Note: Though my new format focuses on publishing in-depth articles twice a month, I still reserve the right to occasionally publish one my classic-style student advice articles.
The Pre-Med’s Lament
I recently received the following e-mail:
“I’ve failed both of my tests in Organic Chemistry 2…I don’t know what I’m doing wrong…no matter how much I review or study my class notes, nothing seems to work.”
This is a familiar lament. I recently reviewed the student e-mails I’ve received so far in 2010, and discovered that I average around one “I failed my Orgo exam!” e-mail per week.
That’s a lot of unhappy pre-meds.
I decided it was time to write a definitive answer to this common issue. This post details my famous three-step plan for turning around a chemistry disaster.
Step #1: Reset Your Mindset
In 2002, the psychologist Carol Dweck, then at Columbia University, working with her graduate student Heidi Grant, received permission to study the students enrolled in the fall semester offering of general chemistry. Earlier research by Dweck found that most students sort into one of two mindsets: fixed versus growth. As she explained in a 2009 speech:
- “Fixed mindset students believe their intelligence is just a fixed trait…they worry about how clever they are…they don’t want to take on challenges and make mistakes.”
- The “growth mindset [students] think ‘no,’ [it’s] something that you can develop.”
In their Columbia study, Dweck and Grant explored how these mindsets affected performance in the chemistry classroom. Their results were striking.
As they concluded in the Journal of Personality and Social Psychology paper describing the experiment: students with the growth mindset scored higher grades in the course and, perhaps more crucially, were much more likely to recover from a bad midterm grade to score high on the final. By contrast, once a fixed mindset student scored low, he was unlikely to escape the spiral of self-doubt that followed.
Put another way, Dweck and Grant demonstrated: pre-med courses do weed out students, but they’re not culling the smart from the dumb, instead they’re separating the adaptable from the non-adaptable.
(In the context of medicine, of course, this makes a lot of sense: students who are able to adapt to novel and difficult situations, aggressively trying different strategies until finding one that works, will fare better under the pressures of med school, residency, and eventually full time medical practice.)
This research indicates that a student faced with a bad grade on his first exam must embrace the following ideas…
- This grade is a reflection of your study strategies and previous experience with this style of course.
- It has nothing to do with innate intelligence.
- It has nothing to do with the amount of time you spent studying. (A factor which is often irrelevant to academic performance.)
- Therefore: If you want to improve, you need to improve your study strategies.
TO SUMMARIZE: A bad grade doesn’t mean you’re lacking some mythical chemistry gene, it simply means your approach to the course is sub-par — hardly a catastrophe.
Step #2: Redesign Your Strategies
There’s no magic bullet study strategy that will guarantee you an A on future exams. But there are some high-level guidelines that most successful strategies follow.
Let’s start with an important law of (academic) nature that any smart plan should obey:
The Law of Mental Energy
Every concept presented in your chemistry class will require between 15 – 60 minutes of hard focus, including time spent asking clarifying questions, before you understand it well enough to ace related questions on an exam.
There’s no escaping this law. This is why the standard strategy of taking haphazard notes throughout the semester, and then holing up in the library three days before the exam, is destined to fail — there’s simply way more hard focus required than you can cram into such a small time frame.
Remember: hard focus is hard. You can’t sidestep this hardness in a course such as chemistry. If you don’t build a study plan that respects the need for this difficult work, then you’re unlikely to succeed.
Here’s a simple rule to help keep this respect central to your efforts:
The 48 Hour Rule
Within 48 hours of first being presented a concept, learn it well enough that you could teach it to a classroom of your peers — walking them through related sample problems while giving an insightful running commentary.
If you respect the 48 hour rule, you’ll avoid the hard focus pile ups that scuttle many students’ grades. This rule takes the mental labor necessitated by the law of mental energy, and spreads it throughout the semester — maximizing the chances that it all gets done.
Here are a few tactics to help make the 48 hour rule a reality…
- Insist on active review.
Reading highlighted notes is worthless. Stop doing it. The best way to learn material is to explain the idea out loud, as if lecturing an imaginary class, without peeking at your notes. This is mentally draining, which is why most students skip it, but that discomfort is a good thing; it’s the sensation of your brain stretching to internalize the concepts. - Take notes in a format that’s ready for active review.
Reformatting notes is a waste of time. Take your notes in a format that’s ready for active review. For example: write the sample problem clearly; put the steps on separate lines, adding little commentary notes wherever possible; conclude with a clearly marked answer. To review this problem later, you can cover over everything below the problem and then try to recreate the steps to the answer out loud. If you falter, everything you need to improve your understanding is right there. The key is to minimize steps between the classroom and active review. - Ask questions immediately.
