DR Muhaya Medic ENG

How to Become a Good & Successful Medical Student
DrMuhaya.com
As Sohwah

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Prof. Dr. Muhaya Haji Mohamad

M.D., Ph.D.
Muhaya Mohamad
As Sohwah

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Published by Rasidah Salleh B-7-13 Oakleaf ParkTaman Bukit Jaya, Bukit Antarabangsa 68000 Ampang, Kuala Lumpur Tel: 603 4107 1 687 E-Mail: sidah13@tm.net.my Digital Publishing by FaizSuberi.com Digital Distribution by As Sohwah via DrMuhaya.com All rights reserved. No part of this book may be reproduced in any form or by any means without permission from the Author. Perpustakaan Negara Malaysia | Cataloguing-in-Publication Data Muhaya Mohamad How to Become a Good and Successful Medical Student Muhaya Mohamad ISBN 983-42676-0-6 1st printing 2005 Printed and bound in Malaysia. Cover Design Trans Creation (M) Sdn Bhd 30 Jalan USJ 8/2A,UEP Subang Jaya 47010 Subang Jaya Selangor Darul Ehsan E-mail: trans1@streamyx.com
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To my dearest husband Dr. Azmi, thank you for your doa' and support
To Aniah and Atiyah Enjoy the journey
Al-fatihah In Loving Memory of our Beloved Son.
Mohd Hilman Azmi (27thJanuary 1989 6th August 2000)
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"An excellent, holistic guidance for medical students. A "Must Read" book not only for Medical Students but for all doctors"
Professor Dr Lokman Saim Dean Faculty of Medicine Universiti Kebangsaan Malaysia
This book is interesting and original and the content covers common everyday issues which require answers. Dr. Muhaya has an engaging style of writing and is able to capture and maintain readers' attention throughout."
Professor Dr Robiah Sidin Deputy Director Institute of the Malay World and Civilization Universiti Kebangsaan Malaysia
"It is an excellent book of Inspiration and Hope for Medical Students and Postgraduate Students"
Professor Dr Raymond Azman Ali Deputy Dean of Graduate Studies and Research Universiti Kebangsaan Malaysia
"It is marvellous piece of work, highly commendable not only for students but also for teachers, not only for medical course but also for other disciplines in higher institutions of learning."
Professor Dr Ropilah Abdul Rahman Head Department of Ophthalmology Faculty of Medicine
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Acknowledgements
Many people assisted me in the preparation of this book. First and foremost, I must thank the medical students of the Faculty of Medicine of UKM. They inspired me to write this book by the many questions they posed to me during my series of motivational talks. Also, I must acknowledge Professor Nafisah Adeeb, Dean of Medical Faculty of UKM (1997-1999) for her encouragement and substantive constructive criticisms and input. Special thanks goes to my friends, postgraduates and undergraduate students for their time taken to read the manuscript and for their helpful suggestions. A special mention to Yam Phui Yee who took dictation by the hour and typed the initial manuscript and for giving valuable suggestions and input. Last but not least to my dear husband, Dr Azmi Jamion, and my two daughters, Noor Aniah and Noor Atiyah for their constant prayers and encouragement in all my endeavours.
Muhaya Mohamad M.D. Ph.D. August 2005
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Foreword
Life as a student is like embarking on a long, uncharted journey. It is the beginning of a new chapter in your lives, where the months ahead hold many exciting opportunities and challenges. For a student, recognizing these doors of opportunities and making the right choices can be a most perplexing affair. As one struggles to acquire as much knowledge as possible during this phase, the scale of life may not be so easy to balance. Perhaps more so for the medical student, the pressures of expectations of excellence commanded by the nature of the discipline being demanded at every turn. This, compounded by the stress of having to master a profound body of knowledge could make the journey seem daunting. The process of moving from being a medical student to physician is complex. Due to the intensity and workload demanded by the discipline, there is little time to reflect on other aspects of ones life. It is at this stage of their lives that guidance and direction is crucial for the students, both in the practical and especially in the spiritual sense. At the end of the day however, the crucial thing to remember is that the Almighty who determines our paths and it is to Him that we should always return to for the ultimate guidance and direction. Prof. Dr. Muhaya did very well as a medical student and is one of Malaysias renowned ophthalmologists. She was also the first recipient of the Toh Puan Rahah Award from the University Kebangsaan Malaysia (UKM) in 1982, an award presented to female students with outstanding academic achievements and personality.
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As an inspiring educator, her work was highly commendable and recognized, hence receiving the 1999 and 2000 Excellent Lecturer Award (Health Section) from UKM. Her flair for motivation is reflected in the many invitations to give motivational talks to medical students. She has been invited annually as a guest speaker to motivate the new intake of medical students in UKM. Her contribution to the nation does not stop there as she is frequently invited as a guest speaker on television and radio programmes, educating the public on the issue of Eye Health and Self-Motivation. The book on How to Become a Good and Successful Medical Student aims to share her journey and life experiences as a medical student. In this book, she shares her personal experiences and offers her insights with much clarity and simplicity. The book addresses the issues involved in the process of achieving the goal to become a good medical student through application of universal spiritual values. It also poses questions that are frequently asked by medical students, and the reader can expect to be enlightened with insightful answers. This book will serve as valuable insight and resource for all medical students, be they Muslims or otherwise, while they embark on this long, challenging journey in their quest to accomplish their dream to become medical doctors.
Professor Dato Dr. Mohd. Salleh Mohd. Yasin Vice Chancellor University Kebangsaan Malaysia
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Preface
Being a medical student has always been a tough chore in my experience. Most students have done very well in secondary schools; however, after being accepted to the university where the culture is very different from that of secondary schools, one may not do as well. Apart from academic responsibilities, medical students also have to cope with their own difficulties in communicating and interacting with their classmates, lecturers and definitely, with their patients. Becoming a doctor is not just passing exams and obtaining a degree at the end of five years. Medicine involves treating patients, and hence one has to have communication skills, be able to acquire new skills besides being able to develop charisma and self-confidence. Most caring students ask themselves, "Can I be a doctor one day?" This small book will try to answer the frequently asked questions posed by medical students. It is hoped that this book will serve as a guide and source of motivation to become a good and successful medical student. It incorporates life's spiritual aspect into the practice of medicine with a built-in positive lifestyle for all medical students. Certain technical aspects of effective studying, note taking, and examination techniques are also highlighted.
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Why did I write this book?

1. To help prevent medical students from falling into possible traps during medical student days. 2. To try and overcome some of the possible stressful situations faced by medical students in their five year journey to become a doctor. 3. As a source of inspiration for medical students to develop themselves in a holistic manner so that they would become wholesome doctors. 4. To answer some of the frequently asked questions of medical students during the many series of motivational talks to them. 5. To provide a soothing solution or remarks to students in their times of up and down which is sure to occur in their career.
If You Fail To Plan Indeed You Plan To Fail

- Muhaya Mohamad
August 2005
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CONTENTS
ACKNOWLEDGEMENTS FOREWORD PREFACE CONTENTS CHAPTER 1: HAVE I MADE THE CORRECT DECISION? 1. Have I chosen the correct field? 2. Can I be a doctor one day? 3. What sort of thinking is required to become a doctor? 4. What are the possible career options after graduation? CHAPTER 2: GETTING AHEAD OF TIME 5. Can I study and lead a reasonable life at the same time? 6. How do I manage my time and plan an effective study schedule? 7. Should I involve myself in many co-curricular activities? CHAPTER 3: POTENTIAL TRAPS FOR MEDICAL STUDENTS 8. What are the common problems for First Year medical students? 9. What are the common traps of studying? 6 7 9 11
14 16 18 20
22 24 37
39 45
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CHAPTER 4: I SURE LOVE THOSE LECTURES 10. How do I get the maximum benefit from the lectures? 11. What do I do when the subject is really boring and I do not understand the lectures? CHAPTER 5: AM I DOING IT RIGHT? 12. What are the effective study habits? 13. How do I study smart? 14. How to read quickly? 15. How do I overcome the frustration of studying difficult subjects? 16. How do I remember what I have studied? 17. Must I have a study group? CHAPTER 6: AM I A GOOD FRIEND? 18. How do I deal with friends who are always depending on me for lecture notes? 19. How do I deal with friends who are always asking me to teach them? 20. How do I overcome envy of other people's achievements? CHAPTER 7: FACING THE EXAMINATIONS 21. How can I pass all the examinations? 22. How do I prepare for multiple choice questions? 23. How do I write a good essay?
53 54
57 63 66 69 72 77
80 82 84
86 95 97
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CHAPTER 8: CAN I DO IT? 24. How do I overcome inferiority complex? 25. What do I do if I lose the motivation to study? 26. How do I keep my interest in medicine going? 27. What do I do if I do not feel like following other people's advice and want to do things my own way? CHAPTER 9: CAN I BE A GOOD CLINICIAN? 28. How do I clerk a case well? 29. How do I present well in case presentation? 30. How do I get the patients to cooperate with me during ward work and clinical examinations? 31. How do I make full use of my clinical sessions in the clinic? 32. How do I correlate the basic sciences to the clinical subjects? CHAPTER 10: ASSETS OF A GOOD MEDICAL STUDENT APPENDICES Appendix 1 - Effective Note Taking Appendix 2 - Paying Attention in Class Appendix 3 - MURDER Study System Appendix 4 - Speed Reading and Comprehension Appendix 5 - Effective Reading and Comprehension Appendix 6 - Taking Notes from A Textbook Appendix 7 - Flip Card Technique to Enhance Your Memory of A Subject Appendix 8 - Ten Tips for Test Taking Appendix 9 - Points to Ponder
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122 140 142 143 145 146 149 151 153 155
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1. Have I chosen the correct field?

Of course you have. The fact that you are reading this book is an indication that you are aiming to become an excellent doctor. If you are a person who is concerned about the wellbeing of others and are always happy to lend a helping hand, then you are in the correct profession. If you are ready to work hard and strive to know as much as possible about the human body so as to be able to relieve another human suffering, then you are off to a good start and will receive all the blessings of God. According to Prophet Muhammad (peace be upon him), there are five things that are very much encouraged to be performed. One of them is relieving the suffering of others. There is no better job in trying to achieve this than being in the medical field, as people who come to you are those with some form of suffering, be it physical or mental.
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Imagine the change you can make to the lives of others. As an example, imagine a person who is blind in both eyes due to bilateral cataract being able to see the very next day after surgery. From experience, I have seen many patients who are in tears after being able to see their loved ones once the eye bandage is removed following a cataract surgery. For many of them who appear morose before the operation, their facial expressions entirely change and their level of activity at home improves. As a doctor you have the ability and opportunity to make a difference in people's lives. Another hadith states that whenever a person leaves his house with the intention of helping another human being, God will give him the blessing equivalent to someone who performs "iktikaf" (meditates in the mosque) for a month. So, a doctor who leaves his house to help other people will get the blessing from God all day long, provided he is sincere and does not expect any direct reward from the person that he helps.
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I am sure by now you have realised that having a strong spiritual conscience would encourage a person to become a doctor and help the needy.
2. Can I be a doctor one day?

If you are determined and remain focused in your goal, have a strong discipline in your study methods and maintain a healthy attitude in your study and course work, you will succeed to become a doctor. You must be positive in your attitude and have confidence in yourself during the process of becoming a doctor. Recall the time in school when you were doing so well and were the teacher's pet. Recall how confident you were to speak in public and answer questions, intelligently in class. In every person there is tremendous potential and God permitting, nothing or no healing others, heal yourself one can come in your way BeforePhysically; Spiritually; from achieving your Emotionally and primary ambition. Socially
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Studying medicine requires that you remain organized, consistent, disciplined and interested throughout the five years of study. Each year in medical school may require different components of your capability in varying proportions such as the capability for understanding, synthesizing, evaluating, public speaking and communicating. The list is too long to describe but you can rest assure that the training in medicine will make you become a wholesome person possessing good values and social skills.
Most of the important things in the world have been accomplished by people who have kept on trying when there seemed to be no hope at all.
- Dale Carnegie (1888-1955)
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3. What sort of thinking is required to become a doctor?

