and just studying on my own.

B) READ EACH CHAPTER TWICE. The chapters in the Examkracker books are pretty short and manageable. However, each chapter is content filled and emphasizes a conceptual understanding of the material (as opposed to rote memorization of formulas). I would suggest reading each chapter AT LEAST twice. In contrast, I found the Kaplan books to emphasize rote memorization which I'm not a big fan of. In addition, since the MCATs emphasize conceptual understanding and not rote memorization, I thought that the Examkracker books were a bit superior in that regard to the Kaplan books.

C) MAKE A STUDY SHEET AFTER EACH CHAPTER. After each chapter, I would make a little study sheet that contained pertinent formulas and conceptually difficult concepts for that chapter. My study sheets for Biology, however, were pretty long since Biology is less quantitative.

D) DO DRILLS FOR DIFFICULT SCIENCE TOPICS. If there were specific topics (e.g. fluids, or acids and bases) that were still unclear to me after reading a chapter in the Examkracker books, I did drills on those topics with the Examkrackers 1001 Questions books. (Some of my friends tried to go through all of the questions in the 1001 Question books, which I found to be a big waste of time. Why study a topic that you have already mastered any more than you need to?)

E) SKIP THE MINIMCAT BOOKS THAT EXAMKRACKER PROVIDES. Don't bother doing the questions in the MiniMCAT books that Examkracker provides. I personally found that those questions were not representative of the level of difficulty of real MCAT questions (I thought that they were too hard), nor phrased in the way an MCAT question would be asked.

F) USE PRINCETON REVIEW TO STUDY THE TOPIC OF OPTICS. I also thought that the lecture on Optics in the Examkracker Physics book sucked. It emphasized rote memorization and employed confusing mnemonics (quite a contrast from the rest of the books). If I remember correctly, it's the last chapter in the Physics book. Use Princeton Review to study Optics. I found their explanation of that topic to be clear and comprehensible.

G) DONT DO EXAMKRACKER PRACTICE TESTS. DO THE AAMC PRACTICE TESTS INSTEAD. I thought that taking the exams under similar testing conditions as the real MCATs was important. I also heard that the Examkrackers practice tests were pretty hard and not representative of the real MCATs, so I ended up bringing my own AAMC tests to their practice exams and used Examkracker's bubble sheets. (The Examkracker people won't mind at all).

H) GET ONLINE SUBSCRIPTION TO ALL AAMC TESTS. Buy an online subscription to all of the AAMC tests (www.aamc.org) from the AAMC. It's a bit on the pricey side (of about ~$200 if I remember correctly), but it's an investment that will pay off dividends. I would plug in my answers from my bubble sheet and see which ones I got right. You can view the explanations of the questions online which I found EXTREMELY helpful.

I) FINISH ALL MATERIAL A WEEK BEFORE THE REAL MCAT. If you follow the Examkrackers schedule, you should finish everything a week ahead of of the test. During that week, I simply reviewed my study sheets and the concepts of the wrong answers from my AAMC tests.

J) PRIORITIZE THE EK STUDY BOOKS OVER EK'S AUDIO OSMOSIS CD. The Audio Osmosis is a severely diluted version of the Examkracker Books. In comparing the CD to the Study Books, Audio Osmosis does not have the practice problems, lacks a lot of the conceptual examples (that really cement the concepts in your head), and lacks the practice quizzes that are all found in the books. In fact, I stopped listening to Audio Osmosis after a few lectures after realizing these things.

K) If you have any other questions, feel free to PM me and best of luck with the studying.

3) What materials you used for each section(Kaplan, TPR, Examkrackers, AAMC, etc)

Examkrackers

4) Which practice tests did you use?

AAMC: 3R, 4R, 5R, 6R, and 7 (I think that they also have 8 out now)
If you have time, do practice tests from the other companies, but DEFINITELY PRIORITIZE THE AAMC ONES SINCE THEY WILL MOST CLOSELY RESEMBLE THE REAL MCAT.

5) What was your undergraduate major?

Psychology and English Literature -- There is hope for us humanities majors.

6) Any other tips you may have for those of us who still have this test lurking over us?

*** The week before the test, simply review your study sheets along with the explanations of the wrong answers that you got on your AAMC tests. Trying to cram in new material, and finding that it was not sinking in would probably stress me out before the trest.

*** Eat a big pasta dinner on the Thursday night before the test. Jon Orsay mentioned that glycogen storages are at their peak two days after consumption.

*** If you are like me and have difficulty falling asleep before important events like this, get a prescription for a sleeping pill (e.g. Sonata or Ambien) from a psychiatrist and take it the night before. CAUTION: Be sure to test out the sleeping pill well beforehand to see if gives you any side effects like drowsiness the day after. For example, Ambien works well for me, but leaves some of my friends feeling drowsy the day after.

*** Bring a digital watch to the test. If you start the stopwatch and you're worried about nasty looks that the proctors may give you when your watch beeps, hold the watch under your thigh to mute the sound.

*** In the beginning, I had difficulty with timing. To correct this, I started timing 9 minutes to complete a verbal passage and all of its questions. For the physical science and biological science section, I would plan for "ROUGHLY" 19 questions every 25 minutes.

*** Bring Gatorage and PowerBars to the testing site. All testing sites are different, but some testing sites will allow you to hydrate during the test while others won't. Thankfully, mine did (to the AAMC's chagrin). I would snack on half a PowerBar between sections for extra boosts of energy. Also, pack your own lunch to the MCATs. God forbid you're stuck with one Deli around your testing site, and everyone rushes there talking about which question they missed and you'll have to stand in this ginormous line for food and not have enough time to eat it.

7) How long did you study for the MCAT?


2) The study method used for each section

I just pmd someone an answer to what my study strategy was, and I'll just paste that here. It's really long, so watch out.

Sorry it took me so long to get back to you, but here are some tips.

I didn't take a regular MCAT course, but I did use Kaplan's online course, as well as the examkrackers CDs. I went through almost all of the old MCAT exams, and I found them to be much more usefull than the Kaplan practice tests.