You only have 48 hours to learn this concept, so the quicker you tackle confusions, the better. Here are five lines of defense to help make this a reality:- Concentrate hard in class, trying to understand the concepts as they are presented. (Remember the law of mental energy: you cannot escape hard focus, so it’s better to pay off some of this mental debt while you’re in the classroom.)
- As soon as you’re confused, raise your hand to ask for clarification.
- If you’re still confused, talk to the professor immediately following class.
- If you’re still confused, use your textbook to guide you, and talk to a TA or classmate for additional clarification.
- You’re final line of defense is to bring the question to office hours. Because you’ve already gone through the previous steps, you should be well beyond “I don’t get it,” and instead be able to pinpoint the specific area of confusion.
- Schedule your review time.
Put aside two blocks per week in your autopilot schedule for reviewing the material from the most recent class. (You are using an autopilot schedule, right?). The key is to make this studying a part of your weekly routine.
Notice, this approach requires time. It won’t devour your nights or cripple your social life, but it insists that you expend reasonably-sized blocks of hard focus on a regular basis throughout the entire semester. This truth inspires an important corollary:
The Hard Schedule Corollary
If you combined organic chemistry with multiple other demanding courses, then you’re an idiot.
As I’ve argued before, hard course schedules are giant sources of stress and difficulty that add little to no benefit. Many students labor under the misguided belief that taking a challenging course loads matters. Here’s the secret: no one cares about what specific college courses you took when, or how hard your semester schedules were. They’ll see your major. They’ll see your GPA. And that’s it. So for God’s sake, drop your double major, and stop trying to take three science courses at once, you masochistic fool! There’s no extra credit given for being overloaded.
TO SUMMARIZE: Learning complicated subjects requires the expenditure of lots of uncomfortable and difficult hard focus. Build a system that respects this mental labor.
Step #3: Refactor Again and Again and Again…
My canonical article on the danger of black box studying identifies a crucial question that must be answered to turn around poor performance:
Why did the students who got the top grades on this test score so much higher than me?
Ignore your instinct to brush aside the prompt with an ego-preserving answer of “they’re geniuses” or “they have no social life.” Really try to identify what specifically they’re doing differently. Don’t be afraid to ask them for details.
This simple exercise provides targeted feedback on what you’re not doing that you should be doing. Without this post-mortem, you’ll devolve into trying random study habits that sound sort of right and then tenaciously clinging to them as if they were there the result of divine inspiration. It means nothing that you tried something different. (So many of my e-mails start by the student noting that they tried some new note-taking strategy or review plan, as if failing with that one random approach that popped into their mind disqualifies all possible strategies from potentially helping.) What’s important is that your strategies are motivated by real world observation, and are then exhaustively evaluated and tweaked.
TO SUMMARIZE: Adaptable students constantly question why they’re studying the way they are, and then seek concrete feedback on whether their hypothesis is correct. They’re not afraid to make informed changes, again and again and again.
(Photo by quinn.anya)
This is excellent advice.
You said “If you’re still confused, use your textbook to guide you, and talk to a TA or classmate for additional clarification.”
I would add, bug the hell out of your TA! Their job is to know the answers – straight answers too. You can look through the book a million times but the TA will give you a straight answer that usually shows up word for word on the exam.
“Here’s the secret: no one cares about what specific college courses you took when, or how hard your semester schedules were.”
This is so true. In applying to medical school, admissions committees do see a list of courses and grades but I’m certain they don’t put stock in what configuration you took your classes. I could give multiple examples where friends took one tough science course and 3 other manageable courses while I took a more demanding/difficult course load each semester. The final transcript? Theirs were littered with A’s while I had a number of B-‘s. This sort of inconsistency kills your academic record for med school applications.
By the way, my friends are in med school right now and I may be reapplying for the third time. Sigh…
nice post. hey cal do u use holistic learnin?
APRIL FOOOOOLLLLLL
As an organic chemistry TA, I think you are spot-on with your advice. For some reason, students seem unwilling to accept that organic chemistry involves a kind of thinking we aren’t necessarily very practiced at. You have to be able to look at a 3D picture and abstract the concept, but also be able to create a picture when presented with a concept. It’s just not the kind of thing you can cram for, and you need many instances of practice involving different concepts and pictures in order to become good at it!
Great post!
This sums up the Study Hacks philosophy: smarts can be learned; use auto-pilot; review sample problems in technical courses and review by pretending you are teaching and have to explain the material.
I was so happy to find your site. After getting a low mark in a course (2.5 yrs ago now), your strategies really helped me. I am done formal schooling for now but may go back to get an MBA soon and look forwarding to using all the tips I’ve learned from you.