Medical students should train themselves to be critical in their thinking. This is crucial as critical thinking is a skill that is required to become a good doctor. Seeing things in a holistic perspective is one requirement of a doctor. A patient will come to you with a complaint about their health rather than a written diagnosis. The complaint may appear to come from a physical illness but it may be a manifestation of a psychological problem. So, if one is able to see a person as a whole rather than just focusing on a symptom, then one will make a good detective at finding the underlining cause of the symptoms. In fact, a doctor is very much like a private investigator who is given a clue by the one symptom the patient complained of. It is his responsibility to look for the next clue to get to the diagnosis using his adequate knowledge of the basic science and correlating it with the clinical signs.
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Attributes of a critical thinker: - asks pertinent questions; - assesses statements and arguments; - is able to admit a lack of understanding or information; - has a sense of curiosity; - is interested in finding new solutions; - suspends judgment until all facts have been gathered and considered looks for evidence to support assumptions and beliefs; - is able to adjust opinions when new facts are found - looks for proof; - examines problems closely is able to reject information that is incorrect or irrelevant; - sees that critical thinking is a lifelong process of selfassessment and - listens carefully to others and is able to give a feedback.
- Ferrett S (1997) -
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4. What are the possible career options after graduation?

General Practitioners A general practitioner attends to patients with common ailments such as cough and cold. For more difficult cases, the patients will be referred to a specialist.
Specialists There are a number of different fields that you can choose from such as ophthalmology, cardiology, neurology and gynaecology, to name a few. Becoming a specialist requires a lot of hard work and minimum training of at least four years. However, the advantage is that you will be able to treat the patient at a level higher than what you can do if you are a general practitioner. You will be responsible for the patient's progress right to the end. As a specialist, you can also opt to work in the Ministry of Health or join universities to become clinical lecturers.
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Lecturers in Pre-clinical Departments If you do not enjoy treating patients and you find clinical work too busy, you can join universities to become lecturers at pre-clinical departments such as anatomy and physiology.
Researchers If you are interested in research, you can branch into doing research in various reputable institutions in the country. As you can see, there are many options to suit everyone's interest and capability. The main thing is to become a doctor first. People's interest may change with time according to the kind of exposure and working experience they obtain. Of course, it is also determined by family circumstances. Most lady doctors try to opt for the less busy schedule such as becoming lecturers in preclinical departments where they do not have to be on call.
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5. Can I study and lead a reasonable life at the same time?

It depends on how you define a reasonable life. If being able to go out every weekend and dining out every evening is your definition of a reasonable life, then you have to be an extremely bright medical student because you would only have two hours of time for studying after your lecture hours. Otherwise, this kind of lifestyle will lead to difficulties in passing your exams well. A smart student will know how to study effectively and will not waste time on unnecessary activities such as chitchatting on the Net or watching television in the evening. From my experience, I have not seen any of my colleagues who led this type of lifestyle and made it through medical school with good grades within the
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required number of years. Many of them who had a "good life" in the early years of medical school, struggled in the later part and became clinicians who are not confident with their clinical skills. An Arabic saying states that "a person who does not stand now will never be able to sit later." This means that a person who does not work hard in their younger life will never have a relaxed life when they are older. Everything in life has to be earned and all of us have to pay the "tax" whatever our achievement is. I am sure that for you to achieve the good grades required for entry into medical schools, you have paid your "tax" in the form of many late nights, hard work and maybe blood, sweat and tears. You must have the determination of achieving something and rewarding yourself later. For instance, be sure to complete your tasks such as revising lectures of the week before watching a movie or going shopping. The important factor here is to learn to prioritize your daily activities according to its importance and urgency.
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6. How do I manage my time and plan an effective study schedule?

Time management is about setting and following a schedule of study in order to organise and prioritize your studies in the context of competing activities of work, family, etc. According to Davidson (1997) and Wetmore (1999), the 7 divisions of time are family, society, health, finance, spirituality, work and self-development.
i.
Family
Ensure that you contact your parents at least once a week.
Scenario from my real experience: A student was not able to answer a vital question in an exam, which could have failed him. When I questioned him whether he had contacted his parents to pray for him for the exam, he told me that he had not contacted his mother for a month. So I told him that I was sure his mother was upset with him. As a result, God too was upset with him. The lack of blessing from both his parents and God might have resulted in him forgetting the simplest but crucial fact. (The question was: What is the one investigation you must do before performing lumbar puncture in a patient with papilledema. Answer: CT Scan.)
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By doing so, your parents will be happy with you and so will God. They will pray for you and of course things will go smoothly.
ii. Society
Be sensitive to the people around you. This includes your roommates, classmates and those you come into contact with. Should someone get into trouble, try to help him or her even if it means some taxation on your time. The time spent helping others will be repaid by God in that you will save time on other things such as being able to understand certain subjects in a shorter time than usual. Have faith.
iii. Health
A healthy mind comes from a healthy body. Even though you are young with no illness, make sure that you maintain your health by having a balanced meal, enough sleep and adequate exercise. Do you know that exercise produces a lot of alpha waves around you, which allow you to study better? Do not try to save time by not having a proper meal and just surviving on cup noodles. Be sure to take nutritious food for good health.
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iv. Finance
Take some time in a day to organise your spending and ensure that you keep at least 10% of your income as a saving for emergency purposes. Remember, do not try to cut down your spending on academic material. For example, if you need to photocopy articles, do not try to save money by choosing a cheap photocopy machine which gives you poor quality prints or by reducing its size, which will tire your eyes reading them.
v. Spirituality
This is an important component to spend time on because spirituality has to be well maintained as it influences your attitude to life as a whole. For the Muslims, apart from the five prayers, ensure that you go to weekly religious group meetings where you would be reminded of your behaviour and deeds according to the Holy Book. By enhancing your spirituality, you seek the blessings of the Almighty, and God, being the ruler of the whole world will show his rewards by ensuring that your life runs smoothly.
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vi. Work (Study)

This of course takes the priority as you are given five years to complete your duty as a medical student and you should be able to achieve your targets. The key factor to achieving this is by adapting the correct attitude in your studies as have been discussed in the previous chapters.
vii. Self-Development
This is important as you are actually developing yourself every time you study. As a doctor, one very important skill that you must possess is communication, in order to make yourself understood by patients. Students must know how to communicate with patients. They must know what to say and when to say it.
Time is the scarcest resource and unless it is managed, nothing else can be managed.
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Guidelines on how to control your time

1. Monitor your time
As someone with faith, ensure that you allocate time for your spiritual enhancement. All Muslims are required to pray five times in a day. Keeping to each prayer time is a good way of disciplining oneself. For Muslims in Malaysia, there are three hours of solid time after or in between prayers. Someone who prays on time has three hours after each prayer time to do other things before the next prayer time comes, in which one asks for forgiveness for things that he or she has done in the previous three hours. According to a hadith, the five praying times is like a river that runs in front of one's house in which one bathes five times a day. Hence it will help to cleanse one's soul.
Time is a fixed income. Plan each day down to the second because once time is wasted, you can never get it back.
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2. Reflect on how you spend your time

Regard your time as an investment given by God to do good deeds. Be aware of when you Control your time. Don't let it are wasting your time. Know control you. when you are productive. Knowing how you spend your time should aid you in planning and predicting project completion.
Self-Imposed Time Wasters Visiting friends Talking on the phone Listening to music Watching TV Games, e-mail, etc. Daydreaming Not being able to say no Worrying Gossiping Poor reading/study skills Poor concentration Lack of planning
Self-audit (reflecting what good and bad things one has done during the day) and a time-audit before you go to sleep. Schedule fifty-minute blocks of study. After one block of study, it is advisable to rest for five minutes by having a drink or talking to your family. Three blocks of a fifty-minute study is more effective and relaxing than a continuous two-and-a-half hour study.
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Plan to use "dead time" - e.g. use your mealtime in the room to listen to beneficial programmes such as religious and motivational programmes.
System-Imposed Time Wasters Over-long visits Phone interruptions Music/noise in the area Waiting/delays Roommate problems Unclear assignments Mechanical failures Illness or fatigue Emergencies Unnecessary meetings
Schedule as much study time as possible during daylight hours. Avoid sleeping late and have a good sleep.
Schedule a weekly review to ensure that you understand the entire topics that have been taught for the week.
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3. Have a "To study list"

Have a daily/weekly planner. Depending on your posting, identify the major areas that you have to cover. Plan your study group discussions. Write down the common cases seen and the essential points that need to be known. Identify gaps in your knowledge as you see the common cases or topics of the day during lectures or tutorials. This is called "gap analysis". Make sure that two things are done in one day: (1) preview of upcoming lectures and (2) review of lectures given on that day.
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Checklist for effective note taking:
Prepare by reading assigned text and reviewing notes from the previous lecture. Keep yourself alert by sitting where you can concentrate on the speaker. Listen for and record the topic of the day's lecture. Write more than the lecturer puts on the board or overhead. Ensure the subtopics of the lecture are easy to see in your notes. Include examples and significant details. Organise your notes to show the relative importance of the ideas. Write legibly to make the notes easy to study later. Edit notes for accuracy and legibility after class as soon as possible. Actively review your notes by predicting exam questions from them.
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4. Always know what's ahead for the day

Always go to sleep knowing you're prepared for tomorrow, be it lectures or tutorials. Have a to-do list for the day. A small planner will help.
The Daily Plan: The To-Do List Planning your day takes very little time and can really pay off. You begin by listing all the things you need to do for the day. Then you decide which are most important to your daily goals. Keep your list with you to stay on track.
To make your "to-do" list: 1. Use a 3x5 card or a small notebook. 2. List your activities/tasks for the day. 3. Prioritize your list: - Write an A by your must do's - the tasks that will help you meet your stated goals. - Write a B by your should do's - the jobs that are important but could wait a day.
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- Write a C by your could do's - easy or fun things that really can wait. 4. Do the A's first.
For example: Revise Physiology A3 Review lecture A1 Call home/get new room key B1 Preview lecture A2 Check e-mail/Friendster C (AAC Study Tips. Ohio University)
5. Have a long-term planner

Use a monthly chart so that you can always plan ahead. Long-term planners also serve to remind you to plan your free time constructively. Plan your holiday well. It can be used to cover the gaps in your knowledge. It can mean going for elective posting or get some attachments to certain clinical departments.
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The Detailed Weekly Schedule Making a detailed schedule of your week may seem too confining. However, knowing when you can get things done actually gives you more time to make changes.
To make your weekly schedule: 1. Enter all of your fixed obligations - classes, meetings, meals, work, exercise, sleeping, TV, etc.
2. Schedule your study hours with these in mind: - Be realistic. - Think of being a student as a full-time job. - Break big assignments into manageable parts. - Complete assignments before you are too tired. - Remember that short study sessions can be more effective than marathons. - Use the time between classes to review notes or prepare for your next class. - Study your hardest class first to avoid putting it off. - Review your lecture notes as soon as possible. - Use weekend time to catch up and to plan.
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3. Schedule your free time. Prioritize naps, socializing, exercise, etc. Planning recreation is as important as planning other activities.
4. Try for a balance between study, work, and recreation. (AAC Study Tips, Ohio University)
The Quarter Schedule Remember, the quarter schedule keeps you tuned in to the big events in your life. It will remind you of quizzes, projects, exams, papers and other events. The schedule will keep you from being overwhelmed at the last minute.
To make a quarter schedule: 1. Get out the syllabus from each of your classes. 2. On your quarter schedule, enter the date of eachquiz, paper due, exam, etc.
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3. Enter important events: trips out of town, co-curricular activities. 4. Put your quarter schedule in a prominent place where you can see it. 5. Update it when necessary. (AAC Study Tips, Ohio University)
7. Should I involve myself in many cocurricular activities?