There were a couple of key points to my preparation.

a) Hitting the content from multiple different angles. I would read through the Kaplan review section, watch the lesson online, listen to the CDs, and review my old textbooks.

b) Preparing with cycles of review. I didn't study straight from December to August. Rather, I studied for several intense periods of ~3 wks, and then let it be for a few weeks. My final cycle was 6-7 weeks straight, and I dropped everything else I was doing about 2 weeks before the exam so I could devote all my time to the final preparation. I tried to cover as many topics as possible each cycle, and then re-review the next time through. This way I was able to really solidify the information. I went into more detail in December for the areas I felt less comfortalbe with (ie, physiology).

c) Practice. I used the MCAT q-bank to test myself with MCAT style questions after reviewing each topic from day 1. I started taking full length practice exams about 6-7 weeks before the exam.

d) Re-evaluation. After each end of review minitest or full length practice exam, I would look at each question I missed, and try to understand what went wrong. Sometimes it was a strategy issue (eg, i misread the question), sometimes it was a content issue (say I didn't understand a particular concept). I kept a record of each of these reasons for missed questions, analyzed why they happened and how to not miss a similar question the next time. When I started to see patterns I would jot them down in a master notebook with some trouble-shooting ideas. I reviewed this master notebook regularly, and went through the few key points early in the morning on test day.

e) Pacing is not about pushing yourself to go faster, it's about making the answers automatic. I got to the point where I could get all the physical science questions right if I was able to take more time, but became frustrated because then I couldn't finish all the questions. When I tried to increase my pace, I would get a lot of questions wrong. Finally I realized that pacing wasn't about going faster, but about having the forumulas and basic approaches to problems down cold. I started reviewing all of the Kaplan PS flashcards that weren't automatic answers (about 70%) right before I would take a practice test. When I started that process, I began getting 14 or 15 on PS every time. I woke up really early on test day to get through all of the flashcards after I reviewed the key themes from my "how not to miss this kind of question again" master notebook. I went through the relevant orgo flashcards (about 50%) and biology flashcards (about 20%) first, and then the PS flashcards -- because PS is first on test day.

I never figured out my pacing problem for verbal, and kind of blew it on test day. I ended up just filling in the C bubble for the last set of verbal questions on test day (5-7 questions?) because I ran out of time.

I think the key to my performance was developing a personal approach by analyzing MCAT style questions I had missed. If you can pick apart the reasons for choosing the wrong answer for practice exams, you can do this.

Good luck!


OK. I took the MCAT 2 years ago and was scoring 7's on my verbal practice MCATS until someone told me this strategy and I scored a 9 on verbal to bring my total MCAT score to 31. Here it is. The problem with verbal is that you don't have enough time to finish the essays most of the time. Firstly, you should have already practiced enough to time your sections to an exact science. Then use this strategy to get you ahead of everyone else: Read the first paragraph of the essay only and scan the questions for questions on that paragraph (on the real MCAT they are out of order). Answer those questions first. Then read the second paragraph and scan the questions for questions on that pragraph. Repeat this procedure until you finish the essay. Note: combine really short pragraphs so you don't do more that 4 steps of reading. You will be left with either no questions or one or two evaluative questions on the whole essay. Answer these last. This tecnique saves you the time of looking back trying to find the location of the material in the essays and the material is fresh in your head so you don't have to reread a lot. I'm telling you, forget what Kaplan tells you and try this strategy. It got me 2 extra points.
yanky5 is offline


Originally Posted by nir1009
I used this strategy on Examkrackers 101 passages Test 7. Got a 10 (but just barely -- 45 Raw Score). I was getting a 44-45 raw score before also, so I don't know how much it helps. But I felt MUCH better about all of my answers and less pressed for time. Its worth a try. Thanks for the strategy!
No problem. I am not joking about the strategy. It really worked for me. You guys should try it a few times and see if it works for you too. When I took the MCAT 2 years ago, I went up 2 points from most of my practices after only trying it a few times. The problem I was having is not that I didn't have confidence in my answers, but I was pressed for time and always barely finished verbal before the time limit or didn't finish it. So, I would always rush the last 2 passages for time reasons. This strategy allowed me to finish the MCAT verbal with time to spare so I was doing better. You'll see that most of the time you waste on verbal is from trying to search the passage for material, but if you read one paragraph at a time, the material is in your short term memory, and if you forget it, there is only one paragraph to search so you save time. There is only a few holistic questions usually so you save these for last (unless the MCAT changed in 2 yrs, but I doubt it). Don't forget that on the real MCAT the questions are not in order, so you must quickly scan the questions for questions on your paragraph.
yanky5

Wednesday, January 25, 2006

MCAT Study Method

It's about time that I posted as much of my personal strategy that I can in this thread. To be honest I'm kind of ashamed that I haven't yet! Without further ado, here is Vihsadas's Personal MCAT Strategy (err...mostly, I think.):

1) Your individual scores and composite score:
PS: 15
BS: 14
VR: 11
WS: S
Composite MCAT: 40S

2) The study method used for each section

As a general note, practice will always be the most important part of your MCAT preparation…for any section. You should make time to do as many practice exams as you possibly can and to do practice problems as you are doing your content review. For the MCAT, you need to become comfortable with the testing format, the types of questions, and the manner in which concepts and information is tested. Being familiar with these aspects of the exam can only come through long and thorough practice of MCAT material. If you are diligent and really put forth maximal effort into practicing the material, you will start to gain an intuition about MCAT questions, and how to approach them. Accordingly, the number one mistake made by MCAT studiers is to only review the material in great depth, and to neglect actually taking timed, full-length practice MCAT exams. In fact, you must do both.

PS:
Understanding Concepts and Developing an Intuition – The best way to approach this section is to be extremely curious about the concepts presented. When you are reviewing a particular concept you should constantly be asking yourself “WHY?” Doing so will refocus your thought process from one of memorization to one of understanding. In fact, you must understand why all of the equations are the way they are, and why they make logical sense. One way to facilitate this process is to try and work through what you think should happen without worrying about the numbers at first. Often, students have memorized an equation and will just settle for plugging values into an equation in order to try and arrive at an answer. Unfortunately, this process often bogs the student down in number crunching at the expense of understanding what is actually going on. The latter is extremely important for the MCAT.
Thus, when you are doing physics and chemistry problems, the first thing you should do is think about the general result you would expect from the situation given. Only when you have understood what should happen conceptually, should you begin number crunching. For instance, if you are dealing with an acid base buffer problem and the question asks, “What will the pH be after I add X amount of Y substance?”, the first thing you should do is ask yourself, “Would I expect the pH to increase a little or a lot, stay the same, or decrease a little or a lot?” Once you think through the concepts, you’ll be more confident in your numerical answer as well as have an understanding of why your numerical answer is correct. After all, the MCAT is a thinking test. If you do not understand the concepts you simply will not be able to confidently answer a fair number of problems on the real exam. That being said, even though I have stressed the importance of concepts, you still must also know all of the relevant equations, and be comfortable with manipulating those equations. Both concept understanding and skill in formula manipulation are necessary for success on the MCAT PS.

Additional Note: When we say we are doing "Content Review" in terms of PS, this includes doing practice problems along with your content review to absorb the material. For physics and chemistry, an integral part of learning to understand the material is to work through problems to make the logical process more concrete in your mind. Thus, do sectional tests, practice problems and practice passage (but not timed, full lengths!) when studying.