Good post Cal, but sometimes students have set courses every semester (well they do in Australia anyway). I’m not a pre-med, but I’m doing a health science course, which is pretty demanding. I don’t get any choice in my timetable or get electives – so all the suggestions you wrote are real good for me, except for dropping or changing courses 🙁
And I like what I’m studying too much to ever consider giving it up for another.
good advice as always. I feel that way in my engr classes. Basically I seem to get within the class avg every time. This usually translates to the grinding B student. Ive tried to switch up how I tackle things for studying but seem to fall back in the same routine with similiar results. Guess I need to swich up again before finals which are like 5-6 wks away.
I am finally starting to see that it doesnt really matter if it takes an extra year to graduate. (this is almost a necessity in engr unless you come with preq credits coming in already) the internship i had last semester has taught me the perspective to enjoy college while you can, work comes soon enough
Right now, I am in a good spot as I can take the courseload of 12 hrs (what is considered the minumum for a fulltime student) and still graduate in 3 semesters. I would have about the same workload as now and my semester before my internship (about 3-4 engr classes +1 lab which is avg for most engr here). I can certainly do it as last semester I have abit above a 3.0 and I feel im headed that way this semester as well. Frankly now, though I am getting tired of the even the “doable” engr workload and am thinking of spreading out to 4 semesters. (as I stress out pretty easily and these last semesters have worked but exhausting at times)
This leaves me in a corner though as I have almost taken all my “easy” elective classes. I could either a) take under the 12 hr minumum all engr (basically 1 less class than what i am doing now) and enjoy free time b) gain a minor and take minimum 12 hr workload that is more balanced (ie 3 engr classes, 1 lab, 1 easy) or c) just take a random fun class every semeter to meet the min 12 hrs. honestly though i dont know what under fulltime status means (other than disqualify financial aid). I dont get financial aid so that doesnt affect me.
On top of all this I am debating about graduate school as well in which case I would probably need to get a research job under a professor. (that could turn up if i keep doing well on my fluids labs)
Thanks again Cal, for keeping up this blog.
ps: also what do you recommend for technical math/physics heavy classes where the prof writes too fast to actually take notes and think about the material at the same time. Im a slow writer by nature, so i feel i cant understand the material and simultaneously write it down. This leads me to put off seriously reviewing the notes until a hw assignment or worse the test. Then its a domino effect of playing catch up with concepts. I feel im sadly already behind.
Excellent article, Cal.
@charpsp20 You could try to record the lecture. Or just write down the most essential parts. If your not a good notes writer then try drawing for understanding instead. Try to focus on the concept and what the teacher says. Yes, you might miss out on some. But then you can always go back and ask clarifying questions. Hope you well.
“pre-med courses do weed out students, but they’re not culling the smart from the dumb, instead they’re separating the adaptable from the non-adaptable.
(In the context of medicine, of course, this makes a lot of sense: students who are able to adapt to novel and difficult situations, aggressively trying different strategies until finding one that works, will fare better under the pressures of med school, residency, and eventually full time medical practice.)”
I, for one, don’t give a damn if my doctor’s life is easier. A more adaptable doctor is more likely to be able to treat me better, adapt to changes in my condition better and more likely to save my health/my life. Drop the fixed mind-set, it’ll make you a bad doctor. Someday whether you have a fixed mind-set or not may save someone’s life/health. Being a doctor is great for personal income, status and prestige (and gettin the ladies, but not so much for getting the men), but remember, those things come at a tradeoff: increased responsibility to those that you treat.
Two things –
-about your Hard Schedule Corollary – if you want to graduate in four years, many schools (especially MIT) require a tough course schedule. You don’t have a choice.
-I think I wasted a lot of time doing the assigned textbook reading for science courses. Now I think that time was totally wasted. Since I was out of school before I was able to test this theory, has anyone else felt this way?
I would define “smart” and “dumb” as “adaptable” and “non-adaptable”, respectively.
Orgo is the craggy shoals upon which have foundered many a med-school bound vessel. There are a finite number of important concepts and they come back again and again in different guises. So advice like Cal’s is helpful for both organic chemistry as well as any other concept-intensive course. Incidentally, I also find techniques like this are useful for learning foreign languages too – at least for the conceptual parts (the vocab is straight memorization however).
One common piece of advice I heard as an undergraduate studying orgo is “just do all the problems in the textbook”. This advice has always annoyed me, not because it is untrue, but because there are huge variations in the didactic values of problems and time is a limiting factor. About a month ago I started a site devoted to exploring optimal strategies and tactics for learning organic chemistry, inspired by Cal’s site and others. The goal is to provide a detailed roadmap for studying based on mastering about a dozen key concepts. It would be extremely valuable to me to hear from students about their experiences (good and bad) in college organic chemistry.
What is the website called?
Hey Cal,
Any advice on how graduate students taking courses and doing research can apply this? I know you said “Research trumps all” but whats the best way to manage courses?
Thanks so much Cal! I’m taking Ochem right now and I did poorly on the first exam, but significantly better on the second. I used your post-mortem strategy of looking at the first test and evaluating what strategies specifically worked and where I went wrong.