Yes, you should, provided it does not interfere with your studies. Joining various societies will help you shape your personality. It will also make you treasure your time even more. However, if you find that you have difficulty in understanding your subjects and require extra effort to achieve your target, then it is not advisable to be involved in a big way in any organization. It may be sufficient to be an ordinary member. Choose your co-curricular activities well. Participating in cocurricular activities can help you develop the right side of
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your brain, enhance your creativity and make you a multiskilled person. However, it has to be done in moderation and make sure that the time spent on co-curricular activities does not exceed your main task of studying medicine. From my experience, limited amount of involvement in societies is good enough. As medicine is a serious subject, there is no replacement for hard work and diligence.
People who make the worst use of their time are the same people who complain that there is never enough time.
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8. What are the common problems for First Year medical students?
1. Living in past glory
Many of those in medical schools were top students in their secondary schools, which may give them a false sense of security. They could have been their teachers' pets and were top students in their class, but what they do not realise is that when they enter medical schools, they are studying with 200 other top students. They do not realise that they are learning entirely new subjects where they need guidance to get the knowledge. Hence, if the approach is wrong, it will be difficult for them to understand what they are learning.
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Real situation: A student who just joined medical school was given a car and a hand phone and was staying in a separate apartment with his friends. The culture of this clique was that they would go for dinner at 8pm and return by 10pm after which they started to study. They continued this routine until the whole clique failed the first year examination after several attempts and had to change to another faculty.
2. Culture Shock
Students entering medical schools will experience a sudden change in their life and study culture, being away from their parents or the discipline of their previous boarding schools. Attendance at lectures may not be taken and should one miss a lecture, it will go undetected. In contrast to schools or matriculation centres where everything that students need to learn is given by the school teacher or tutor, in medical school, lectures are mainly given to provide the fundamental principles and
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some core knowledge upon which the students have to expand and be able to apply. This sudden change in culture may result in some students having difficulty to adapt themselves. Unless this is stressed upon them and they become prepared, it may jeopardize their performance. The approach of problem-based learning used in many medical schools is something new and it applies the student-directed learning methodology, which is entirely different from the study methodology in school.
3. Choosing or being chosen by the "wrong" friends.

Talking from experience, many students who did so well in school did not perform as well in universities as they found the wrong circle of friends who do not know their priorities and goals as medical students. They are excited meeting new friends and found new ways of occupying their time and enjoying themselves especially when they are given a lot of money by well to-do parents who think that by giving everything, their children will do well.
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4. Loss of motivation (burnt out)

Most students study hard for exams just to get into universities. Unfortunately, their future career pathway after entering universities is not taught of or discussed with the school counsellor. After studying so hard to enter medical school, they feel burnt out and lose the motivation to study.
5. Being forced by parents to do medicine

Some students are not interested in medicine but enter medical school because they are being forced by their parents. Medical subjects cannot be learned if one is not interested.
Through experience, I have seen students who have reached the fourth year resign because they could not go on and had to start new at other faculties.
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6. Studying alone
In medicine, having a regular study group is important. Three common reasons why students do not want to have study groups: i. Do not want others to know their ignorance in medical subjects. ii. Afraid to share their knowledge with other friends who might score higher than them. iii. Do not want to put the extra effort.
Through my experience, many students who do not do well are those who do not have any study group and feel contented at just being able to stay in the library for hours and read their books. Whenever they do not do well in the exam, they become depressed as they have no one to turn to. This will lead to further demoralization and loss of inspiration to study. It may later become a vicious cycle with further loss of morale. In contrast, students with study groups do much better and should any one of them not do well, the others will try to
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help them as the weakness of each person in the group are made known during the discussion sessions.
7. Too Competitive and Not Cooperative

This is quite common especially among female students. This could be due to them being top students in their previous schools or matriculation centres. As a result, they want to remain being top students and might be overzealous and try to get as much knowledge as possible without considering others. This problem is manifested in any or all of the following behaviours: i. ii. Fighting for the lecturer's attention. Being selfish and unwilling to share the notes and good books given by seniors with others. iii. Dominating the lab sessions and not giving others the chance to participate in the experiments. iv. Hiding the fact that they have been studying.
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9. What are the common traps of studying?

1. I Don't Know Where To Begin
This is a common problem. Do not panic. It is quite normal to be overwhelmed by the amount of things that you have to learn. Begin by making a list of all the things you need to know which will be available in the syllabus or told by the lecturers. Divide your workload into manageable portions. Learn to prioritize and schedule your time realistically.
Studying medicine is like going to the war. You cannot do it single-handedly. Teamwork is important. Nobody is your competitor and everybody is a collaborator. Everyone has to share their ammunition to win the war and get a common victory. There is no quota of how many should get A in medical schools. The fact that a friend gets A does not deprive your chance of getting A. The more you give, the more you will get. In other words, the more you give your knowledge to your friends and share your notes, the more they will share whatever they have with you. So, two plus two is equal to five, which is what we call "synergy".
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Discipline yourself to use the few minutes between lectures to review lecture notes. Avoid last minute work and begin studying early with a minimum of four hours per day. Never skip any lectures as missing one-hour lecture can never be replaced by five hours of studying on your own.
2. I've Got So Much To Study ... And So Little Time

Be smart. Ensure that you practise PCR (Preview, Concentrate, and Review) of your lectures. Make a study sheet summary of all your subjects. This can be made easier with a group of friends in your study group. The summary should include the lecture notes, tutorials, problem-based learning and laboratory work which all have to be well inter-related. Identify the most important topics that have been emphasized and areas which are difficult to understand.
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3. This Subject Is So Difficult, I Can't Understand Any of It

Be patient! Learning about the highest creation of God is never easy. But believe me, once you acquire the knowledge, it is the most satisfying thing you can ever get in this life. Regard it as a challenge. A good approach would be to discuss with others in class. It helps to know that others find the subject difficult too. Have the courage to make an appointment with the lecturer to clarify on the difficult areas. Lecturers are always more than happy to help. Personally, I get thrilled when students ask questions. One key point to remember is that the more difficult the subject is, the more useful it will be for your future clinical practice and post-graduate studies.
4. I Read It. I Understand It. But I Just Can't Remember It

Discuss. We remember best the things that are most discussed. Research has shown that we remember 70% of what we discuss. Try to relate it to something meaningful to you. As you are discussing, try to relate the topic to your
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own examples. Try to co-relate the subject with what you have learnt before.
5. I Guess I Understand It
Don't be too sure. Test yourself by talking about the subject. Make up questions with your friends about the key sections and test each other. Keep in mind what the lecturer has stressed in the lectures. Study the relationships between each topic. Try to generate your own exam questions for the topic and answer it.
6. There's Too Much To Remember

Organise. Information is recalled well if it is represented in an organised framework that will make retrieval more systematic. There are many techniques that can help you organise new information, including: Write chapter outlines or summaries. For example, in pharmacology a tree diagram to show the relationship
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between the various autonomic drugs will prevent confusion of their various modes and sites of actions. Group information into categories. For example, pathology of a kidney can be categorised into those affecting the glomeruli and those affecting the pelvicalyceal system. Information Mapping. Draw up a matrix to organise and interrelate material. For example, in obstetrics and gynaecology, a table comparing the different stages of management in different types of obstetrical problem such as multiple pregnancies or breech presentation will help to differentiate the different emphasis at different stages of pregnancy.
7. I Knew It A Minute Ago

Review. After reading a section, review and practise Output Learning. Try to make up questions about the section and answer them. If you cannot recall enough, re-read the portions you have trouble remembering. The more time you spend on studying, the more you tend to recall. Even after the point where information can be perfectly recalled,
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further study makes the material less likely to be forgotten entirely. In other words, you can't over-study. However, how you organise and integrate new Information is still more important than how much time you spend on studying. It is not the number of hours spent but how much you obtained during the study session that matters. A measure of how much you have learnt can be reflected upon by the number of questions you can answer. Try to make some essay questions and answer them, and try to answer some multiple-choice questions to consolidate what you have studied.
8. But I Like To Study In Bed

This is no good. Treat your study seriously. Reading medical books is not similar to reading storybooks. You have to study with a paper and pen in your hand and scribble or make diagrams in order to study actively. You can never do this while lying down. In addition, recall is better when the study situation is similar to the test situation. The greater the similarity between the study setting and the test setting, the greater
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the likelihood that material studied will be recalled during the test.
9. I Study Better At The Last Minute

This is never true. Recall increases as study time gets spread out over time. There is of course, some stress induced hormones that make you more alert and active and feel full of energy to study. However, this will lead to easy exhaustion and you may get panic attack especially when you find that there is too much to cover. This is futile and you will get the repercussion during the exam. I have seen many of my friends who had this attitude ended up having to repeat so many papers and in the end had to repeat the academic year and many of them took two extra years compared to others to graduate. This will lead to frustration and lack of self-confidence.
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10.
I Will Stay Up All Night Until I Finish
This is counterproductive. The most important thing during a test is to have an alert mind. Therefore, you must have enough rest. Avoid mental exhaustion. Take short breaks frequently when studying. Before a test, have a rested mind. It is more important than ever to take care of yourself before an exam. Eat well, sleep, and get enough exercise and pray hard. (Adapted from AAC Study Tips, Ohio University)
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10. How do I get the maximum benefit from the lectures?

Prepare for discussion/ recitation courses before class. This is called preview. Preparing for the lecture will help you to identify the areas that you have difficulty in understanding. So when the lectures are given you will have a better chance of grasping the facts and will be sensitive to the topic that you do not understand which you can write down.
Schedule time to go over the lecture material is immediately after class. Remember: Forgetting is greatest within 24 hours without review.
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Should your doubt not be clarified during the lecture, be ready to ask the lecturer at the end of the session. Mark the difficult part with red ink. Allow no doubt in any area. Make sure you take good notes during lectures. (See Appendix 1 Effective Note Taking)
11. What do I do when the subject is really boring and I do not understand the lectures?
Remember: no matter Do not feel inferior to how boring the subject is, answer it is important for your Try to answer questions Do not be afraid to ask future practice. There is NO stupid question Otherwise it will not be taught and given the credit hours. You must realise that you ought to have adequate essential knowledge in order to practise as a doctor later in your life. Adopt the attitude that the time you spend to study and work hard at understanding some facts will be considered as good deeds and blessed by God.
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During Tutorials

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Keeping yourself interested in the subject will prevent you from getting bored. Try to see the subject as a leaf on a trunk. Therefore you must try to identify the trunk in order to know the importance of the subject. Ask yourself, what the impact would be on your career as a doctor should you not know about that subject. If possible, in a polite manner, try to ask the lecturer the significance of the subject being taught.
Try to make an appointment to see the lecturer and ask on whatever that you do not understand. If you feel awkward going alone, bring a friend who has a similar problem in the subject. Do not feel shy to show your ignorance; a smart person is one who knows what he does not know. As a student you are not expected to know everything, and being exposed to a new subject, any person will need some help at understanding it. You must have a good mindset when studying. Bring your ego down; you gain nothing by being egoistic. Do not live in your past glory when you were the best student in school. It is all right to show your ignorance and
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make mistakes while you are learning. This will prevent you from repeating the mistakes later. It is important to have the attitude that you are responsible for your achievement and do not blame anybody or anything for any shortcomings. (See Appendix 2: Paying Attention in Class)
To admit your ignorance once is to reveal your ignorance once. To hide your ignorance is to reveal your ignorance again and again.
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12. What are the effective study habits?

