About The Goldberg Files

Medical school is stressful.  I taught at the University of Miami School of Medicine for 25 years, and in that time I was told that some 20% of students had sought psychological counseling for stress of one sort or another.

Stress, of course, may result from financial, psychological, and family reasons or uncertainty as to field of choice.  Most stress, though, arises from the sheer volume of material that needs to be learned.  There is so much to learn and so little time to learn it.

Students admitted to medical school are the cream of the crop.  They typically do quite well in undergraduate school.  However, despite their excellent qualifications, the fact is that in every medical school in the country exactly 50% of the  class is at the bottom of the class.  This can be a difficult adjustment for a high achiever.

Students enter the wards where there are life-threatening events, but commonly lack the experience and confidence in dealing with such clinical situations at this stage in their education.  When I was an intern, I often felt as if objects were constantly thrown at me and I had to keep catching them or a patient might suffer an adverse event.

This blog is devoted to reducing the stress level in medical education, to explore more efficient ways to learn and retain the vast information needed to become an excellent clinician, and to help in dealing with stress in general in medical school, internship, and residency.

I welcome comments and suggestions from students in any area of the health professions.

Stephen Goldberg, MD

President, MedMaster Inc
Professor Emeritus, University of Miami Miller School of Medicine

  1. Dr. Goldberg:
    Former UMSM student here…

    Glad to see you’re doing this, great service for medical students! Could you add an RSS feed to your blog? Thanks!
    RDM

  2. Thanks for the suggestion, Ryan. An RSS feed button has been added to the top right of the menubar. Alternatively, you can subscribe to this blog via email, using the signup field at the top of the sidebar.

  3. I started consulting MRS series books from my undergraduate years and still often consult them and more importantly recommend them to all the students who find making concepts in medcine an impossible task.
    MRS series book are right upto my own mode of learning, simple clear and use of annotations and diagrams…
    🙂
    Great Work Dr. Goldberg….Please keep producing medical publishing marvels

  4. Thanks for your encouragement, Saif.

  5. Cesare Bonventre

    I very much enjoy the “ridiculously simple” materials and deeply appreciate your empathy and concern for the medical student.

    It is for that reason that I feel I can trust a very special question to you:

    It is my feeling that the fundamental medical education system largely consists of the rote memorization of innumerable factoids – Factoids that often fail to enhance my ability to understand the underlying CAUSE & EFFECT of disease processes and fail in assisting my ability to translate those relentless factoids into clinical solutions.

    For example I give you my Medical Immunology Text: The factoids therein are innumerable and of dubious relevance. I say ‘dubious’ because within the Immunological text I see very little that lends itself to actual clinical application. Also, often times I see inconsistencies in the factoids as well as a lack of clarity (are we speaking about Th-1 systems or Th-17 systems?)!

    In short, what is the SENSE of having no time to learn because medical students are inundated with the task of memorizing an over whelming sum of seldom relevant factoids? How is memorizing every immune system receptor ligand, (SR-A1, MARCO, CD36, Dectin 1, MR, DC-SIGN, Siglec1, CD14, TLR2/6, TLR4/4, CDllb, etc.), and their physical makeup going to help me formulate a treatment strategy for a patient?

    I feel that the two main psychological barriers to medical students peace of mind are:

    1) The requirement to memorize an overwhelming barrage of factoids of dubious usefulness
    2) And despite all the factoids, feeling the stress of being no closer to actually being able to formulate a plan to heal a sick patient!

    Is it just me or is there in fact a conspiracy to deliberately dumb down (3D) students by forcing them to memorize innumerable & frivolous factoids of dubious use?

    For instance, why can’t the immunological text start up by saying:

    Basically, you have Th-1 (cellular) immunity which is mostly concerned with viral infection; and a Th-2 (humoral) immunity which is mostly concerned with bacterial infection. [Overlooking for the moment Th-17 and Treg immunological systems for simplicity; cancer & parasitic infection].