I’m not pre-med, I’m a neuroscience major…keep in mind that many (most?) students taking ochem aren’t pre-med, we’re majoring in Biology, Neuroscience, Chemistry or Biochem – for us if we don’t pass this class, we won’t get our Bachelor’s degrees!
These are my favorite kinds of posts. Thanks, Cal!
Thanks for the blast from the past Cal! You should do this more often – maybe once a month or so. It acquaints newer readers with your strategies – there’s so much in your archives worth (re)reading.
This seems like it will be useful for me as I begin studying for my grad school prelims. Cal, since you must have done something like that, I’d be very interested in a future post on how you approached yours.
Cal,
Big fan of the blog. While not politically (or “intellectual”ly) correct, do you believe that is it important to distinguish between learning/understanding Organic Chemistry and getting good grades on exams? I feel that getting good grades on exams has a lot more to do with knowing what concepts will be emphasized. The question then becomes, how do you find out what will be emphasized?…
@charpsp20 I think recording engineering lectures and listening to parts that went by too quickly works faster to help with understanding theory, derivations, examples etc, than “developing hard focus.” Sure, one can pay the hardest/most attention in lecture, but you can only concentrate for so long and with only so much intensity. Likewise, you can’t work out in the gym all the time and expect to devote a constant amount of high energy — minds have limits. The material is hard, so it can’t be understood automatically.
Oh man, to have had advice like this when I was an actual undergrad…
Does anyone have any tips for revising languages? It seems like rote review is the only way to master grammar and vocab, but it takes so long and is so boring!
I’m talking about ancient languages, incidentally – Latin and Greek – where you don’t speak them, you only write them.
I see similar stories all the time…
It’s funny how students get this idea in their mind about what studying is supposed to be like. Then, when their idea fails to pan out, instead of questioning the idea, that assume the flaw must be with their brain.
Try taking notes on your laptop. I’ve had success with this in technical classes, you just have to get used to short hand for representing equations, etc.
Students make it harder than it needs to be. Having spent 5 years here at MIT, I see it all the time.
Grad student course loads should be comparably light. You should use an autopilot schedule to divide time between research and courses. And you should keep in mind that during the relatively brief period where you are taking courses, the time won’t be divided evenly between the two.
That’s my current plan.
The CS program at MIT doesn’t have traditional prelims. So long as you can A’s in your required courses, you’re set.
I’ve never been a big believer in the idea that there’s a difference between preparing to get an A on an exam and “learning” the material. You can’t do the former without the latter. Put another way, the A students know the material better than the B students.
At Wilhelm
Yes. For the love of Mike, please, please use an SRS (spaced repetition software) such as Anki or Supermemo. These should be mandatory for anybody learning just about anything.
That’s so true. I’m using Anki for Spanish and Japanese… I have 4 decks: Spanish vocab, Japanese Hiragana, Katakana, and Kanji. It really does help a LOT. Much better then flash cards. Could probably use SRS for non-technical courses too!
The 48 hour rule makes a lot of sense. I will do my best. I will have to focus a lot in class and be in office hours frequently.
charpsp20: I found it best to come up with a student shorthand of abbreviations & symbols to make note-taking faster, read @ least half the assignment before going into the lecture (study hard the pix & graphs) ===> that way your notes can be just of key words. Immediately after the lecture, sit down and flesh out your notes using your short-term aural memory & your text.
Easy fun courses aren’t always easy
What do you advise about not forgetting the information, versus first learning it? Or is it sufficient to follow the 48-hour rule, and then begin reviewing 1-2 weeks before the exam? Maybe it depends on the class..?
Hey Cal! 🙂
I have to say I love most of your advices and try to follow most of them.
Problem? I can’t not chose more than one tough courses per semester. In my degree, the list of courses is everythng but flexible, as we can only choose courses on the last year: most of them are mandatory. If I could have less courses? I could. But do I really want to perform a degree that in theory takes 5y in 10? I will do it in 6,5y and believe me, it’s a really great deal, considering the average is 8y.
But education is expensive and I can’t work and study at the same time, for I have no free time.