You can prepare yourself to succeed in your studies. Try to develop and appreciate the following habits:
i.
Take responsibility for yourself
As a doctor, one has to have enough core knowledge in certain subjects. Without this, there will be a lot of gaps and grey areas. Believe me, whatever grey areas you have as a student will remain grey if you do not try to erase them. As a result, the subsequent knowledge acquisition in certain areas will be Studying is the process of grouping together and hampered. Hence, organising the material to be learned. It is the one will have basic process of memorising the material. - Dr. Lamon H. Small difficulty passing exams and it can
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lead to mismanagement of patients later. I have seen this happening and the doctors usually feel very remorse and they wish that they had taken their studies more seriously. Therefore, as a student you are responsible to ensure that you have a good grasp in some core subjects. In order to do that, you have to decide and make decisions about your priorities, time, and resources.
ii. Centre yourself around your values and principles

Do not let friends and acquaintances dictate what you consider important. This is very important as everyone has to have missions in life. Whatever religion we belong to, we always strive to make this life given to us beneficial to others as well as to ourselves. Our values will be dictated by our upbringing and the input we receive from our environment. Having a clear objective in life will help us to focus, stay on track, and prevent us from being led astray by friends and acquaintances.
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For example, if you choose to master Learning is the process of acquiring knowledge medical knowledge and knowing the material studied. This is when the new knowledge is entered into memory. It is and be good at your the process of organising the material to be work, should your learned into meaningful mental processes. - Dr. Lamon H. Small friends try to prevent you from doing so by telling you that you are young and should get the most in your lifetime, you would not be influenced by that. Of course the easiest thing to do is to follow your heart and have momentary enjoyment, but suffering will come once the exam paper is in front of you, and you are trembling before the lecturer during oral examination due to lack of knowledge.
Understanding is the process of studying, learning and knowing the material and having control over it. Understanding is the level of learning where comprehension takes place. This is where you know the meaning of what you have learned and know it thoroughly. - Dr. Lamon H. Small -
iii. first
Put first things
Follow up on the priorities you have set for yourself, and do not let others or other interests distract
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you from your goals. Your priority as a medical student is to understand your lectures. In order to do this, the three important steps - preview, concentrate and review (PCR) - are mandatory. There is no shortcut in grasping the knowledge during lectures. The most common mistake is to procrastinate and only try to read everything that has been learnt over the past three months in a week before the exam. Do not fall into a trap of spending more time in extracurricular activities especially during the prime time, i.e. from 9 to 11 p.m. This is the usual time most meetings are held. Try and arrange to have extracurricular meetings during less productive times such as on Saturday or Sunday Effective tips: afternoons. Preview the lecture Another common trap Review the lecture especially for boys, is being distracted by friends who come and ask them out for 'teh tarik' or `burger'. If you do not practise PCR in your daily schedule as your priority then you will be easily distracted.
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iv. Discover your key productivity periods and places

Try to identify the time and study spaces where you can be most focused and productive. Prioritise these for your most difficult study challenges. Sleep early and rise early every day. You should have a minimum of 5 hours of sleep every night. Morning is always the best and most productive time, so train yourself to wake up early to make use of this valuable time.
v. Consider yourself in a win-win situation

You win by doing your best and contributing your best to a class, whether for yourself, your fellow students, and even for your teachers. If you are contented with your performance, a grade becomes an external check on your performance, which may not coincide with your internally desired benefits.
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vi. Look for better solutions to problems

For example, if you do not understand the lectures, do not just re-read the material. Try something else! Consult the lecturer, a tutor, an academic advisor, a classmate or those in your study group. Look to continually challenge yourself. (Partially adapted from the audio cassette by Steven Covey, Seven Habits of Highly Effective People.)
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13. How do I study smart?

It is not enough to just study hard. Studying in a smart manner is the key to success in medical schools. I would like to stress the importance of the effective study method, i.e. Output Learning, in contrast to Input Learning.
Daily Strategies Checklist: - Complete all homework /reading assignments. - Write or recite ideas in your own words. - Attend all classes. - Take complete lecture notes. - Schedule enough study time. - Review notes using a Recall Column. - Get help if confused. (AAC Study Tips, Ohio University)
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Output Learning in contrast to Input Learning Input Learning involves one to read and make notes. It has been shown to be highly ineffective and extremely tiring and boring. In contrast, Output Learning has been shown to be highly effective.
Important skills for medical students: Effective note taking Effective studying Effective examination techniques Effective presentation techniques Effective discussion groups
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Steps in Output learning

Read Recall Mind mapping Review the map Recall the map and say it out
For more tips on studying, refer Appendix 3 (MURDER" Study System).
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14. How do I read quickly?

Reading is to the mind what exercise is to the body. Richard Steele, English 1672-1729
Before you start reading, have an aim of what you want to know about the subject. This will lead to an active learning. Write down some questions before reading and aim to answer them after reading the chapter. You will remain focused and try to find the answers to your questions. There are three stages to reading textbooks for studying and outlining: Skimming, Thorough Reading and Attentive Reading. 1. Skimming is a process of familiarising yourself by skimming through the text. You are only interested in getting an overview of the material and looking for a theme. 2. Thorough Reading is concerned with focusing on the main and important ideas of the materials. This is the time when you stop and make mental pictures of what you are reading.
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3. Attentive Reading is where the learning and understanding of the material takes place. Create questions while you are reading the material. Try to think of the questions that could be asked about the material.
Why the need to recall? When we recall, we are transferring the knowledge from the book to our brain memory cells.
Active study strategies:
Make condensed summaries/outlines of chapters or big topics Organise ideas in charts or graphs Complete questions at the end of each chapter Draw pictures, make and label diagrams or processes/systems Create time lines Make note cards for vocabulary or formulas
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Create a list of the 20 most important questions or ideas Write a list of questions/topics to take to a study group Explain concepts in your own words Work problems until solving them becomes second nature (AAC Study Tips, Ohio University)
"To study medicine without books is to sail an unchartered sea, while to study medicine only from the books is not to go to sea at all." -Sir William Osler-
For tips on speed reading, comprehension and taking notes from a textbook, refer to Appendix 4 (SpeedReading and Comprehension), 5 (Effective Reading and Comprehension) and 6 (Taking Notes from A Textbook).
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15. How do I overcome the frustration of studying difficult subjects?

Your mindset is very important. As a Believer you should regard every minute spent on studying as a good deed and hope that God will bless you. So, even if you do not understand something and it takes you longer to read, you will go on learning as you know that every minute and effort that you put in will be regarded as a good deed and virtue by God, and the kindness will be rewarded in some other forms such as good health. It is important to be sincere in whatever you do. One should study to know and not to pass only. If you only study to pass, you may pass but you are likely to forget the facts. However, if you study to know, you will gain knowledge, pass the exam and still remember the facts. Should you decide to take up the challenge and plan to do your postgraduate studies, all these I love the man that can smile in trouble, that can basic knowledge gather strength from distress, and grow brave by reflection... and he whose heart is firm. becomes very -Thomas Paine (1737-1809) useful.
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Medicine is one of the fields where every line that you read and every fundamental fact that you learn will be used in your everyday practice and examination.
To really learn the material, you need to sort, condense and organise it. 1. Condense, Summarise, or Outline Put ideas in your own words. No simple-minded copying. Use for any subject to see concept relationships. 2. Draw and Label Your Own Diagrams/Pictures Use for complicated systems. Increase visual memory. 3. Create Time Lines Use for chronological events or sequential systems/processes. 4. Make Charts Use to compare several theories/systems/ processes. 5. Organise/Work Problems (AAC Study Tips, Ohio University)
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One good way of studying a difficult subject that I find effective is by teaching others. This is due to the fact that in trying to make others understand a certain topic, I have to truly understand it first and for any questionsasked, I have to read up further to explain to them. The human body is such that everything is connected. Being good in one subject will increase your understanding in another. Speaking from personal experience, as a medical student I was never satisfied if there were some areas that I did not understand. I would make sure that all the facts were well understood, and I always found ways to remember a subject, not only by mnemonic, but also by the logical way of understanding and thus remembering the points.
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16. How do I remember what I have studied?

To remember what you have studied requires a lot of sincerity during studying and blessings from God. By God's grace I can still remember things that were taught more than twenty years ago such as Additional Mathematics, Organic Chemistry and Physics, and I have been able to teach these secondary school subjects to form five students. If one studied for the love of it and never regarded studying as a chore, then one will enjoy and remember the subjects well. Teaching others does help a great deal. It forces you to know the material very well in order to teach others. We must be aware that there are many steps of learning including reading, understanding, remembering, synthesising, analysis and evaluation. For one to be able to teach well, one has to reach the stage of analysis which is not easy to do. But once this knowledge is acquired, it will stick in the mind and can be recalled when needed especially in exams,
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which is to one's definite advantage. In the end, it is the people who teach others that benefit the most, has full control of his or her knowledge, and gain the blessings from God in the process.
Learning through our senses: Sight - 83% o show pictures and diagrams o make a good effort to illustrate points Hearing - 11% Smell - 3.5% Taste - 1.1% Touch - 1.5%
Here are some tips on how to have a good and solid understanding of your pre-clinical material where a lot of reading, understanding, remembering, synthesising, analysis and evaluation are required. Review your notes and readings frequently, so the material is "fresh".
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As you're reading your text or reviewing your notes, generate and write down questions about the material. Keep track of any terms you need to know. Mark these on a separate note and title it as grey area' or 'mustknow list'.
Must-know, good-to-know. Must-see, good-to-see. This is a very important list for all medical students and they should obtain the help of lecturers to develop them. The list will help highlight to them which cases, subjects or topics need to be emphasised over and over again. An example of a must-know: the clinical features of heart failure. A goodto-know may be the current treatment of heart failure. As for the must-see, as an example, all students must see and recognise a case of papilledema, and a good-to-see case is one of optic atrophy due to glaucoma. (See Appendix 7 - Flip Card Technique to Enhance Your Memory of a Subject)
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The do's and don'ts of studying The do's: Prepare before any lecture or tutorial Practise output learning Start studying with a prayer Smile while studying Ensure conducive environment Green and yellow colours have been proven to be stimulating and able to enhance learning While reading, use your index finger to point the lines in the book or to underline to remain focused and maintain concentration
The donts: Studying while lying down Study with the music on Being absent from any lectures or tutorials Study passively Read only, with no pencil or paper to scribble
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Research has shown that we remember: 10% of what we read Not effective if done without the next four steps. This is the most common cause of students studying so hard and yet still fail the examination. 20 % of what we hear Attending lecture is mandatory 50 % of what we hear and read Hence it is important to see the presentation and hear the lectures 70% of what we discuss Study group will help 90% of what we do Need to do MCQs, essays, etc. 100% of what we teach
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17. Must I have a study group?

Belonging to a study group is important for a medical student. It is very difficult to do well without having regular discussions with colleagues. A study group is not meant for reading a book together. It should be used as a way to ensure that one studies consistently and regularly, and to have a point of comparison of one's knowledge with others in the study group. Solitary studying has the disadvantage of being unable to cope with periods of depression, loss of interest and feeling demoralised. In many religious beliefs, being in a group is very much encouraged. It teaches one to be tolerant, cooperative and interactive, and gives one the opportunity to acquire the interpersonal skill vital in becoming a doctor. Another advantage of a study group is that you will be able to help your friends who have not grasped the subject as well as you do, or, you may need the help of your friend who understands the subject better than you do. So there is a two-way advantage, a win-win situation when you are in a study group. In addition, it increases your social and
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communication skills by being able to impart your knowledge clearly and accurately. Having members in the study group doing different postings during the clinical years have many advantages. One main advantage is that you will be made aware of the important cases with good clinical signs in the different wards. This would allow you to see the cases together and later discuss the pathogenesis and clinical implications of the cases. Any uncertainty met during the discussion can be clarified as a group with various angles of approach and this will lead to a solid foundation on a disease process. Having a discussion group will also keep you organised and committed to a fixed timetable, and it pressures you to manage your time to be prepared for the group discussion. Certain difficult topics require a lot of time to understand. A group consisting of five people for example would be able to share the academic burden on certain topics. This division of work will lead to less stressful evenings (imagine you alone trying to finish some 10 pages of material to understand a disease process).
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Another advantage is that the summary of certain diseases can be put together onto a piece of paper with inputs from different people. As an example, the features of liver cirrhosis can be summarised onto a piece of paper with the diagram of a human, and one member will fill in the clinical features of one region of the body such as the face, abdomen and hand. However, a study group is not a substitution for your own studying. It is very important that you continue your study schedule. The group should be used to supplement and enhance your own study. Do not depend on the group or another person to supply you with all the information that you will need to prepare for class or a test. Depending on someone else can prove to be a futile.
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18. How do I deal with friends who are always depending on me for lecture notes?
You should feel good as it means that your notes are good, easy to understand and that your friends find you trustworthy. Do remember that if you help others God will help you. Regard it as a way of helping your friend who is not as organised as you are. Remember that studying medicine is like going to a war where everybody has to work as a team to get the victory, i.e. having a degree in medicine. It is a degree with which you can serve the community better and help to increase the standard of health care in this country. Remember that today your friends need your lecture notes, another day you may need their notes
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because none of us can be sure that we can maintain and enjoy good health all the time.
A friend in need is a friend indeed.
A day may come when you are unwell and need your friends' help with the notes for the missed lectures. Furthermore, your friends in medical school will be lifelong friends because there is every possibility that you may become specialists in the different specialties when you will be referring cases to each other.
Keep your fears to yourself, but share your inspiration with others. -Robert Louis Stevenson (1850-1894)
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19. How do I deal with friends who are always asking me to teach them?
It is definitely good, if you have been asked by your friends to teach. It means that they trust you. During the act of teaching them you will revise, learn and consolidate your knowledge. In sharing my experience, I remember teaching my friends in the same year and some of my juniors once I have passed to the next academic year. Due to these sessions I became much better in basic subjects and clinical, with the added bonus of being able to remember the facts vividly. In addition, I am sure it is the blessings showered by God which enabled me to perform well in my exams. In the clinical examination, I had good patients with straightforward diagnosis and the questions asked by the examiners were those that I was well versed with. I always believe that performing well in exams does not depend solely on how hard you study. There is always a strong external factor controlled by God. I find that I was asked questions that I knew the answers and seldom those that I was unfamiliar with.
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Also, in the clinical examination, the patients allocated to me were always co-operative and I did not have to struggle with the history taking, which can really affect one's performance in the exams. I am certain that all these are rewards from God for all the help that I may have given to my classmates and juniors. Many of them still remember this and keep reminding me of the difference I made to them. In addition, it is such a great satisfaction to see your friends doing well in their career with the knowledge that you had assisted to plough some seeds into their success.
Helpful attitude: Help others to receive help from God Do things to the best of ability Respect others to gain respect See good in others Be generous o Money o Love o Advice
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"Because we are mortal, every talent, skill and ability we possess, every thought and feeling we ever have, every beautiful sight we ever see, every material possession we own will ultimately be lost. Unless we share it..." (Excerpt from "The practice Of Kindness" Canary Press)
20. How do I overcome envy of other people's achievements?