    In humans, a cytokine called IL-12 apparently stimulates Th-1 immunity; while IL-4 and IL-10 seem to stimulate Th-2 immunity. Consequently, IL-4 and IL-10 inhibit Th-1 immunity while IL-12 inhibits Th-2 immunity.

    Wow! From that sort of information I can treat a patient! But don’t look for anything this useful in Medical School: a place to do little more than memorize an endless cycle of relentless factoids of little “apparent” use to the clinical physician!

    Useful is research going back to the 1980’s that has elucidated the process whereby the immune system in Multiple Sclerosis, Insulin-dependent diabetes melitus, Uveoretinitis, Sarcoidosis, Inflammatory bowel disease, and Rheumatoid arthritis follows a pattern of hyperactive Th-1 immunity (and consequently a hypoactive Th-2 immune set).

    Furthermore, the immunity in cases of Systemic lupus erythematosus, systemic sclerosis, HIV, Hep C, Asthma, and aging, follows a pattern of hyperactive Th-2 immunity (and consequentially hypoactive Th-1 immunity).

    The clinical significance of this information is electrifying! But information of such clinical relevance is seldom found anywhere within the context of the vast sums of factoids I am to memorize as a medical student; to wit an actual example from the Immunology Text:

    “…RA in mice is a striking example of a shared epitope, consisting of a 5-amino acid sequence motif in the third allelic hypervariable region of the HLA-DRβ1 chain (QKRAA in the *0401 allele, QRRAA in the *0404 and *0101 alleles). In addition to MHC-linked genes, mutations or genetic polymorphisms involving non- MHC genes also are strong candidates for autoimmune disease susceptibility genes in mice…”

    The aforementioned quote from my immunology text is not only frivolous to any clinical application, it is dubious in that animal immunological cytokines, reactions & genetics are largely different to that of the human!

    Is it any wonder so many students turn to alcohol to numb the pain?

    • I agree completely with your assessment, Cesare. There is far too much esoteric material that the student is required to memorize. Part of the problem is that there are too few clinicians teaching the basic sciences in medical school. The needs of the medical student differ from those of the graduate student.

      Moreover, there is so much concern that something might be on the Boards that there is overteaching that includes material that is not that clinically relevant. That material might eventually become clinically relevant, but then would be the time to memorize it. Board review books present the factoids that you mention without any clear understanding of the subject. And reference texts are often so overwhelming that it is difficult to grasp the subject as a whole. That is why it is important to have a small, clinically relevant book that presents overall key concepts, which is what MedMaster is about.

      It is an important issue these days as to what should be memorized and what you should just know where to look up, in order to be a competent practitioner. I’ll have more on these issues in forthcoming blogs.

    • I am a medical student from Jordan. Thank you! I share what you said 100%! Memorizing tons of information while not knowing its clinical significance!

      While studying each basic science subject, you feel that you are being trained not to be a doctor but an Anatomist, a biochemist, an immunologist…. Why am asked to memorize all of these information without telling us how is relates to clinical practice?

  6. I am a MedMaster author (since 1990). One of my main attractions to this company and the books published by MedMaster is the heart-felt desire on the part of the publisher, Dr. Stephen Goldberg to help medical students learn efficiently and at the same time to survive medical school. From the very beginning it was clear to me that he had a genuine desire to reach out to medical students, to encourage them, to empathize with the struggle of medical school and to publish books that make learning more manageable. I think that Dr. Goldberg has made a huge difference…since 1979.

  7. The RSS feed button does not seem to be working

  8. The feed button is a graphic that is peaking out near the upper right of the page. What happens when you click on it?

  9. Hello Dr Goldberg. I’I wonder if you have any good resources (book/websites etc.) that students can read about study skills? I think it’s really important but it’s not something that we’re really taught about, yet the way you study determines how you think and ultimately how you perform in exam situations. Studying smart is better than studying hard.

    Thank you!

    • Simon, there are a number of 5-star recommended references on amazon.com under the topic of “Study skills.” A number of them have amazon’s “Look inside” feature so you can get an idea as to how they may fit your needs.

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