Learning to be Highly Proficient with Simple Math – This is a point that is grossly overlooked both by students themselves and test prep companies. In my opinion, the most important factor that separates the average speed test taker from one who can finish the PS section with 10-20mins remaining is the ease at which the latter uses estimation methods, tricks with formula manipulation, and answer elimination techniques to reduce the amount of scratch work necessary to complete a problem. On my real exam, I used no more than ¼ a single-sided page for scratch work on the PS. Because I was intensely comfortable with order of magnitude estimation, decimal estimation, log estimation, dimensional analysis and conceptual knowledge I could eliminate answer without too much written math. Sure, you could use the formulas to explicitly solve each problem, but using estimation along with formula manipulation will save you whole minutes on the real exam. In previous posts I have highlighted one example of this:
Estimation trick for pH and log calculations

In addition, you must be completely comfortable with orders of magnitude estimation. You should be able to figure out just from estimation what the order of magnitude of the answer should be. This will aid you in eliminating one or two answers right away. One way to start to get good at this is to treat every number in scientific notation:
If X = n x 10^-4 and Y = p x 10^8, then Y/X = (p/n)x 10^(8 + 4).
You must be completely fluent in order of magnitude manipulation like this. Definitely practice it.

You should also become familiar with estimating the decimal values of weird looking fractions and the fractional values of weird looking decimals. For instance, .3145/.6021 might look difficult, but it’s approximately = ½. This kind of estimation is usually sufficient for the MCAT, and GREATLY simplifies the manipulation of formulas and numerical calculations.

Dimensional Analysis – Using the units of physical quantities to your advantage is also often grossly overlooked by students. One way to check your math is to manipulate the units of the quantities you are using while you are manipulating the math.
The following post sufficiently explains one very MCAT relevant way of how you should be able to use dimensional analysis on the PS section of the MCAT:
An example of how dimensional analysis can really save you one the MCAT.

An additional way dimensional analysis can be helpful is if you forget the formula for something. Let’s say that you forgot that one of the formulas for electric potential (Volts) is Volts = Electric field * distance. Let’s say that you know that Voltage is expressed in Joules/Coulomb and Electric field is Newtons/Coulomb. Then, you remember that Work (Joules) = Force (Newtons) * Distance (meters). Therefore, if I multiply Newtons/Coulomb * Distance I get Joules/Coulomb, which is the correct units for electric potential. Usually, this trick will lead you to the right answer!
A word of warning, however, about this last point: Sometimes there will be an extra constant factor needed to arrive at the correct answer. Therefore, only use this technique when you really forget the correct formula and be wary for extra constants! Example:
Let’s say that you know the units of energy are [E] ~ kgm^2/s^2. Knowing that, it would be reasonable to guess that one correct formula for energy would be E = mass*velocity^2. Afterall, mass*velocity^2 has the correct units…but because of how the formula for energy was derived, energy, as you know, is actually = ½ mass*velocity^2.
So while this particular trick with dimensional analysis can be useful, you must not rely on it.

VR:
See the following post: My Verbal Strategy
Just as a note, I wanted to say that I was scoring 13-15s on the verbal practice exams for AAMC CBT 7-10. As a word of warning, please heed the part I mention about being able to do the verbal section with 5-10mins remaining. If you get a monster verbal section like I did on the MCAT, you’ll at least be prepared to get through the entire thing. My real verbal was hard. Really hard. Be prepared!

BS:
Biology is like a Modified Verbal Section – The trick to the BS is treating this section a little like the verbal section. You should definitely memorize everything that you possibly can in terms of biology and organic, but, while your are memorizing you MUST think long and hard about the logic of what you are memorizing. For instance, you can memorize all of the favorable and less favorable conditions that lead to Sn2 or Sn1 or E1 or E2 reactions in organic, but, do you have a conceptual understanding of WHY these different conditions favor one type of reaction over the other. This type of conceptual understanding on the bio section is absolutely necessary for the MCAT. Then, you will have to be able to understand the logic that is presented in the passage (because it will be more convoluted than in the PS) and using the logic set down by the passage, apply what you already know.

Know Intimately what you Expect to be Tested on– One type of logic useful for the BS section is to be familiar with the topics that you would expect to be tested and to use that knowledge to your advantage. Let me give you an example. Let's say you are given a large organic macro-molecule diagram with various keto/acetyl-groups labeled "A" "B" "C" "D". You are then asked "Enzyme X is added to a solution of the macromolecule, which keto/acetyl group do you expect to be cleaved?"
Now let's say you have absolutely no idea what enzyme X does and you have never even heard of enzyme X. What would you do? On the MCAT, with the information I've given you, you should be able to guess what the operative characteristic is that the test-maker is trying to test. I can guarantee that it has something to do with how strongly that "O" is drawing electrons from that C=O bond. So without even looking at the answer choices, you should be able to narrow it down to two possibilities: the highest amount of electron draw, and the lowest amount of electron draw.

Applying knowledge to novel situations – While this is important for the PS section as well, it's much, much more likley to show up on the BS section. You will be asked to integrate many different subjects in one passage and use your conceptual knowledge to find an integrated answer. Sure you know all the oxidation and reduction reactions, but if I gave you a novel reaction could you logic out whether it should be an oxidation or reduction reaction? Then, could you use that information to determine whether that reaction would help or hurt the aerobic capcity of a mammal? Do you understand WHY the oxidation and reduction reactions proceed the way they do? Can you hypothesize mechanisms for different reactions? Do you understand WHY electrons move the way that they do? Always, always, always ask ‘why?’ Then, of course, you still do have to memorize all of the information as well.
It take all of 1) Memorization, 2) Conceptual understanding, and 3) Problem Practice!

Additional Note: Although more helpful for the PS section, doing practice problems during your content review including sectional tests and practice passages can also be helpful to drive home important concepts in the BS section. This is especially true for the organic chemistry section. I definitely recommend doing some practice problems as you finish various sections in your content review, but again, timed full length practice during your content review may not be that helpful. Save those full-lengths for after your content review study months.

3) The practice materials you used
Kaplan Premiere Program Book (2008)
Princeton Review ‘Cracking the CBT’ (2008)
The Princeton Review Verbal Workbook
Kaplan Sectionals and Topical Exams
Kaplan QBank
Monthly Quizzes and Tests from Kaplan Online (Comes with Premiere Program)
Wikipedia and Google (Seriously, for random things I wanted to know)

I studied the Kaplan Premiere Program and Princeton Review Cracking the CBT book side by side. Although there is a large amount of overlap between the two books, each book covers the material from a different angle and there is some information that is not doubled in each section. I found this tactic to be very helpful in gaining a deeper understanding of the material, particularly for the organic chemistry section of the exam.