Remember that knowledge is valued as holy and will fall only onto clean, sincere heart. Envy is something that will burn all your good deeds just like fire burning the dry leaf (hadith). Why should you feel envious of anyone when everyone is created special in his or her own way? You may feel that the person whom you feel jealous of is superior to you and may have everything that you do not have, but you may not know what the person's perspective of herself or of yourself. Life is a cycle with ups and downs and everybody will have their highs and lows at some point in their lives. Just clear yourself of all these negative inner feelings as they are
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counter-productive. They make you a very unpleasant person and this will be reflected on your face. You will find then that you have less friends and of course, fewer blessings from God. I have seen many people with such negative feelings who do not do well in life and God has His way of showing His punishment for them. It does not pay to have any grudge against anybody. As I have said, knowledge only falls onto a clean heart and you have to continuously cleanse your heart by 'zikir' for the Muslims and some means of spiritual enhancement for other religions.
Someone with shoes size of 6 should not feel envious of someone with shoes size of 8.
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21. How can I pass all exams?

There is no short cut to passing an exam. Situations are different from secondary schools where you can do things perhaps at the last minute or just practise the multiplechoice questions. It is different in the, university as the subjects are wide and you are' expected to do some work on your own. You have to, adjust to the new environment and have a healthy attitude towards examinations. Examination is a way of making sure that you have the grasp of the subjects. The only way to make most students study is to have exams. There are of course exceptional students who are consistent whether there is an exam or not. But for the rest of us there has to be the pressure of an exam to make us study. For tips on test taking, refer to Appendix 8.
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If you are conscientious and have a good rapport with your lecturers, you can ask them for the important checklist or the essentials that you need to know or can expand on. Ensure that you are in control of the subjects, meaning that you know the salient points. Do not study at the last minute. Discuss the difficult topics with your colleagues in your discussion group. It is crucial that you have a healthy attitude towards the exam. Whatever the outcome may be, you must regard the exam as a way of finding out how much you know about the subject and doing a gap analysis. Your grade is an indication of how well you have prepared for the exam. Below is a useful chart that you have to make immediately after the exam.
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Learning from the exam: Analysis of incorrect answers

Type of Question (T/F, MC, Short Answer, Essay, etc.) Location of Answer Reason for Incorrect Answer (Chapter, Page#, Lecture (Misread, Notes Incomplete, Notes, Date) Never Read, etc.)
Guidelines for taking the exam: Be ready o Test yourself to be sure you know the material. Be rested o Get at least 5 or 6 hours of sleep the night before an exam. Be fed o You need to be alert. Eat a light breakfast or lunch. Be positive o Say "I'll do my best" and not "I can't do this."
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Be on time o Give yourself a chance to settle down. Be calm o Close your eyes and take 3 deep breaths to reduce anxiety. Be systematic o Look over the test. Budget your time. Read directions carefully. Be focused o Read items carefully. Spend time on what you can answer. Be logical o Use the time you are given. Review your work before leaving. (AAC Study Tips, Ohio University)
Checklist for exam preparation: Think of exams as a chance to find out how well you have mastered the concepts you have been studying. Know when your exams are scheduled, what they will cover and whether questions will be objective or essay.
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Complete your reading and homework as they are assigned so you don't end up cramming at the last minute. Identify the material you need to study and then schedule time to review it over several days. Review each chapter/topic systematically, starting with the oldest information first. Use the headings and subheadings in lecture notes and textbook chapters to organise information and predict exam questions. Make study guides, charts, outlines, summary sheets, etc., to condense material and show the relationships of ideas. Review actively by asking yourself questions and then answering them in your own words. Keep reviewing concepts until you understand them well enough to explain them to someone else. (AAC Study Tips, Ohio University)
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Holistic approach to passing an exam: 1. Physical Stay healthy and take steps towards this. 2. Emotion Avoid stressful situations. Be friendly to all your friends and offend nobody. 3. Intellectual Prepare yourself well as explained earlier. 4. Spiritual This is one component that has to be stressed upon. It is often overlooked by many students. It is important to realise that whatever that happens in this world is disposed by God. After doing everything that is humanly possible, a Believer would leave the consequences in the hands of God. They will be ready for any consequence and will not be unduly stressed by any adverse result. This is one of the important components in stress management.
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Helpful tips to pass well in the exam after studying enough: 1. Show obedience to God. He will shower you with blessings. Do extra prayer. For the Muslims, "solat hajat" is very effective and useful. 2. Be good to your parents. Ask for forgiveness from them and ask them to pray for you. 3. Be good to your teachers. Respect them and pray for them. Ask for forgiveness before the exam and ask them to pray for you. 4. Be good to your friends and help them in whatever way you can. 5. Do good deeds to please others. Donate to the poor. Get your parents to find poor relatives and donate whatever they need. As much as you allay the difficulty of others, God will allay your difficulty in the exam. Give food or small gifts to children. As much as you cheer them up God will cheer you up after the exam. 6. Do not do sinful things or immoral acts.
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What do I do if I fail the exam? 1. Never give up. A quitter never wins, a winner never quits. Accept the result with an open heart. Cry if you need to as it will help to reduce your burden of frustration. 2. Get to work. Learn "I have not failed. I've just found 10,000 ways from the exam. that didn't work." Analyse your areas -Thomas Alva Edison (1847-1931) of weakness and take steps to overcome them. Make an appointment to see the lecturer of the subject and get advice. If possible, try to ask for remedial classes from him or her. 3. Identify friends who fail the same exam and make plans to discuss the subject in the group to ensure that you have a good support mentally and academically. 4. Identify your not-so-good habits that lead to the failure. Do not hesitate to ask opinions from your close friends. Correct these habits. 5. Identify the time wasters that lead to reduction in your studying time. Do not repeat these time-wasting habits and avoid time-wasting activities.
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6. Get your parents to pray for you. Increase your submission to God and do more God-favoured activities. 7. For the Muslims, try to increase the quality of your prayer in terms of promptness and doing it in a group (jamaah). 8. Avoid missing lectures in your effort of trying to study in the library for the repeat exam. Missing a single lecture will take you hours of study to acquire the same knowledge. 9. Involve more in discussions and practise more past year questions in order to increase your Output Learning. 10. Have a healthy mindset towards failing an exam. It is not a failure but a delayed success. You will get more knowledge of the subject that you have to repeat.
Some of my friends became specialists in the field that they failed badly during medical school because the more they studied for the repeat paper, the more interested they were in the subject.
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22. How do I prepare for multiple-choice questions?

MCQ is meant to test the depth and width of knowledge... In medicine there is no guesswork. Hence any wrong answer is penalised. No guessing is allowed. Here are some tips to help you answer the multiple-choice questions. Read the directions carefully. o Clearly identify whether you must mark the one best correct answer or all correct answers. o Know if you will be penalised for guessing; find out if an incorrect answer will cost you more points than a blank answer. In other words, find out whether the minimum mark for a question is zero or the mistake is carried forward to the next question. Read the stem of the question (the question itself as opposed to its options) all the way through, then read each possible answer all the way through. o Use these options to provide you with hints about things you need to know.
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o If you are uncertain of the correct answer, cross out the options you know are definitely wrong, and then mark the question so that you can reconsider it at the end of the exam. o Circle all negative words and "100% words" within the question stem and options. 100% words are those that do not allow for exceptions, like "all". o "All of the above" answers are often correct. If you know two out of three options are correct, "all of the above" is a strong possibility. If you're not sure about a number answer, toss out the high and low and consider the middle range numbers. If you have no idea of the answer, check for "look alike" options to find what you consider the best answer among them. Check for the most inclusive option - the option that contains the most information. (Adapted from Walter Pauk's How to Study In College.)
Last but not least, always say the prayer before you make the choice for the best answer.
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23. How do I write a good essay?

i. Read each question three times before starting to answer. ii. Plan the answers for all the questions. - You have to start planning when your brain is still alert, not exhausted. Avoid the temptation of answering one full question from the start just because you know the answers for that. By writing down the plan and important facts when you are still alert, you will get more information onto the paper even though it may appear haphazard. - Once you have gone through all the questions and have some form of answers to all the questions, you will feel more confident in doing one question in detail at a time. You will not be apprehensive as to whether you have any idea of what to write for the subsequent question whilst doing the first one. iii. Have subheadings. - This will be easily seen by the examiner correcting the paper and will give an impression of good organisation. It is a good way to show the examiner the topics that you know well.
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iv. Write legibly. - You will be surprised at how much time you have if you are calm and have planned your essay well. The fact that you can write clearly and legibly is good and will make you more confident.
v. Make paragraphs to explain a core fact. - A paragraph is a visual signal to readers that the group of sentences is devoted to a single topic. Without such visual groupings of sentences, examiners feel confronted with line after line of text for which they cannot plan their reading time or their concentration. - Work that is divided into paragraphs helps examiners anticipate how much information they will get on one idea and help them scan quickly through pages of material when they are searching for particular types of information.
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Before writing: Set up a time schedule to answer each question and to review or edit all questions. If six questions are to be answered in sixty minutes, allow yourself only seven minutes for each. Use the other three minutes to Six incomplete answers will usually check the answers and receive more credit than three spend time on more complete ones. difficult questions. If questions are "weighted", prioritise that into your time allocation for each question. When the time is up for one question, stop writing, leave space, and use a new booklet to begin the next question. The incomplete answers can be completed during the review time. Read through the questions once and note if youhave any choice in answering questions. Pay attention to how the question is phrased or to the "directives", or words such as "compare", "contrast", "outline", "discuss" or "describe".
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Answers will come to mind immediately for some questions. Write down their key words, listings, etc., as they are fresh in mind. Otherwise, these ideas maybe blocked (or be unavailable) when the time comes to write the later questions. This will reduce "clutching" or panic (anxiety or fear which disrupts your thoughts). Before attempting to answer a question, put it in your own words. Examiners are influenced by the compactness, completeness and clarity of an organised answer. Writing in the hope that the right answer will somehow turn up is time-consuming and is usually futile. To know a little and to present that little well is, by and large, superior to knowing much and presenting it poorly - when judged by the grade received.
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Speaking of my experience as an examiner for essay paper, I find that a paper that is well organised with clear headings and subheadings is easy to correct as the points stand out well. Illegible handwriting is an eyesore and creates a bad impression. Do not scribble. Write legibly. You must understand that examiners are humans and have their limitations. Good presentations pay in the end. Avoid using a bright highlighter to underline the subheadings. Instead, use a normal pencil or a red pen.
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24. How do I overcome inferiority complex?