From a fixed mindset student, trying hard to change 🙂
(And organic chemistry was never my biggest problem… Just follow logic! 😀 and here, OC in chemical engineering is a “bit” stronger than in med)
I was a pre-med student at a prestigious small-liberal arts college and after hearing stories about how difficult this course sequence was, the intimidation factor got the better of me and I shut down emotionally and intellectually as the semester progressed. I did not study and wondered why I was on the verge of failing the course. I resigned myself to not only not having what it took to succeed in the course, but that I was not able to hack pre-med, med-school, and even turned it into a ‘I don’t belong at this school’ psychological badge of pathetic nonsense. I even got an authorized medical withdrawal from the course because I was ‘depressed.’ A year later, I signed back up for the course, worked every problem in the book three times, and ended up not only making an ‘A’, but changing my major to chemistry and going to graduate school in synthetic organic chemistry. Presently, I tutor undergraduates and teach AP Chem and Honors Chem at a public high school where students come into the courses with the same misconceptions that they aren’t smart enough to succeed. I have students who never study or pay attention or take notes, will write ‘IDK’ (I don’t know) on a test because they are being asked a word question and because they see 1/4 of a page blank for an answer, they skip it altogether because it must be hard if it requires them to read and think. I tell them my own experience in Organic Chem I (the first time I took it LOL) but also tell them that because I was persistent, I expect nothing less from them. Thank you for this post–sometimes getting out of our way is the difference between success in life and never reaching our true potential.
I agree that they only see your major and GPA, but when it comes to interviewing for jobs,a lot of times you are asked questions that were taught and tested only in the “challenging” classes, so theres no way to get around those, especially in fields such as computer science and computer engineering(such as a tough course on operating systems puts you well more in place that other people with the same background applying for the same job]. Just thought I should get that out there.
Also while I agree that people shouldn’t overload themselves with tough courses, they should not not take courses only because they’re tough and impact their grades. The whole point of an education is having a meaningful and intellectual engagement with content that progresses an individual in the positive direction. If this for a student comes through taking difficult courses, so be it. However learning and not difficulty or GPA should be the consideration. GPA is not the only criterion to measure one’s mental success. Asking yourself how much have you truly learnt often gives a better estimate of one’s learning curve.
Perhaps this is true, but is it really worth a C-student’s time and suffering to adapt enough to get the A in orgo?
In college I worked my way from not knowing basic algebra to knowing calculus, graph theory, combinatorics, and linear algebra (I had a “growth mindset”), but it’s hard now to see how it was worth the pain. After that torment, I thought medicine might be a rewarding career, so I went back to school. Was that smart? I’ve just gotten my first C in orgo — and I’m realizing that the kids who drop out of school and work in cafeterias and have kids must have a kind of wisdom. It’s not that they’re non-adaptable, it’s that they know how to invest their energy wisely. This adaptation crap is highly overrated. Soon we’ll design machines that can do diagnostics better than MDs do anyway, so those of you taking a hard-nosed attitude toward doctors can soon take out your aggression on machines and stop conflating the issue with academic performance.
Thinking about angling for an A in orgo, kids? Don’t do it! Make babies and be happy!
Trenchant analysis…
Oh, analysis. Sorry. How’s this: To say that organic chemistry’s demands on a student’s adaptability is important for his or her training as a doctor is to reveal that your knowledge of medicine comes from watching House. How many doctors engage in creative problem-solving of that kind? Arguably the most rigorously vetted MDs are orthopedic surgeons, but their primary skills, as far as I can tell, are mostly craft. The academic requirements to go into orthopedic surgery are far more rigorous than those to go into, say, neurology, but undoubtedly there’s far less intellectual problem-solving involved in orthopedics than in neurology.
What does this tell us? It tells me that the reason difficult coursework is required to get into medicine is simply that a lot of smart people want to go into medicine, so it’s competitive. Is a good doctor a doctor who did well in orgo? Possibly in certain enclaves of certain specialties. In general, a good doctor is a doctor who cares about people but doesn’t go to pieces over their problems, who has strongly associative reasoning (not a requirement for orgo), and who is responsible. Not that I don’t think doctors should be rigorously trained in the sciences; I just object to comments like this:
“I, for one, don’t give a damn if my doctor’s life is easier. A more adaptable doctor is more likely to be able to treat me better, adapt to changes in my condition better and more likely to save my health/my life.”
I think everybody would be better off if this guy were treated by machines. Doesn’t sound as if he’d be very responsive to the healing touch of a human anyway.
I’m not a doctor, so I don’t know the differences between approaches to problem-solving between neurology and orthopedics.
I am a medical student, though, and the primary focus of our scientific learning is in PBLs (Problem-Based Learning groups). These are at the start and end of every week, and go for three hours, and they are, frankly, enjoyable to the point of exhilaration, at least for me.
I did my undergraduate degree in chemistry, my Honours in synthetic/organic chemistry, and I did quite well in 2nd and 3rd year organic chemistry. I did not do as well in first-year. But I was the sort of person, and I still am, who examines and amends their learning methods constantly. (This is something of a neurosis for me, actually, driven in part by fear, i.e. the fear that I am not working as effectively as possible.)
So I amended my approach to learning. I started using James Ashenhurst’s website. I used Pushing Electrons. I sat down and identified the ‘knowledge gaps’ I had, and how I’d correct them. I prepared for the courses in the holidays/time off. I recorded lectures and played them in the car, on the way to and from Uni. I’d spend at least 15 mins in the car thinking about structure and reactions and functional group interconversions. This type of abstract thinking is similar, in a way, to learning about something like limits or differentiation, although the mathematics is probably more abstract and challenging than the organic chemistry in many ways.