4) Which practice tests did you use?
I made absolutely sure to get my hands on as many practice tests as I possibly could. Altogether I took 20 practice exams. I had access to:
AAMCCBT 3 – 10 and the extra passages from 3R – 9R (8 exams)
Exams that came with the Princeton review ‘Cracking the CBT’ (4 exams)
Free Princeton Review Exam (1 Exam)
Kaplan Full Lengths 1- 11 (11 Exams)
Free Kaplan Exam (1 Exam)
Gold Standard CBT Free Exam (1 Exam)
Two Kaplan Exams on CD, Premiere Program, (2 Exams)

A Copy of my testing schedule is attached to this post.

5) What was your undergraduate major
I started off as a B.Mus in Music Theory at the McGill Conservatory of Music and then started all over again in a joint program in Physics and Physiology in my 3rd year. I finished my undergraduate degree after 6 years.


6) Any other tips you may have
Post-Game Analysis: The most important thing you can do is post-game analysis of your practice exams. Keep a log of the types of questions that you are missing, and why you thought you missed the question. Make sure that you review every single problem, right or wrong on your practice exams. Even though you may have gotten a problem correct, you need to ensure that you got it right with the correct thought process and also, in the most efficient manner possible. Therefore, you need to review every single problem that you do on practice exams. If you do this you will begin to see a pattern about how the MCAT test makers have structured the exam questions, and how to develop what I call ‘MCAT intuition’ about what the correct and incorrect answers are.

What is the test maker thinking? Accordingly, think about what the test maker is trying to test! Really try and figure out what concept or thought process or piece of knowledge the test maker is trying to test with a particular question. If you think about that, you have a better chance of not over-complicating problems and seeing what you are supposed to do. It is important to try and think from their perspective.

Critically think about what you are a doing! Although it seems obvious I guarantee that many of you are not doing this! I know, because when I started studying I wasn’t doing this either. Always ask ‘why?’ and always question the process you are taking. You must always be critically thinking about how you are approaching each problem. Make sure that you are completely aware of exactly what you are doing, and why you are doing it when you are testing.

Practice! The more practice you do, the more familiar you will be with the material in an MCAT format, and the more familiar you will be with doing the calculations or thinking that will be required of you on the MCAT. This is extremely important. Practice as much as you can, and whenever you can.

Ample Content Review: Although practice is definitely more important than studying, in my opinion the best way to study (if you have the luxury of time) is to do solid content review for 1 – 1.5 months and then do a very, very arduous string of practice exams for the next 1 – 1.5 months. I believe that taking full-length, timed practice exams when you lack a cursory knowledge of the topics and material covered on the MCAT is a waste of time. You can’t improve your MCAT test-taking skills if you don’t have the basic MCAT knowledge at hand. Personally, I did 1 to 1.5 months of solid content review with a diagnostic at the beginning, and then 1.5 months of practice exams, reviewing the material between exam days. Note, however, that I did do practice problems in the course of my content review. In fact, practice problems are very important for gaining a solid understanding of some of the concepts, especially in the PS! What I am saying is to avoid doing practice tests during your content review, but practice problems, however, are very important!

In my opinion, the four most important keys to MCAT success are:

1) Practice!
2) Know everything. Really.
3) Understand the Concepts and Logic.
4) Do many, many full length timed practice exams.

In the final days before the exam: In the final 2-3 weeks before you real exam you must develop a routine to get your body and mind ready for test day. For instance, I planned my 'homestretch' for 2.5 weeks before my exam. At this point content review is long ago done with. I'm not really even opening up my books anymore unless there's a random/weird fact I somehow missed. The last 2.5 weeks are for tying up loose ends, final test-taking preparation, and getting yourself into an MCAT Rhythm. Here’s what I did:

1) I took four AAMC CBTs in these final days and I planed 3 day breaks between each of these last four exams so that my actual MCAT was synchronized with this schedule. It is important to make these last exams AAMC exams because they are the closest thing you have to the real MCAT.
2) In addition, I took each of these last four exam at the exact time that I would take my real MCAT, and woke up and went to sleep at the same time that I would on and before real test day.
3) I also restrained myself from going to my refrigerator during breaks, and brought an ‘MCAT lunch and snack’ which was exactly what I would take to the real MCAT to my room on practice test days.
4) In the days between exams, I reviewed the tests (the same way as I suggest above) and also did peripheral content review if there was a particular concept or question I was still shaky on.

By simulating real test taking conditions as close as possible and developing a ‘routine’, when I got to my real exam, it was just another day at the office so to speak. My body, my sleep cycle, and my mind were just continuing the routine I had developed over those last 2.5 weeks.

I took the first of the final four tests on a Wednesday, the next on the following Sunday (3 day break), the next on the following Thursday (3 day break), and the final one on the following Monday (3 day break). That way I had a 3 day break until my real exam which was Friday.

I believe that making my last four exam times periodic and treating them like my real exam really helped. When I sat down to do my real exam it really felt like it was nothing unusual from my normal routine. I was prepared, and I had done this before... That helped to calm my nerves and give me extra confidence.

7) How long did you study?
Total time studied: I studied for approximately 3 to 3.5 months for 4-8 hours every day, 7 days a week.

Guys, you really can do this. Just treat the MCAT like a big game, a competition of sorts that you are trying to win at. Get excited about studying and doing better on the next practice exam. If you are able to take that pseudo-masochistic viewpoint, the MCAT almost becomes fun. Put your mind, body, soul…put your entire existence into this MCAT for a few months. Remember, it’ll be worth it in the end. If I can do it, you can to. You just have to figure out the best way for you to gain your own success. Good luck, and kick that MCAT straight in the crotch!

bozz - what do you mean by dimensional analysis?
As Bozz said, this is using the units of the variables/quantities you are given to arrive at the answer. On the MCAT this can be a very poweful technique for a number of the chemistry and physics problems. Here's an example:

Often you'll get a passage that gives you some new formulas that apply to a specific situation. Let's say...an electron passing through a curved plate capacitor: You might be given some novel equations that deal with the velocity, energy, etc. of the electron. Then you'll get a question which says something like:

"Which of the following expressions describes the force that is applied to the electron?"

The answer choices will all be expressions containing variables and quantities that are in the passage. Now, there are two ways to attempt these types of problems:

1) Figure out how the formulas that were given in the passage (usually complicated) and the formulas that you know from your studying fit together and eventually simplify down to one of the answer choices. This usually requires some tedious algebra, and also understanding of the equations themselves. This is the slow way.

2) What is funny about the MCAT is that questions like the one above, will often be structured so that every single answer choice will have different units! Since the question asks for an expression of force, one of the answer choices must have the units of force (kg*m/s^2). If you realize this, you can easily exploit dimensional analysis to arrive at the correct answer.