First and foremost, remember that everybody is created equal and is the same in the eyes of God. This is the teaching in all major religions. Your lecturers are not superior to you. They are just born earlier than you so they have the benefit of having more experience. You must acquire this mindset so that you can overcome the intimidation that you may feel when facing your very senior lecturers such as the lecturers and senior consultants in the clinical years. Lecturers have had many years behind them, and so it is all right if you are not as good as them.
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Even if your English is not very good, go on and speak in English because the only way to learn a language is to continue practising it. Poor command of English is one of the most common reasons of inferiority complex faced by students in local universities.
No one has the right to harass or look down upon anybody else. Humbleness is important to be instilled in whatever stage of your life especially so when you climb higher in the ladder of life. A good way to have this humbleness is to train oneself to do things like cleaning the toilet, eating on the floor and make friends with the poor rather than the rich.
Only God is great and no man is superior to another. We are brought to this world with different roles and achievements. Each of us has our own potential and our ceiling of achievement. What is important is that we all work to achieve the best that we could with what is given to us.
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Once we are awed only by the greatness of God, other humans or worldly things will not fascinate us. This can prevent the feelings of jealousy towards others who have achieved more than we do. It is important to realise that you only strive for the life hereafter rather than the current temporary life which no one has any control of as to the duration, which is all in the hand of God.
25. What do I do if I lose the motivation to study?

Have a positive thinking and use the power of the mind. Always suggest good things about yourself. Visualise yourself in five years to come. If you continue being unmotivated, visualise what will become of you. Your action today will decide your fate tomorrow. Look at the successful people around you. Remember that there is nothing easy in life; even a simple chore like cooking rice requires an effort. Remember your parents
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who have put so much hope and spent so much money and time on you. Be warned that you will be that parent one day and you do not want your children to disappoint you in the manner that you may disappoint your parents by feeling demoralised or demotivated and losing interest in studying. All religions teach their followers to work hard, as all efforts put to improve one's knowledge is highly regarded by all religions. A knowledgeable but poor person is far superior to one who is rich but ignorant.
Believe you are defeated, believe it long enough, and it is likely to become a fact. -Norman Vincent Peale-
The Law of Progress Any progress consists of ups and downs. Watch a tree grow. It grows some leaves and a storm comes along and blows some away. It grows more leaves and another storm comes along and blows some away. Watch the stock markets or the tides at the beach. There are ups and downs. Quitters don't understand this. They figure that progress should all
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be one way up. As soon as they slide a little, they think the game is over and they give up. Understand the progress principle and etch it in your mind. It might change your life. - Andrew Matthews (Author of "Being Happy")
26. How do I keep my interest in medicine going?

Be aware of your surroundings. Appreciate all the medical development that you see and look forward to be part of it. Look around you and see your seniors who have passed their exams and watch how they progress. Talk to your seniors who are doing well in class and get inspiration from their success. Be careful when choosing your friends. Avoid those who are always grumbling and have negative attitudes towards studies.
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Visualise yourself in five years to come. Whatever you do today will have an impact on your life later. Imagine the kind of person and doctor you would like to be within that time. Think of the impact of your work on someone's life. You will be helping someone to improve his or her life and the job satisfaction that comes with it should keep your interest in medicine going. Try to watch movies or TV programmes that have medical themes such as "ER" and "Chicago Hope". Even though it may not be the optimum theme but there are some medical facts and messages that will keep you interested in medicine.
I am only one; but still I am one. I cannot do everything, but still l can do something. Therefore, I will not refuse to do the something that I can do. -Helen Keller-
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27. What do l do if l do not feel like following other people's advice and want to do things my own way?
Remember that it is the ego that is preventing you from listening to other people. It is ego that has caused iblis to be discharged from heaven. If someone who is successful has given an advice on how to achieve something, why not follow it as the person has gone through the same process and is willing to show you the shortcut of the long journey. If you are certain that your own way is Learn from people. Find a good role good, then go ahead, model. Ask questions. Get inside their heads. Learn to think how they think. but do not give In time you will develop your style but excuses for not a role model can get you rolling. following the advice.
-Andrew Matthews (Author of "Being Happy")
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28. How do I clerk a case well?

The golden rule is to establish a good rapport with the patient. This can be achieved by having good communication skill. There are two main parts to clerking a case i.e. history taking and doing physical examination. A good history will provide eighty percent of the clues in making a diagnosis. A good framework is illustrated on the next page.
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Problems of students: Inability to utilise and apply knowledge acquired to the clinical problem Study with the aim to pass only Not knowing the significance/relevance of the subjects being taught
1. History
Questions are asked according to the chief complaint of the patient. A good framework would be CDC (CAUSE, DIAGNOSE, COMPLICATIONS). History is taken to find out the CAUSE, to help in making the DIAGNOSIS, and to elicit for COMPLICATIONS.
Case illustrations History to be taken for someone who complained of haemoptysis. Leading questions need to be asked to find out the CAUSE of the haemoptysis. Two important causes to be ruled out are tuberculosis (TB) and cancer of the lung.
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Hence symptoms suggestive of TB such as contact with PTB patients, night sweat, and symptoms suggestive of both TB and cancer of the lung such as weight loss, loss of appetite and chronic cough will have to be elicited.
2. Physical examination
This is done to look for the cause, to help in diagnosis and to look for complications. Clues to look for the CAUSE would be those suggestive of TB such as lymphadenopathy, those suggestive of cancer of the lung such as clubbing of the fingers, chest finding such as pleural effusion which can be due to both TB and cancer of the lung.
3. Investigation
This is done to look for the CAUSE, to confirm the DIAGNOSIS and to assess for COMPLICATIONS. In the above said patient, investigations to look for the CAUSE would be a chest x-ray which will show the changes typical of TB or cancer of the lung. It would also confirm COMPLICATIONS of pleural effusion if any.
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The Chest X-Ray will assist in the management of the pleural effusion by confirming the level of the pleural effusion and help in the removal of the pleural fluid.
4. Management
To complete the management, it is crucial that the CAUSE, the DIAGNOSIS and the COMPLICATIONS are treated. It is very important that the history taking includes three very important aspects of symptoms, i.e. onset, duration, progression.
Classification of aetiology of disease based on onset and duration of symptoms.
The onset will give a clue as to the CAUSE o Symptom that has a very acute onset within minutes is vascular in origin such as Central retinal artery occlusion or cerebrovascular accident. o Symptoms that occur within days may mean acute inflammation which can be infective or nonAs Sohwah 112

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infective in origin. The younger and the older age group make infection more likely. This includes things like a swelling on the skin due to a boil. o Symptoms that occur for a duration of a few months tend to be due to chronic inflammation such as TB and malignancy such as cancer of the lung. o Symptoms that occur for a duration of a few years tend to be due to a benign tumour or degenerative disease. The progression of disease is important especially the relationship to food intake in gastrointestinal symptoms or the response to medications of certain ischaemic heart disease.
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29. How do I present well in case presentation?

Most importantly, you have to know your subject well. You must have the substance in order to present well. Clerk your cases well and be organised in your clerking. Ensure that you do have an organised way of clerking cases. (See Question 28) An important point to know is the definition of diseases. It is a good way to start talking when asked by the examiner on the cases that you have presented. One main weakness of medical students is uncertainty of the definition of diseases. Knowing the definition of diseases carries a lot of advantages to medical students, as it is self-explanatory. Another important point is knowing the natural history of diseases. It will help in the clerking and determination of prognosis and predicting the squeal of the disease. After knowing all that need to be presented, a good student should have the ability to speak well and express himself/herself. This can be achieved by regular practice which can be done in front of the mirror or presenting
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among friends. A good eye contact is crucial during case presentation. It gives an impression of high self-confidence. From my experience, better marks are given to students with better speaking ability although the things said are similar.
30. How do I get the patients to cooperate with me during ward work and clinical examinations?
You must like and respect them. Do not treat them as objects and appear only to be interested in the interesting signs that they have. Establish rapport and ask about their illness. To some senior citizens, asking about their grandchildren does make them happy and they will feel that you are interested in them as a person. Explain to them the importance of you Sometimes, how things are said is more getting the signs and important than what things are said. emphasise to them
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that they will get the blessing from God when they cooperate with you as it helps you to learn. They help you to become a good doctor so that you can help others in future. Practising medicine is not only about being academically qualified, but it also involves personal grooming and personality development. Personal manners are something that will carry you far in life. Whenever someone meets you for the first time, be it your patient, lecturer or friend, it is your manners and etiquette that will give an impression to him or her. Good manners will draw people to like you and you will get all the co-operation that you need. It is important to know what to say, when to say and how to say it. This is crucial when one is clerking a patient.
Talking to an elderly person will be different from talking to a child. The awareness of the patient's diagnosis will help. A patient with cancer of course may not be as cooperative as someone with a simple treatable illness.
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31. How do I make full use of my clinical session in the clinic?

First, make sure that you are punctual. A five-minute delay to the clinic may mean that you may have missed an interesting case. Make sure to jot down all the cases that you see in the clinic. Try to ask the medical officer or lecturer about the case. If they are too busy to attend to you, note down the case and write down your doubt about the case. Clarify it during the tutorial session or any time you can get hold of the lecturer. A very useful thing to do is to have a clinical notebook and jot down the learning point against every case that you have seen. This is a good way to ask the medical officers or lecturers with whom you see the case.
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An illustration of a clinical notebook

Date: Case: Diagnosis:
Learning Points/ Doubts
Important: History Physical signs Investigations Treatments
Things to revise about this disease - Basic science - Clinical subjects
After the clinic, be sure to check up on the cases and read around the topic. Should there be any basic knowledge that is preventing you from fully understanding the case, ensure that you read about it. Most students find it a big chore having to revise the basic pre-clinical subjects. They do not realise that studying the subjects in order to understand the clinical features will have a tremendous impact on the understanding of the clinical subjects and remembering the pre-clinical subjects.
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Anything that is understood in a logical manner by the application of the basic anatomy and physiology will be much consolidated and will stick in your mind for a long time. An example in the ophthalmology clinic setting: seeing a patient with a dilated pupil will lead you to read what muscles control the size of the pupil. The action of a dilating drop can be understood if you know the receptors on the muscles controlling the pupil. Make sure that you read up on the cases seen after the clinic and discuss the cases with your colleagues. Try and learn to clerk the cases that you see in the clinic. Avoid the passive attitude and do not expect Refrain from these situations in the clinic: to be told or Feel intimidated by the senior consultants spoon-fed all the Become passive observers time. Be proactive Reading books while lecturers are clerking patients and ask questions.
Discuss among yourselves while lecturers are talking to patients
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32. How do I correlate the basic science and the clinical?