Once I realised the creativity involved in chemistry, and particularly in organic chemistry, I was hooked. (I was always better at English than mathematics in high school: I took the lowest course, ‘general maths’, in high school and I got about 60/100 for the final exam, so I did very poorly. I had low mathematical ability, low confidence, and a general desire to avoid mathematics. At Uni, my first-year teacher was an inspiring and very, very engaging teacher and that allowed me to re-evaluate the way I thought of numbers and stats and mathematics.)
Organic chemistry is a creative art. Which may be hard to see at the 1st or 2nd year level, but it really is, because you’re learning Functional Groups and FGI so you can design molecules that have very specific effects. Targeted effects. I spent my Honours working on Alzheimer’s PET agents and therapeutics, and despite the frustrations and difficulty with the chemistry itself (we had trouble every step of the way frankly), I still enjoyed it, and the challenge, because I learned so much about the structures of the brain that in my first semester of medical school I had to review, and actually, really ‘zoom in’ on.
But blahblahblah, the point is, creative problem-solving is a very big part of medical school, maybe the biggest part of the human biology block, which is the biggest block (50 %). We’re learning how to take diffuse information from patients, make observations, deductions and inferences, apply our lecture/lab learning for that week, apply learning from clinical skills tutorials, apply learning from the ‘doctor-patient’ theme where we take patient histories, learn about how to read lab results, etc. We use all that information in the PBL scenarios, and we have 2 of these scenarios per week. They require lots of work but they are immensely fun. I’ve never once watched the show ‘House’ but I did read the Wikipedia article on it, and they are supposedly diagnosticians. Well, in PBL classes, a great deal of what we do is diagnosis, but we’re not JUST trying to diagnose the patient/case. Sometimes it will be quite clear – e.g. if we have a patient who is anemic (low Haemoglobin), we will choose the diagnostic tools to use, and, based on the test data and the importance we place upon the data, we’ll be able to determine a treatment path.
For example, if a patient presents with malaise, dyspnea, pallor, tachycardia with palpitations and low blood pressure, or has been hospitalised for chest pains/angina, loss of consciousness, in the latter case they’ll be checked out for cardiovascular issues and have a full blood examination (FBE) done as routine; given the first presenting complaint, the PBL group would write a series of differential diagnoses (DDx), any one of which could be responsible or involved in the pathology causing the symptoms.
Then we’ll talk about possible tests to order, how we can immediately rule out certain differentials, how to focus our investigation. The PBL tutor guides us sometimes with this, but often they’ll encourage us to determine what we need ourselves (and they’ll help us if a case is complex enough or we’re just not picking up the signals, so we don’t just fall back on guesswork, which rarely happens).
So if we order a FBE on the first presenting complaint, and we see that the mean corpuscular volume (MCV), the Mean Cell Haemoglobin Concentration (MCHC) are below the reference ranges. This tells us we’re looking at a microcytic anaemia (in which lack of haemoglobin is reducing RBC size). The low MCHC count tells us that we have a high level of hypochromic microcytic RBCs, and we can confirm this by viewing a peripheral blood smear, which will show a number of small RBCs with a lack of substantial colour. The smear will also show smaller entitites called reticulocytes, these are immature RBCs. We can use these, and another measure called RDW (RBC distribution width) to determine the type of microcytic anemia, i.e. is it caused by iron deficiency ? Is it caused by protein (globin) deficiency ? (Both inhibiting Hb production) Is it caused by a combination of other factors, or single other factors ?
The Reticulocyte Index (% of reticulocytes in a sample: reticulocytes are immature RBCs) is useful, as I mentioned. IDA typically shows decreased RI. Normal or elevated RI is consistent with haemoglobinopathies (inhibited globin production, so inability to form the haeme protein subunits in Hb). In our PC, we’ve got elevated reticulocyte count.
Still, we haven’t differentiated completely between these globinopathies (thalassemias) and IDA. So we examine the measure called the RDW, a measure of the uniformity of RBC volume in a sample: higher RDW = less uniformity.
IDA manifests with elevated RDW, while thalassemias typically have median RDW, although this is most pronounced in children. In our patient, RDW is normal/not elevated.
While there is another RBC index-based method of discerning IDA from thalassemia (the Mentzer index, (MCV in fL / RBC count in millions/uL); if 13, IDA. However this is not something you’d rely on, since there’s an easier way, outside of RBC indices). That way is to check serum ferritin levels:
Ferritin is a protein that transports iron in the plasma and is a marker for iron storage in the body: normal serum ferritin with microcytic anaemia indicates thalassemias, while low serum ferritin with microcytic anaemia indicates IDA.