You just take 20 seconds to check the units of each answer choice, and then answer that has the units of force must be the right answer. Et Voila! Done in under 30 seconds...

On the MCAT board, when I harp about learning to do problems "in the most efficient, quickest way possible, using the least amount of paperwork and math", this is the kind of thing I'm talking about.

My verbal strategy...(I bombed on the real thing comparatively to my practices. I avged 12-15 on practices, scored a 12 on my diagnostic, but an 11 on the real thing. That being said, I'm still ecstatic!)

1) Practice under harsher timed conditions than you will encounter on the test. You will have about 8.5 mins for every verbal passage. Get a stop watch and a verbal workbook, and practice finishing every passage in 6.5 mins. When I started doing this, two things happened: 1)Even though I was using less time, my scores did not decrease. They stayed the same. 2) When I became really good at answering the passages quickly, I found that I had time to refer back to the passage on every question. Now, since I can read the passages much more effectively (meaning faster) when I see a question that I'm not sure of, I have time to go back and quickly re-read the 3-4 sentences that pertain to the question. At this point, my scores started to increase.

2) Attack every single paragraph. Read very quickly, but read very actively. Don't try and go too slowly to remember every detail, this will kill you. What you should do is Gather the main idea of every paragraph, and make sure you're always thinking about the POINT of the passage. Eventually, when you've done enough verbal practice, gathering the idea of a section or paragraph will come very naturally. As a byproduct, you will start to gain a sense of the types of details that are important to remember, and you will begin to remember them automatically.

3) When doing the read-through, DO NOT re-read a sentence if you think you weren't paying attention. Try this on any reading material: Try reading very actively, but force yourself not to re-read sentences you just read or to go back on the first read through. If you are actively reading, its amazing how much you retain without having to re-read. Your brain often tricks you into thinking that you didn't understand something, when in fact you did.

4) You should be categorizing the paragraphs in your head. Remember that the reading material on the verbal section is always written so that the information is organized in some logical way. The AAMC specifically picks passages that are not haphazardly organized and written. "Categorizing" means that you should be thinking about the general subject of each paragraph so that you know where in the passage to look for information when you need to refer back as you answer the questions. It does not mean stopping and summarizing every paragraph in your head as you read. This way you don't waste time re-reading large sections of the passage (or the whole passage!) to find helpful information when you do need to refer back. Instead, your categorical map of the paragraphs will give you a general idea of where that information should be located. This will save you important time when you reach one of those questions that you don't know right off the bat. Lastly, the categorical map you create as you are doing your first read through should be in your head. This means you are really just making mental notes that point you in the right direction, and not summarizing.

5) Answer every question in order, do not skip questions. I think that this particular point works really well because often the questions themselves are ALOT of reading! If you read a question, decide that its too hard and skip to the next, you'll then have to come back and re-read the question on your second attempt thereby wasting time! Make a mental note of and use the CBT's "mark" function on the questions that are iffy so that when you do go back and review all of your answer, you know which questions you should focus more time on.

6) Be aware of the different question types on the verbal section. The princeton review book has a list of these, and I think the Kaplan one does as well. In addition, when you are reviewing your practice exams you should make your own list of what you think the different question types are. As to HOW to answer every question type; This is one of the major areas where practice comes into it. As you get better, you'll begin to realize the types of things that look like 'correct' answers, and you get a feel for the types of things that the examiner is looking for. Check out the "process of elimination" section (number 8 in this post).

7) Do heavy post-game analysis. You must, must, must go back over your verbal questions and ensure that your thought process was correct for the questions that you got right. Figuring out what exactly you were thinking when you answered a question incorrectly is absolutely essential. That way, when you find yourself thinking in a similar way on a future exam, you might stop and think twice about your answer. Do not ever say, "Oh I totally should have gotten that question! It's easy!" If you missed a question, you missed it for a reason. Instead of passing it off as a "stupid mistake" make sure you understand exactly why you made that mistake, and what you were thinking when you made it. Then, you should try and figure which types of questions you are most often missing and analyze your thought process to see what wrong thought caused you to pick a wrong answer. Then, be aware, and fix that thought process.

8) Learn to use process of elimination (POE). There are a few tricks you can use to POE the hell out of some verbal questions.
- Extreme sounding answers are almost always wrong. Exception: If the passage itself sounds extreme. You should still make sure that your answer choice fits with the logic of the question and the passage itself. For instance, the question could ask, "Which of the following is NOT representative of the author's stance of issue X". In these types of questions, the extreme answer might be right.

- In questions that ask you to describe the 'mood' of the author, or any question with 'one word' answer choices, answers that are similar or say the same thing are almost always both wrong. Check and see if you picked an answer that sounds very similar to another one, and make sure you know exactly why you chose that answer. The MCAT will never be cut and dry, so just make sure your logic about an answer choice is clear.
- Watch out answer choices with identical or similar vocabulary to the passage. A very common trick is that often words that were used in the passage will be transplanted into an answer choice with either: 1) a cause and effect relationship reversed so that it is wrong, 2) a fact from the passage taken out of context, 3) a hypothesis that is mis-stated, 4) a slight twisting of the author's logic, 5) an incorrect detail has been inserted into the answer choice. Watch out for these, and when you see an answer choice with alot of identical words to the passage, be very sure to dissect it so that you understand its meaning. As you practice more and more, you'll begin to find other curious aspects of answer choices and question stems that stick out at you.

9) PRACTICE!!!
No seriously, practice. Developing an MCAT intuition is like developing a muscle. You can't cram for it, and you can't practice it "sometimes" while expecting major gains. You have to practice, consistently, repeatedly, and often.

10) Closing Note
This is my entire strategy. What worked for me may not work for you, but it's worth a shot! If something different than what I've posted here works for you, then use it! (and more importantly, come back to The Studentdoctor Network and tell us about it!)
I picked up a princeton review verbal workbook (I think you can only get them from the class) and I did two passages every 1-2 days starting at about 3 months before my MCAT. Toward the end of my practice test runs I was consistently getting 13s and 14s in verbal on the AAMCs. This section is doable guys. Just make sure you are practicing properly and meticulously reviewing your answers! Just doing passages isn't going to give you exponential gains in performance. You have to practice and review the right way.
Good luck guys. If I can do it, you guys seriously can too...

http://forums.studentdoctor.net/showpost.php?p=6695902&postcount=273

MCAT studying tips

Hello everyone, I've been reading these forums for a while, and I decided to contribute something since I got my scores a few days ago. I'd like to explain my study "techniques" that got me a high score with a relatively short amount of studying (~ 1 month).