This is something that many students have difficulty in doing. This is because it is a painful process for most people to go back to the books which they have covered one or two years earlier. However, if one is conscientious and sincerely wants to master a subject, then there is no short cut but to look back and revise what one has learnt and forgotten to enable one to understand further on the subject. Speaking from personal experience, I used to have so many books in front of me in the library while trying to understand the pathology of an organ. Reading the anatomy and the physiology of the organ such as the kidney, in order to understand the pathology and why it causes renal failure in a patient that one sees in the ward is extremely helpful. I tried to find the explanation of all the symptoms that the patient showed based on the pathology that occurred at the cellular level. Having done this, it helped me to retain the most essential facts about renal failure and has helped
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me along my medical career. Of course it is painstaking but it is a worthwhile step to take. You should see it as a long-term investment with long-term benefits. If you take the short cut by remembering the symptoms just for the sake of the medical examination only to forget it later, this will affect your preparation for your final exam, where you will find that you probably need to read the symptoms again. This, in turn will encroach into the time allocated for reading a new subject.
You will waste your valuable time as you are doing things twice because you did not do it well the first time.
"This is what knowledge really is. It is finding out something for oneself with pain, with joy, with exultancy, with labour and with all the little ticking, breathing moments of our lives, until it is ours as that only is ours which is rooted in the structure of our lives" - Thomas Wolfe (1900-1938)-
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The three important aspects that achievement of a person in life are: i. Attitude ii. Knowledge iii. Skills
determine
the
Among these three assets, the most important one that acts as the determinant is the attitude. The correct attitude will ensure adequate acquisition of knowledge and skills.
MEDICINE IS A ZERO DEFECT BUSINESS
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I. Attitudes
Enthusiastic Enthusiastic individuals will end up getting what they want in the end. Their enthusiasm will drive them to go for their goals. Their enthusiastic spirit will also have an effect on the people around them. Such individuals will have positive effects on people around them such as their friends and colleagues in their career as a doctor. Good medical students: Passion in studies and work Makes good doctors This means that they are o good specialists very proud of their work and will o good lecturers o good teachers be fully involved in whatever they Who will teach well to do to push their career pathway medical students and ahead. This passion for paramedics knowledge acquisition will result in constant motivation to work hard. Students are likely to practise `eat, drink and sleep' medicine and not `eat, drink and sleep football'.
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Proactive Students are likely to be independent in their effort to acquire knowledge. They will know exactly what to do to achieve their academic goals. Motivated This constant inner drive is important as the study period in medicine can be long and laborious. It will be filled with a lot of hard work and heartaches at times when the subject is difficult. However, if one is motivated, whatever adverse feeling one has can be overcome easily. This is one of the most important assets to have in order to last in the medical field, which requires one to continuously educate and develop oneself professionally. Adaptive This is the ability to adapt to one's surrounding and working environment. Medical students come from various backgrounds and so do the patients that they deal with. Interacting with patients of different socio-economic status might be difficult as they have different levels of knowledge and
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expectations. Hence being adaptive will make life much easier for them. Competitive This spirit is important as medicine is a field that is highly challenging and the exams can be tough. This does not mean that one has to be selfish and not help one's colleagues to acquire knowledge for fear that they will get better marks. There has to be a healthy mindset where a benchmark is set and students should strive to achieve it. Respect for others All medical students must develop this highly crucial value as they will be dealing with people who, as well as their relatives, are physically well but can be mentally or emotionally disturbed (as a result of the patient's illness). Respectful behaviours will automatically gain respect from the other party and this will help in the management of both the patients and relatives. In addition, respect from the lecturers, friends, and colleagues will foster good relationships and will create a healthy working environment.
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High EQ-emotional quotient This very much talked-about new quotient, apart from the usual IQ or intelligent quotient, is important as it will determine how one handles one's emotion in a stressful situation. It is about expressing one's emotion in a way that will not hurt other people even though what has to be said is a negative remark. As an example, one can show his or her anger or displeasure in a polite and gentle voice but the message of displeasure is put across. The strongest person in the world is actually one who can control his or her anger. High SQ Spiritual and social quotient: this involves ensuring one's relationship with God. All religions teach their followers to exercise good behaviours. A person who has high spiritual quotient will do what should be done and not otherwise. This will lead to the development of a wholesome person who will be gentle to the people surrounding him and other creatures created by God. This will then lead to a high social quotient where a person will not harm or hurt anyone by his looks, words and deeds.
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Goal-driven This makes someone focused on his or her work and not lose his or her direction in life no matter what happens along the way. This will create a, healthy attitude towards their study, examination, training and relationship with their friends.
Team-spirit This is extremely essential in the medical field as medicine is always about teamwork where a patient may present with a problem that has to be managed by a team of doctors. This requires one to be tolerant and accommodative, with a high EQ and SQ. Serenity The common Malay term is `lapang dada'. In this age of academic achievement and material gain, soul cleansing is very important. In the medical field, different people have different levels of achievements, especially during medical schools. A medical student who does not appear to study
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may do well in his or her exam compared to another student who has been slogging for the past few months. The lack of soul cleansing or high spirituality will lead to unhealthy feelings of jealousy towards the high achievers and blaming of perhaps the surrounding, lecturers or even God for one's failure. However, if one has serenity as a result of soul cleansing, seeing the success of others will further motivate one to work hard and create the feeling of happiness of other people's achievement. This will allow one to accept his or her failures and work hard for future exams whilst preventing any ill feelings towards others. Accommodative This is an important asset that is needed to allow a person to tolerate negative values or situations around him or her. As a medical student, one is bound to meet various types of personalities who may not be to his or her liking. This can range from one's friends, lecturers, patients and medical staff. Lack of accommodative attitude can lead to loss of
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tolerance to others. This will cause disharmony in one's relationship with other people. Compassionate A compassionate person is one who has a lot of empathy, not only sympathy, for others. He or she is able to feel for other people and as a result, behave in a very caring and gentle manner to them. Imagine a doctor who is not compassionate. He will be very insensitive to the emotion of the patient to whom he has to break some bad news. Medicine is not only about facts and figures, but also about having good human relationship.
A grandson walked in and complained that his 90 year old grandmother was unable to see in both eyes and unable to recognise faces. The grandmother had come from 400 km away. A compassionate doctor immediately saw the patient without prior appointment and had the patient admitted and operated the next day. The patient was discharged after two days and was very happy that she was now able to lead a normal life again. Her facial expression also changed - from a stressful to a cheerful one.
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Perseverance For centuries, it is known that medicine is a field which is equivalent to running a marathon where you have to preserve your stamina throughout the years of studying. Not forgetting the possible hitches one may have in the exam. One has to persevere whatever the consequences of the exam is. Losing six months of one's Failing an examination is not a lifetime to repeat an failure but a delayed success. exam can be a daunting task for all students. Looking at the positive aspect, actually one will have the opportunity to study more of the subject which will make him or her better. In medicine, no knowledge is a waste. It will always be useful in one's future practice. Hence, medical students need to persevere to ensure that they get through the academic hurdle every year. Without this, they will give up easily and later, ten years down the road, they will regret not persevering just for that short moment, which results in them losing the opportunity to be a doctor forever.
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A postgraduate student in her Masters of Ophthalmology training wanted to give up her studies after failing one exam, which requires her to repeat the subject in six months time. I persuaded her to persevere and asked her to grit her teeth and study for the next exam. Thankfully, she passed all her subsequent exams without any problem. Currently, she is heading one of the eye departments in the country serving the nation. It is her perseverance that leads to this well sought-after position.
Efficient This means that whatever input that is put in will result in a good output. This is obtained by studying smart and not just studying hard. (Refer to study methods) High self esteem Feeling inferior can be quite usual for a student who is faced with many unfamiliar subjects delivered by lecturers who are highly qualified academically including consultant clinicians. A high self-esteem will influence how one talks, asks and answers questions. It will influence the marks one obtains in the oral examination.
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All medical students will acquire high self-esteem if they have confidence in themselves, which can be obtained by knowing that they have worked hard, acquired all the necessary academic knowledge and done all their assignments. There is no room for feeling inferior. (Refer to Question 24)
Dedicated This will be obtained by having clear visions and missions of one's life. It is a sense of leaving something in this world that will be useful to mankind once one is no longer on this earth.
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Commitment to life-long learning Continuous medical education is part of a program in hospital setting. It emphasises that all doctors should continuously improve their skills. Hence, it is this attitude that needs to be nurtured in all medical students.
As lecturers teach medical students, they are not just serving one person. For every doctor that they train they are actually giving service to seven thousand Malaysians (the doctor to Malaysian population ratio. This mindset provides many lecturers with the dedication to stay on in the government service and teach to ensure that the medical students acquire adequate knowledge to be safe doctors. Similarly training an ophthalmologist is not about training one ophthalmologist, but it is about serving ninety thousand Malaysians which is represented by, an ophthalmologist in Malaysia.
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II. Knowledge
This will vary according to the medical curriculum in the various medical schools. Some amount of core knowledge needs to be acquired to become a safe doctor.
III. Important Skills

There are additional skills apart from medical skills. As medicine is about human management, therefore communication skills are essential. Communication skills o Communication skills Verbal: in the clinical years, students have to present their cases in both long and short cases. A student with a good command of language and ability to speak will definitely impress the examiner and is more likely to get better marks. Writing: this is a skill that is important as medical students and as doctors later because one has to write well for case write-up and
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theory examinations. Once qualified, doctors have to be able to write well on cases or research as part of their publication. o Intra-personal Knowing self-limitation: a wise person is one who knows his or her limitations. As a student learning to be a doctor, some maturity is required to identify one's limitation and the steps to take to overcome it. After becoming a doctor, it is important for one to know one's limits and know when to ask for help or refer cases to the specialist in that field. Interpersonal skill is important as you have to make sure that your relationship with patients, colleagues and subordinates is a healthy one and you do not offend anybody in your daily interactions.
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To be effective students, time management and study skills are mandatory. Study skills (Refer to Question 13) Managerial skills o Time management (Refer to Question 6) o Human management: this is important as medicine involves dealing with people all the time. How do you get a patient to co-operate with you during the exam and clinical work? (Refer to Question 30) o Financial management: this is a very crucial skill to be acquired as medical students usually have limited financial resources.
Other important skills for medical students are: Clinical Skills o Clerking Clerking of cases requires a good approach refer to clerking scheme - Question 28. o Presentation This is an art that will be learned over the years. This is when ability to speak is so
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important. Practice makes perfect. Many students will try to avoid presenting and this is not a clever move as they get no practice and in the end in the final year examinations they will face problems to express themselves leading to poor marks. o Documentation Appears not important but crucial in many medical records which later become medico legal documents. o Clinical skills and procedures This is again obtained by practice and getting adequate supervision during the procedures. Hence a good relationship with the senior medical students and junior doctors will increase the chance of getting opportunities to try new procedures. o Bedside manners This is an often forgotten aspect by students but much assessed during clinical examinations. Having the attitude that one will only practice good bedside manners during the examination only is futile as it is
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very obvious if one is doing it as `showmanship' in the exam. o Bedside tests These are simple tests such as urine test that will be required to be done during examination. It is important that it is practised well. o Clinical reasoning- Problem Based Learning This is an approach to stimulate critical thinking among medical students and is increasingly used by many medical schools. Life Skills o ICT skills o Social skills o Stress management skills o Personal management o Time management Public Education Skills o Ability to express medical facts in layman's term o Ability to do public health education o Communication skill Academic Skills o Listening skills
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Assets of graduates:
successful
medical
school
Innovative Pioneering Open-minded Critical Professionalism Self-audit Sense of pride in work
o Effective note-taking skill o Summarising skill, compare and contrast o Schema drawing (e.g. i. Two minute approach to unilateral visual loss and ii. Approach to optic disc swelling) o Examination skills o Critical appraisal skills
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APPENDIX 1
Effective Note Taking Record * Reduce * Recite * Reflect * Review
You can develop your own system based on a few elementary strategies: Get a good loose-leaf notebook. o This will enable you to add, delete, and re-sequence pages and materials. Develop an organizational system; include o Headings such as the system you are learning e.g. CVS, the date, the lecturer even the number of the class (e.g. 3/34) o A system of "sections" to organise your notes o Leave plenty of white space for additions. (This is especially important in the clinical years where the relevant revision of the basic anatomy and physiology of the system studied need to be revised.)
Think in terms of three main sections: A central space for identifying the main points capturing the main ideas not quoting the lecturer (if you want to quote someone, bring a tape recorder if it is permitted). A marginal space for editing or annotating what you have written, linking information from the text or other sources and adding definitions - identifying grey areas or facts that you do not
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understand. This will serve as a guideline for you to read further on the lecture. A "condensing" or summary section. (Try to draw a mind map, flow chart or tree diagram for lectures that describe many things at one time such as pharmacology. A tree diagram will help to differentiate between the various types of autonomic drugs.)
Taken from http://www.iss.stthomas.edu/studyguides/
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APPENDIX 2
Paying attention in the classroom
If you attend lectures and have difficulty paying attention to what is being said: Before lectures, look over the notes of the previous lecture and read the course material pertaining to the lecture. If you have questions about materials from the previous class or text, ask the lecturer before the class about them. Resist distractions by sitting in front of the room and by focusing on the lecturer through listening and note taking. Show outward interest during lectures (attentive expression and posture) to self-motivate internal ' interest. Take good notes! When appropriate: ask a question, ask for more clarity, or engage the lecturer and the class in a dialogue. Schedule time to go over lecture material immediately after class. Remember: Forgetting is greatest within 24 hours without review. Schedule a weekly review for each course.
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APPENDIX 3
"MURDER": A Study System Mood: o Set a positive mood for yourself to study in; o Select the appropriate time, environment, and attitude; Understand: o Mark any information you don't understand in a particular unit; o Keep a focus on one unit or a manageable group of exercises; Recall: o After studying the unit, stop and put what you have learned into your own words; Digest: o Go back to what you did not understand and reconsider the information; o Contact external expert sources (e.g., other books or an instructor) if you still cannot understand it; Expand: o In this step, ask three kinds of questions concerning the studied material: 1. If I could speak to the author, what questions would I ask or what criticism would I offer? 2. How could I apply this material to what I'm interested in? 3. How could I make this information interesting and understandable to other students? Review: o Go over the material you've covered,
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o Remember what strategies helped you understand and/or retain information; o Apply these strategies to your future studying.
Adapted by Bob Nelson from the Complete Problem Solver, John R. Hayes, Lawrence Erlbaum Publishers, Hillsdale, NJ: 1989.
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APPENDIX 4
Speed Reading & Comprehension Reading rates o Each chapter or system of the human body has to be read at a different rate. For example, the biochemical pathway is more difficult to read compared to the anatomy of a muscle. o Textbooks also vary in how well they are written, and as a consequence some are more difficult to read. o Each semester, time yourself while reading a chapter in each of your textbooks. See how many pages an hour you can read. Once you have an accurate estimate of your reading rate, you can better plan your reading and studying time. Comprehension o Scan the chapter first. Identify the sections to which the author devotes the most amount of space. If there are lots of diagrams for a particular concept, then that must also be an important concept. If you're really pressed for time, skip the sections to which the least amount of space is devoted. o Read the first sentence of every paragraph more carefully than the rest of the paragraph. o Take notes on headings and first sentence of each paragraph before reading the chapter itself. Then, close your book and ask yourself what you now know about the subject that you did not know before you started.
Adapted from "Being a Flexible Reader" by Gail Kluepfel, Rutgers University