In the presenting complaint I mentioned, we have normal ferritin.
So we’re tending to thalassemia. Now we run a Hb electrophoresis, to help further confirm our diagnosis, and to identify to the type of thalassemia (we’re tending to beta, due to the RBC indices); the electrophoresis tests for HbA2 (Hb with two delta and two alpha haeme units, instead of the typical two alpha and two beta subunits found in normal adult Hb A; in our PC we find elevated HbA2 levels, indicating a lack of the Hb beta globin subunits, so the Hb beta protein (beta globin) formation is deficient in this patient. This is caused by mutation in the HBB gene on chromosome 11: if the patient bears a mutation in only one HBB allele at chromosome 11 (i.e. a heterozygous mutation) then they have the milder thalassemia minor. If both alleles are affected (ie the mutant form of HBB is homozygous) then they have the more severe form of the disease, thalassemia major.
In both cases, reduced beta globin means less HbA is generated; a deficiency of HbA results in microcytic anaemia and lack of proper RBC functioning: there are too few RBCs of healthy morphology and function to sufficiently oxygenate the tissues, and so in beta-thal major, blood transfusions are required on a regular basis throughout the patient’s lifetime. The patient is at risk of haemochromotosis due to iron buildup from these transfusions, but the risk can be mitigated somewhat with the use of iron chelating agents.
So anyway, I don’t mean to go on so long. But I hope you get a bit of a taste as to what it is like, in medical school anyway, with respect to learning human biology in the preclinical aspect: there’s a huge focus on sort of “medical detective work” if you like. I enjoy it immensely. The same goes for taking patient histories too, it is similarly, a detection of sorts, in which you are communicating with the patient (and he or she with you), so that you not only make the correct diagnosis, but also address any other reasons the patient may have presented (which they might be reticent to mention, but nonetheless could be affecting their lives and their health, for instance what we call the upstream health effects, like the location of the patient’s house near a main highway, might be deleterious to the lungs of an elderly patient with a history of lung pathology. However, lack of money might be preventing them from moving, and so this would be an upstream impact on the patients health which could be worth discussing, and is certainly worth noting as a GP/primary care physician (and as a medical student).
So five years later, wherever you are now, I hope you are either still studying, or are in medical school yourself, because if the latter you’ll know that it is quite enjoyable despite the often hefty workload. If the former you’ll perhaps be able to take some solace from my post: yes, it is absolutely enjoyable studying medicine, and yes, it does require problem solving from a scientific standpoint. But not to the exclusion of communication skills, listening skills, note-taking skills, and frankly, the ability and willingness to work hard and extensively to learn a broad range of topics, some of which you’ll find more interesting or less challenging than others.
Take care, and if you want any advice or help re: getting into med school or study tips or anything of that nature, let me know. (I’m also studying a research Masters in chem right now, and that is something I’ve enjoyed doing in tandem with the medical degree; the Masters I do part-time and the project is based on computational chemistry so requires no lab work, and allows me to pursue paper-writing and so on in my own time/free time).
All the best,
Pete
Late to post, but the question is eternal. Cal, what role would you say that doing practice problems should play in this?
I just took my third orgo exam today. I think I might have fail. I made one mistake that contributed to getting the whole page wrong. But then I thought about the problem and figured it out as I was leaving. I felt so dumb. I feel so depressed from this situation and can’t stop thinking about it. I knew how to do the problem, i just made one mistake.
any advice?
Great information. I have implemented a similar method in this finalizing quarter. Worked out great. Cal, I’m new to this website and so far I’m loving all of the valuable information. I’m on the way to purchase one of your books
The most successful and happy students are those that are relentlessly strategy focused. They wouldn’t sweat the outcome of one tests — mistakes happen! — they would instead ask what changes, if any, need to be made to their preparation or test-taking habits. Make the changes. And then move on.
If you live life in fear of things going wrong, you’re going to have a fearful life. Take control of what you can control, and let the rest slide.
Cal,i’m in a scientific career. In my college the standard schedule are five courses, three of them are just plain science (e.g Organic Chemistry II, Microbiology, physics) . Following this course load, my major will take five years (the standard in my country). I have to fill in the five courses or i will graduate like in eight years. I haven’t read any advice on your site about staying long in college.. so it would be nice if you help me tackle this two specific questions that are in my mind right now:
1. According to your experience.. if i graduate too old, will i loose opportunities to enter a graduate program?
2.With the five course schedule in mind… how can i become less stressful? or do you actually recommend to underschedule and graduate a little older?
Thank you very much.
Ruben
I tutor organic chemistry students across the country and just had 5 of my best students share their techniques and strategies for doing well. I didn’t get the sense that any of them adhered to the “Zen Valedictorian” method of studying, but it’s a small sample size. If you’ve done well in orgo through following the techniques in Cal’s blog, I’d love to hear from you – it will benefit many others.