Some background: 4th year biochemistry student at a fairly prestigious university, no mcat prep courses, and this was my first time taking the test. I finished all of my courses at the end of the fall, so I could concentrate "full time" on studying for the January 25/26 exam date.

My study setup: sitting at my desk with my computer, listening to music, taking semi-frequent breaks (just don't overdo it).

First step, I picked up the entire ExamKrackers MCAT Prep series, with the chem, orgo, bio, and VR sections, as well as one written practice test. I actually picked this up last spring, but kept on putting off studying until it came down to it. During winter break, about a month before the exam, I started studying several hours a day. I found that the EK series provided almost everything I needed for the exam. If I had trouble understanding something, I usually checked wikipedia. One time I referred to a Physics SATII review book, so don't forget old sources and textbooks you may still have.

If you haven't looked at the EK series, each book is divided into several "lectures". My study habit consisted of reading each lecture in order, while taking detailed, yet highly condensed notes on my computer for each section. If you read the chapters carefully and try to absorb the material before moving on, it should be easy to do this. When I say condensed, I mean each lecture was reduced to about 1/3 of a printed page, 11 point font, with bullet points. For example, one bullet point says:

* peptide hormones: preprohormones cleaved in rough ER lumen to prohormones -> modified in golgi w/ cleavage and/or glycosylation -> exported via vesicle -> acts on effector (target cell) via receptor -> intracellular second messenger

If you condense the entirety of the exam material to 15 pages, it's no longer too much to handle and you can study *everything* multiple times per day!!

If you're able to write these notes as you study each section for the first time, and do not move on until you're able to answer all of the sample questions interspersed throughout each lecture, you should end up with a solid understanding of each concept. I averaged 1.5-2 lectures a day, leaving the 30-minute exams in the back of each book for later.

Once I'd finished with a book, I'd move on to another subject, then after completing those lectures, I'd return to a previously finished subject, review my condensed notes (remember, 3-5 pages for each entire subject), then take all of the 30 minute exams, stopping after each one to grade it, figure out my mistakes, reread the relevant content, and possibly update my notes if needed. I feel that mixing up the reading and the 30-minute exams gives both the necessary practice, as well as allowing you to review the material more effectively, so you can remember it. FYI, I was scoring fairly poorly on these (often around 8-9): I think they were rather difficult, but they were great practice if you went back to review to figure out your mistakes AND UNDERSTAND THEM!

Once I had gone through all the sciences, I started on the VR book for last, which then gave me all sorts of general tips at the beginning that I should have known as I was doing the rest of the series . Make sure you do this entire book, as I felt is was very helpful and took very little time.

As for the writing sample, I read the EK advice, read a few sample essays from AAMC, then condensed it down to this exactly:

1. explain statement and its context, why it applies to the human condition (1 paragraph). first sentence should present main idea, but allow for possibility that it may not always apply.
2. provide an example and clarify it (1 p) and maybe another example if you have time
3. provide a counterexample, develop/explain, and explain why it contradicts
4. provide guidelines for determining when it applies and when it doesn't, in context of the given examples

I believe that if you use flowery language, and more "touchy-feely" examples that would make liberal arts professor proud, that the graders will be more impressed with the writing. During the exam, I followed these steps exactly to create a quick paragraph-by-paragraph outline to make sure I didn't skip anything, then filled it in, finishing about 2-3 minutes before the 30-minute mark for each essay.

I should say that at this point, I had a pretty major obstacle come up with my studying plans: a bad case of the flu, starting about 5 days before the exam date. Considering how much I was cramming, this screwed things up considerably, as I could barely sleep, let alone function while trying to study. Still, I kept on trying, with generous doses of ibuprofen to keep the pain down, and large amounts of caffeine to keep me awake.

Moving on, once I had taken all my notes, done all the 30-minute exams, I still had not done any full length practice exams! Still, I went over my notes, printed out, while skimming the book alongside them. This helped make sure I could recall any diagrams, as well as again reinforcing everything in my mind. Once I felt fairly comfortable with this, it was actually the day before the exam. I signed up for the free electronic practice exam from AAMC and took that, scoring in the low 30's , but also occasionally using the "cheat" feature that would explain the answers. My entire purpose at this point was to drill as much of the material into my head as possible, and immediately after the practice test, I again went over my notes repeatedly. Since the entire set was 15 pages, I could do this multiple times very quickly.

That evening, I was still very sick and only managed to sleep for 4 hours. In the morning, I felt even worse, but still went on to take the test. I again took my notes with me to the exam room, and studied them over and over again, until I was called in to take the exam (see a pattern here?).

As for the exam, I somehow completely skipped 2 questions in PS that I didn't notice until there was <5 seconds left, so I couldn't even guess on them. I thought that was the hardest section. I followed my set of steps for the essay, did my VR with no idea of what score I'd get, but actually felt pretty good with the BS section. I felt that I may have done well enough to not void my score, so I went ahead and had it graded. I was honestly expecting something in the 20's, and spent my time up until the score release trying to decide when I was gonna retake the test.

When my scores were released (1 day late after 30 days... thanks AAMC), I checked them online and found a 38S! 15/12/11 (BS/VR/PS). Apparently my study habits worked well enough for a perfect score on biological sciences, and as good as I could ever expect on the VR. My PS score was obviously hit by the few questions that I skipped completely but still was respectable.

So, my main advice is to create a set of detailed, highly condensed notes, and *repeatedly* review them. This way, you won't get tripped up by obscure details or equations, since you'll have them all memorized. And if you did all the sample questions, you should be somewhat familiar with the testing style.

If you condense the entirety of the exam material to 15 pages, it's no longer too much to handle and you can study *everything* multiple times per day!!

What I'd do different: first, get a flu shot. second, I feel if I had even a few more weeks to study and do more practice exams, I could have scored even better, had I not been sick. Ideally, I would have set my own schedule across 3-4 months, but I still would have the same study process, just much more of it.

In addition: this study method is definitely not for everyone! If you require lots of structure (like a 2-3 month course), this obviously won't work. Also, I had learned almost all of the material before, but the courses were so long ago (such as AP chemistry from 10th grade) that I effectively was relearning everything as I went. I had taken more advanced material in the meantime, so that may have helped with a subconscious understanding of the fundamentals.

One last thing: I'd post my set of notes, but it's written in such shorthand that it would likely be detrimental for someone else to use it. Write your own set of notes, and the process itself will help you absorb the material.

Thanks to everyone that's posted on this board! It's been helpful reading from people in the same boat as me. To everyone who is still going to take the MCAT, good luck!
Last edited by gecko45; 02-27-2008 at 02:59 PM.