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APPENDIX 5
Effective Reading and comprehension
The SQ3R Reading Method
Survey! Question! Read! Recite! Review!
Before you read, Survey the chapter:
the title, headings, and subheadings captions under pictures, charts, graphs or maps review questions or teacher-made study guides introductory and concluding paragraphs summary
Turn the title, headings, and/or subheadings into questions Read questions at the end of the chapters or after each subheading Question while Ask yourself, "What did my lecturer say about this chapter you are or subject when it was assigned?" surveying: Ask yourself, "What do I already know about this subject?" Note: If it is helpful to you, write out these questions for consideration. This variation is called SQW3R. Look for answers to the questions you first raised Answer questions at the beginning or end of chapters or study guides Reread captions under pictures, graphs, etc. Note all the underlined, italicised, bold printed words or phrases Study graphic aids Reduce your speed for difficult passages Stop and reread parts that are not clear Read only a section at a time and recite after each section
When you begin to Read:
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Recite after you've read a section:
Orally ask yourself questions about what you have just read and/or summarise in your own words, what you have read Take notes from the text but write the information in your own words Underline/highlight important points you've just read Use the method of recitation which best suits your particular learning style but remember, the more senses you use the more likely you are to remember what you read - i.e., TRIPLE STRENGTH LEARNING: Seeing, saying, hearing. QUADRUPLE STRENGTH LEARNING: Seeing, saying, hearing, and writing!!! Day One After you have read and recited the entire chapter, write questions for those points you have highlighted/underlined in the margins. If your method of recitation included note taking in the left hand margins of your notebook, write questions for the notes you have taken. Day Two Page through the text and/or your notebook to reacquaint yourself with the important points. Cover the right hand column of your text/notebook and orally ask yourself the questions in the left hand margins. Orally recite or write the answers from memory. Make "flash cards" for those questions which give you difficulty. Develop mnemonic devices for material, which need to be memorised. Days Three, Four and Five Alternate between your flash cards and notes and test yourself (orally or in writing) on the questions you formulated. Make additional flash cards if necessary.
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Review: an ongoing process

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Weekend Using the text and notebook, make a Table of Contents list all the topics and sub-topics you need to know from the chapter. From the Table of Contents, make a Study Sheet/ Spatial Map. Recite the information orally and in your own words as you put the Study Sheet/Map together. Now that you have consolidated all the information you need for that chapter, periodically review the Sheet/Map so that at test time you will not have to cram everything.
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APPENDIX 6
Taking Notes from a Text Book
First: read a section from a chapter of your textbook Look through the subheading so as to have a bird's eye view of what is to be covered. Have a small organisation in your mind about what is to be covered. It is important to read just enough to achieve an understanding of the material. Do not take notes, but rather focus on understanding the material. Avoid the temptation of taking notes while you are reading the first time. This is not an efficient technique. One is likely to take down too much information and simply copy without understanding. This is important in clinical years where a good understanding of the definition of diseases is crucial. It has to be followed by a simultaneous discussion on the subject.
Second: Review the material Locate the main ideas, as well as important sub-points. Always make a habit of skimming through the subheadings. It will give an idea of the coverage and what is expected. In addition, one will know the important basic science that has to be understood to further comprehend the subject. This will then trigger a question and will motivate one to read up the subject. Set the book aside and try to recall what you have just read.
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Rephrasing the information from a textbook in one's own words helps one to become actively involved with the material. A more effective way is to talk about it to your friends or try to explain what you have just read to a friend or to yourself. As a personal experience I usually talk about the lectures during lunch break after these lectures.
Third: write the paraphrased ideas as your notes Do not copy information directly from the textbook Add only enough details to understand
Review and compare your notes with the text, and ask yourself if you truly understand them.
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APPENDIX 7
FLIP CARD TECHNIQUE TO ENHANCE YOUR MEMORY OF A SUBJECT
Write each question or term on the back of an index card On the front of each index card, write an answer or an explanation for the question or term written on the back. Use your notes and text for reference, but put the answer or explanation in your own words whenever possible. For an example, in Biochemistry it is good to summarise all the chemical reactions onto a card with different colours for different metabolism. This will help one to compare, contrast and not be confused by the different enzymes in different metabolisms at different locations. For the students in the clinical years it is very useful to know the definition of disease. The flip card technique is very useful.
Shuffle the index cards (so you cannot figure out any answers based on their location in the deck)
Look at the card on the top of the deck: Try to answer the question or explain the term. If you know it, great! Put it on the bottom of the deck. If you don't know it, look at the answer, and put it a few cards down in the deck (so you'll come back to it soon)
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Proceed through the deck of cards until you know all of the information. Some Tips: Carry your cards with you everywhere. o Take advantage of little pockets of time. Test yourself while you're waiting in line, riding the bus, etc. If you think you know an answer, o But cannot put it into words, you probably do not know it well enough. Being able to explain the information is the only way to be sure that you know it. It is also the best way to prevent test anxiety. Consider testing yourself someplace where nobody can see you(and think you are crazy), and reciting the answers out loud. That is the best way to ensure that you can explain correctly. Study with a friend from your class. o You can share ideas and help each other out with concepts. Also, you can use each other to make sure that you are explaining your answers adequately.
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APPENDIX 8
TEN TIPS FOR TEST TAKING
1. Come prepared; arrive early for tests Bring all the materials you will need such as pencils, pens, and a watch. This will help you focus on the task at hand. 2. Stay relaxed and confident Remind yourself that you are well prepared and are going to do well. Do not let yourself become anxious; if you feel anxious before or during a test, take several slow, deep breaths to relax. Do not talk to other students before a test; anxiety is contagious. 3. Be comfortable but alert Choose a good spot to take the test. Make sure you have enough room to work. Maintain an upright posture in your seat. 4. Preview the test (if it is not timed) Spend 10% of your test time reading through the test carefully, marking key terms and deciding how to budget your time. Plan to do the easy questions first and the most difficult questions last. As you read the questions, jot down brief notes indicating ideas you can use later in your answers. 5. Answer the test questions in a strategic order Begin by answering the easy questions you know, then those with the highest point value. The last questions you answer should be the most difficult. Take the greatest amount of writing or have the least point value. 6. When taking a multiple-choice test, know when to guess First, eliminate answers you know are wrong. Always guess when there is no penalty for guessing or you can eliminate options.
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Don't guess if you have no basis for your choice and if you are penalised for guessing. Since your first choice is usually correct, don't change your answers unless you are sure of the correction. 7. When taking essay tests, think before you write Create a brief outline for your essay by jotting down a few words to indicate ideas you want to discuss. Then number the items in your list to indicate the order in which you will discuss them. 8. When taking an essay test, get right to the point State your main point in the first sentence. Use your first paragraph to provide an overview of your essay. Use the rest of your essay to discuss these points in more detail. Back up your points with specific information, examples, or quotations from your readings and notes. 9. Reserve 10% of your test time for review Review your test; resist the urge to leave as soon as you have completed all the items. Make sure you have answered all the questions. Proofread your writing for spelling, grammar, and punctuation. 10.Analyse your test results Each test can further prepare you for the next test. Decide which strategies worked best for you. Identify those that didn't work well and replace them. Use your tests to review when studying for final exams.
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APPENDIX 9
Points to Ponder
How to be a good doctor? Be a good person
How to be a good person? Develop good relationship with God Other Human beings Other creations of God o Living o Non-living
A good relationship with God Will lead to good relationship with others Accountability and responsibility Sincerity o Expect reward from God Striving for excellence o For the present world o Life Hereafter
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Good relationship with God Doctors should be amongst those who believe in God o Those who do not believe in God will discover God in their journey o Those who have lost God will rediscover God ~ fulfill His rights are aware of His greatness obedient to His orders refraining from His prohibitions observing Him in secret and in public
Saying of Islamic Scholars and Confucius 5 steps of learning: Read Hear Discuss Do Teach
Passing examinations Does not depend on studying only Depends very much on God's will Hence, need to remember God Then God will help you when in need If you help God's creations, God will help you
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Questions: Who determine one to understand? Who determine one to remember? Who determine one to answer correctly in the exam? Answer: Of course God, the Creator of our brain.
Final message: Everything done in the name of God Be sincere Do things to the best of your ability
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References:
1. http://www.iss.stthomas.edu/studyguides/ 2. Hayes, John R. The Complete Problem Solver. Hillsdale, NJ: Lawrence Erlbaum, 1989. 3. Kluepfel, Gail. Being a Flexible Reader. Rutgers University. 4. Covey, Steven. Seven Habits of Highly Effective People. 5. The Practice of Kindness. Canari Press. 6. Pauk, Walter. How to Study in College. 7. Small, Lamon H. Productive Study Techniques. 8. AAC Study Tips. Ohio University, http://studytips.aac.ohiou.edu/
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How to Become a Good & Successful Medical Student

How to Become a Good & Successful Medical Student

Prof. Dr. Muhaya Haji Mohamad

How to Become a Good & Successful Medical Student

How to Become a Good & Successful Medical Student

To Aniah and Atiyah Enjoy the journey

Al-fatihah In Loving Memory of our Beloved Son.

Mohd Hilman Azmi (27thJanuary 1989 6th August 2000)

How to Become a Good & Successful Medical Student

How to Become a Good & Successful Medical Student

Muhaya Mohamad M.D. Ph.D. August 2005

How to Become a Good & Successful Medical Student

How to Become a Good & Successful Medical Student

How to Become a Good & Successful Medical Student

How to Become a Good & Successful Medical Student

Why did I write this book?

If You Fail To Plan Indeed You Plan To Fail

How to Become a Good & Successful Medical Student

How to Become a Good & Successful Medical Student

How to Become a Good & Successful Medical Student

102 106 109 108

109 114 115 117 120

How to Become a Good & Successful Medical Student

1. Have I chosen the correct field?

How to Become a Good & Successful Medical Student

How to Become a Good & Successful Medical Student

2. Can I be a doctor one day?

How to Become a Good & Successful Medical Student

- Dale Carnegie (1888-1955)

How to Become a Good & Successful Medical Student

3. What sort of thinking is required to become a doctor?

How to Become a Good & Successful Medical Student

How to Become a Good & Successful Medical Student

4. What are the possible career options after graduation?

How to Become a Good & Successful Medical Student

How to Become a Good & Successful Medical Student

5. Can I study and lead a reasonable life at the same time?

How to Become a Good & Successful Medical Student

How to Become a Good & Successful Medical Student

6. How do I manage my time and plan an effective study schedule?

Ensure that you contact your parents at least once a week.

How to Become a Good & Successful Medical Student

How to Become a Good & Successful Medical Student

How to Become a Good & Successful Medical Student

vi. Work (Study)

How to Become a Good & Successful Medical Student

Guidelines on how to control your time

How to Become a Good & Successful Medical Student

2. Reflect on how you spend your time

(AAC Study Tips, Ohio University)

How to Become a Good & Successful Medical Student

(AAC Study Tips, Ohio University)

How to Become a Good & Successful Medical Student

3. Have a "To study list"

How to Become a Good & Successful Medical Student

Checklist for effective note taking:

(AAC Study Tips, Ohio University)

How to Become a Good & Successful Medical Student

4. Always know what's ahead for the day

How to Become a Good & Successful Medical Student

5. Have a long-term planner

How to Become a Good & Successful Medical Student