ARITHMETIC tricks

ARITHMETIC tricks you could implement int he MCAT

Key things that I have found hurt people are:

Powers of ten: This is helped by decimal hopping and labeling numbers with "increased by factor of 10" or "decreased by factor of 100". It comes down to paying attention really.

Ratios: These are made easiest by making denominators easy to deal with. Also, if a ratio is hard to calculate as written, flip it and see if it is easier the other way. We somehow emotionally deal with bigger-over-smaller ratios better than smaller-over-bigger ratios.

Fractions and Equivalent Decimal-based Value: Learn the correlation between fractions and decimals 1/4 = .25, 1/5 = .2, etc... These can prove EXTREMELY useful on the exam.

There are many more strategies and techniques, but these are generally the big three for most people. A little practice goes a long, long way.

The funny thing I've found is that the supposedly more difficult math skills like logs, square roots of complex numbers, and exponential decay/growth are typically easier for people than basic division, fractions, and multiplication.

One of my favorite tricks is Left Add Right Subtract. This refers to exponents, for example, if you move the decimal point to the left one, you need to add one to the exponent. If you move the decimal point to the right one, you need to subtract one from the exponent.

1 x 10^5, move left one decimal point to the left and you got .1 x 10^6

I hope this helps.

Here's an invaluable one that we use to help our students. Its a process more than a trick, but the end result is the trig function value of every important angle on the MCAT. Is seems long when written out, but its completely brainless and takes about 15 seconds to write down (tutorial anyone?)

1. create a table with 3 columns, one for angle, one for sin, one for cos.
2. write in the most important angles on the mcat in the left column: 0, 30, 45, 60, 90
3. in each cell in the sin and cos columns, put in "/2". Essentially every value has a 2 in the denominator.
4. now put a square root sign with nothing inside of it in the numerator of each cell fraction.
5. now start counting from the top. in the sin of 0, put a 0 inside the sqrt, in the sin of 30, put a 1 inside the sqrt, 45 gets 2, 60 gets 3, 90 gets 4. If you did it right, the sin of 0 should show up as sqrt 0 / 2, which is 0. sin 90 should show up as sqrt 4 / 2, which is 1.
6. do the same, but in reverse, for the cos column, cos 90 is (sqrt 0)/2, etc.

Like I said, it looks much worse written out than if you just create the table. Using this you'll have an elegant way to pull up the sin and cos of any important angle on the mcat.
I love that table! It works wonderfully...and you'll have it memorized if you use it enough.

Another good one is just simply becoming comfortable with scientific notation.

This one is more just practice than anything. The basic rule is that you can add exponents of scientific notation and multiply the number in front, and, you can change the sign of exponents on the bottom and move them to the top.

Here is one. It might be a little much for the mcat, but it is cool nonetheless. It's the Babylonian Method (old school).

To calculate the square root of a number:

First guess roughly what you think it would be (number less than 1 guess bigger, for a number greater than 1 guess smaller)

Then divide your guess into the square root number.

Now take your answer and add it to your guess and divide by 2. Presto, you should be very close to the real number.

so for example:

sqrt of .78 = Guess .85

.78
-----= ~.9
.85

.85+.9
-------= ~.87 And this should be your answer (or close enough)
2

The real answer using a calculator is: 0.866 or rounded .87!!

Also, Berkeley Review has a great method for decimal and fraction conversions. This is straight from their stoichiometry chapter.

If you memorize common fractions and decimals, you can mutiply and divide fractions by quickly converting an easy denominator. I've memorized the decimal values of the all fractions from ½ to 1/12 and just wrote them down in a little table. I'd list them here, but it's a little too much time. lol it's the one time you can prob use a calculator for the next however many months!


Ex) 18/66=?
18/66=3/11----->>> 1/11 = 0.091; 3/11=
3 x (1/11)=
3 x (.091)=.273


Ex2) to estimate 11/12,
*1/12=.083


11/12--->(12-1)/12--->12/12 - 1/12----->1- (1/12)--->1-(0.083)=.917

Although not really MCAT related, my favorite math trick is when you multiply two number, multi-digit in the from XA and X(10-A) (i.e 23x27, 35x35, 41x49), or in other words the ones digits add up to 10 and the rest of the digits are the same. So first multiply the ones digits normally and write that down. Then, add one to the rest of the digits and multiple those4 together and place them in front of the two digits you wrote down eariler.

and by the way if the ones digits are 1 and 9 you wriet down 09.

For exapmple 23x27

One digits - 3x7 = 21
add on to rest and multiply 3x2 = 6
place both halves together and 23x27= 621
and it works for every single case.

Oh and when multiplying two numbers (that are relativly reasonable) together without brute forcing it is to multplie two numbers taht are close to it and then add on the diffference. Say 52x18, you could do 50x18 (which can bee done in your head) then add 36, or 20x52 (which is also preety simple) minus 104. not too bad really.

You can use 0kazak1's method...but the fastest way to do 48*52 would be to to rewrite it as:

48*52 = (50-2)(50+2) = 50^2 - 2^2 = 2496.

If two numbers are close together, both even or both odd (so that their average is an integer), you can use this method if you know the square of the average.

Bu t if you do the second way you could do 50x48=2400 + 96 (48x2)
or 50x52= 2600 - 104 which would give you the same thing. or up above works too, but if you get good at

Tuesday, January 24, 2006

Robots Replacing Doctors in Operating Rooms

Many science fiction writers have dreamed of it. But not even Phillip K. Dick would have imagined the day should come so soon ― robots are replacing doctors in operating rooms.

The world is seeing a craze for robotic surgery, where machines take care of precise sewing, clipping or other procedures. Patients undergoing operations and doctors performing them claim they are safer and less painful, and more and more people are expressing their willingness to go under the knives of these machines.

Amid the craze, there is the Da Vinci surgical system, which is said to be the best in the business.

Da Vinci Robot: Epitome of Medical Robots

Robotic surgery involves making three to five 0.5-1 centimeter incisions near the affected are instead of cutting and opening it up, and then using robot arms inserted into them to perform the surgery.

The idea for the system came first from the military. The United States government thought robots could conduct basic combat surgery in the field remotely operated by doctors.

The basic idea was for robots to repair wounds and injuries using micro-tools controlled by doctors in urban medical centers ― certainly one of the most fascinating ideas at the time.

The prototype was developed in 1992 and was first introduced to the public in 1997 in Belgium after winning U.S. Food and Drug Administration approval.

The machine consisted of two-lens endoscopes with attached articulated instruments having a full-range of three-dimensional movement. The operator, sitting at a consol, puts his or her arms through two armholes and manipulates the instruments as if they were actually performing the surgery.

The endoscopes send three-dimensional images to the operator and the power and directions of the robot hands can be controlled by several pedals. Doctors testified that once they get used to the images, and the feel and sense of the instruments, the process is easy to use and convenient.

In 2000, the Da Vinci system was used in about 10 cases in the U.S., but this jumped to more than 40,000 cases in 2007.

In Korea, Yonsei University's Severance Hospital first adopted Da Vinci in 2005 and has conducted successful operations on gall bladders and prostate glands. Since then, the hospital alone has conducted more than 500 surgical procedures using the robot. Now, there are 13 robots in the country and more institutions are planning to buy them.

Da Vinci Lessens Pain, Increases Comfort

Surgeons and their patients admire the machine as it brings about a win-win effect for both groups.

Prof. Lee Young-goo of Hallym University Medical Center, Kangnam Sacred Heart Hospital said Da Vinci is the best operating tool to date. Lee, also the chief of the Da Vinvi Robot Surgical Center at the hospital, said because the surgery requires smaller incisions in the abdomen, patients do not bleed so much leading to faster recovery times.

``If we have to perform open surgery, patients lose about 900 ccs of blood, but with the Da Vinci incisions they lose only about 150 ccs,'' he said. Therefore, the body receives less shock and the period for hospitalization is shortened, he added.

``It lessens patients' pain, which also leads to a shorter hospitalization period. It also has less possibility of contamination or infection, and leaves much smaller scarring,'' he said.

Kim Young-joo, who had a cancerous prostate removed in January, said he was very satisfied with the result. He said the shock of his disease and all the talking added stress to his heart beforehand.

``But I was really happy to get the surgery,'' he said. He showed his wound where only a small scar remained.

``I was able to move the day after the operation, which I never imagined. I even joked that it was a relief I was diagnosed with the disease late enough meet the robot,'' he said.

For the doctors, the robot is convenient, too. The arms move in a micro-scale and doctors say they are more articulate than human hands. Also, while human hands can shake in the middle of a procedure, the machine compensates giving a consistent performance.

``And because it is very small, the tip of its hands can move a lot and reach to a very small space in the body rapidly,'' Lee said.

Lee, an authority in urology, said the robot is especially good for prostate cancer. ``One of the side effects of the prostate cancer surgery is that incontinence often happens because surgical scalpels can cut veins. But with the robot surgery, it doesn't happen. Also, the chances of being accidentally made impotent are dramatically reduced,'' he said.

Da Vinci Taken up by Major Hospitals

Since its successful launch in Korea, the robot has been rapidly adopted by many hospitals in Korea. The Severance Hospital, Samsung Medical Center, Youngdong Severance Hospital, Korea University Medical Center, Asan Medical Center, Kangnam Sacred Heart Hospital, Bundang Seoul National University Medical Center, Donga University Hospital and Kyongbuk University Medical Center have all bought machines.

The Severance Center opened an educational institute for the robot for Asian countries while the Sacred Heart Hospital opened its own robot center.
``Because Korean surgeons have sensitive hands, teaching techniques are getting better and better,'' Na Gun-ho, a surgeon at the hospital, said.

Bundang SNU Hospital has recently started main arterial surgery with its robot. Surgeon Lee Tae-seung said the procedures were difficult, but with the Da Vinci system exceptionally precise surgery was possible.

Da Vinci Has Ups and Down

While Da Vinci surgery is successful, the high price is something that holds patients back. The Severance Hospital spokesman Lee Sung-man said the surgery costs between 7 million-20 million won.

The high costs is due to the eye-popping price of the robot itself ― 2.8 billion ― and the fact that its arms must be changed after every tenth procedure.
``It is why some people back out at the last moment,'' he said.

However, Lee Young-goo said the good outcome outweighs the cost and the pain a patient has to endure.

``I say it's the best surgical method yet,'' he said.

According to hospitals, the price is cheaper than in the U.S. and other countries ― ``I say about 20-30 percent,'' Lee said. He added that many foreigners have actually come to Korea for surgical procedures.

``For Koreans, there is no need to go abroad as surgeons here are catching up with the skill and are ready to perform,'' he said.

http://www.koreatimes.co.kr/www/news/nation/2009/05/242_21380.html

The Future of Doctors

Dr. Manish Shah is trying to figure out why Thelma Shoe's nose keeps bleeding. At least once or twice a week, the 73-year-old has been getting nosebleeds that last up to an hour. Shoe's no stranger to the clinic; she has emphysema, cirrhosis of the liver (from medication she took for tuberculosis), and has already had heart-bypass surgery.

Shoe was Shah's first patient at Duke's outpatient clinics three years ago, when he was a first-year resident, and the two have established a comfortable rapport. "Oww, that hurts!" she says, wincing as he inserts an otoscope into each nostril. "That hurts? I'm not even touching you," he counters as he peers into her nose. Shah suspects that the bleeds are triggered by her dry nasal cavities and recommends an over-the-counter nasal saline spray, available at any drugstore. He spends a few more minutes chatting with Shoe, then reminds her to return in a few weeks for a flu shot.

This is Shah's classroom, and patients like Shoe are his textbooks. Now in his last year of residency in internal medicine, he spends two afternoons each week at the clinic, seeing patients under the supervision of an attending physician who must approve every medical decision he makes. Only the short length of his white coat betrays his status as a doctor-in-training--an M.D. after four years of medical school, he examines patients, writes prescriptions, orders tests and fills out insurance forms.

Even at a hospital like Duke, where the emphasis is on specialty and cutting-edge medicine, almost half the 130 residents in the department of medicine are training to become primary-care physicians. This is the future of health care--a back-to-basics return to the profession's roots, when small-town doctors made house calls and were expected to deal with everything from births to a burst appendix. "Our mission is to train residents in the reality of where medicine is practiced, and that's in the outpatient setting," says Dr. Barton Haynes, chairman of the department at Duke.

Shah is one of five residents participating in an innovative program that allows him to act as a primary-care physician in an HMO. All five doctors share a PCP number and take responsibility for 10 patients each week. "When I went to medical school, I don't recall learning anything about managed care," says Shah. "But working here has helped me to think about prevention more. Now I ask my patients about health-maintenance things like diet, nutrition and exercise."

The forces that have changed Shah's career path are changing Duke as well. In the department of surgery, the faculty once relied exclusively on hospital patients as case studies for teaching residents, but the average number of days that patients spend at Duke has dropped from 8.3 to 6.9 in the past five years. That prompted administrators to scrap plans for a nine-story inpatient addition to the 1,124-bed hospital and opt instead to construct the ambulatory surgery center, completed last June, which houses seven operating rooms for same-day surgery procedures. "We spent hours deciding [on the] best way to involve the residents there, because that's the way medicine is going--up to 70% of surgery is going to be done on an ambulatory basis," says Dr. Robert Anderson, the surgery department's chairman.