Thanks to Cal for providing inspiration and developing a passionate community here.
-James
I’ve been a long time reader of study hacks, and I have to ask- Cal, have you ever taken a pre-med or medical course? For instance, I am currently in pharmacology and the professors go VERY quickly- so quickly that they record the lectures because students have to go back and catch a lot of the info. Your solution is always “take notes in a away you can study” but honestly that is NOT possibly with most of these type courses.
“So for God’s sake, drop your double major, and stop trying to take three science courses at once, you masochistic fool!”
Hahaha, thank you. That was probably the highlight of this post. This website has helped me a ton! I’ve been testing out some new studying strategies on some technical books I’ve been reading, and it seems to help! I love how these tips can be used for more than just orgo chem. (I guess I won’t try to kill myself with the Mechanical/Electrical engineering double-major, but how will I choose?!)
The only problem with working on the “don’t take a million science courses at once” principle as an undergrad is that once you go into medical school (or veterinary school, which is my current affliction – yes, I mean “affliction”) you WILL be taking a million science courses at once and there’s no way around that. And then there simply isn’t time to learn every concept in the way that one should while still trying to retain sanity and have a life outside of school – I very strongly practice a minimal memorization approach and try to nail down concepts, and I’m a decent but not great student as far as vet school is concerned (B+/A-). I honestly think that memorizing would move me more into the A-/A range but to be honest, not worth it to me.
Taking 3 science courses is foolish?? I definitely don’t want to do that, but my university sets courses for all the engineering students, and out of 5 courses, 4 of them are sciences & calculus. I have no choice.
I got lot of B and two C . One year did at State school and one year at community school. Now I really want to go medical school. Is there any where I can go?
Read each question carefully, answer only those questions for which you positively know the answers.If you are not certain of the answers, then eliminate the wrong (dumb) answers first and then choose the answer that seems to you the most nearly correct(in case of multiple choice questions). Answer every question. Even guessing is better than no answer at all. You may very well guess correctly.Your first impression is normally your best impression. Don’t change any answers unless you are absolutely certain that another answer is a right one.These are the basic tips to every students who write the exam;whether your subject is physics or chemistry,whether it is distance education or regular!!!!
You are absolutely right about the ‘teaching an imaginary class’ method. It not only helps in O Chem but also in classes like Gen Chem 1 and even Anatomy & Physio 1 and 2. It allows your brain to think for itself. I always use that method. Chemistry is a critical thinking and problem solving subject, use your brain power, not a highlighter(honestly, i don’t even think I own one). If you’ve never tried this method, you’ll never know its benefits! I also heard from some people, drawing pictures helps in the beginning and once you start to imagine the molecules and reactions, you won’t need to draw them anymore.
I also failed my first 2 exams. It was too late to drop the course so I searched high and low for a tutor and found a guy in my area that recommended I use StudyOrgo.com. Well there is a god! I was able to learn the reactions much easier than what my professor was teaching. I ended up acing my final exam 100%. My professor was in shock. Unfortunately, my average was a C and I’m pre-med, but I was honestly just happy to pass and move on. I think medical schools can understand my C here, but I’ll def pick it up in all my other classes. If you are taking orgo, start with studyorgo.com from the start. Don’t wait until I did.
Any advice on articles to look at. I’m getting overwhelmed. I start school soon and have done well but am taking 3 challenging Science courses. I used to spend way too much time studying and not have a life over than school. What are some good articles you would recommend reading especially for Science courses and studying habits?
I unfortunately have to take 3 science courses at one time. I’m staying 3 years at a community college to save money. I’m really worried but I have really good professors which helps.
Kudos!!! for creating such a great education site.
What about students who don’t do well on exams? I just took an exam and my brain was not working and knew the material but don’t know what I was thinking. I thought I could get an A but didn’t do well.
I get anxious and need to figure out what went wrong. Any resources for me?
Hi! I am also an O chem student. My suggestion after finding out you got a C is to celebrate. Organic chemistry is really hard and a C isn’t so bad. You’re doing what tons of people can’t and it sounds like you’re doing it well so don’t worry too much.
Excellent post. Currently on the Orgo Chem bandwagon. Although this question could have been posted here:
https://calnewport.com/blog/2014/12/07/deep-habits-never-plan-to-get-some-work-done/
I think it fits better on this page. Here goes:
How do you plan (or budget) your time for course workload when you have no idea of how much time a problem set will require (or how long *one* problem can syphon an hour before you know it) ?
For Orgo Chem, I went to the classes, I know I’ve got 21 exercises to complete for the current chapter. I typically keep them on a weekend day because I can get in that Deep Work mindset (flow would not be the best term, more like Me, This Problem, Time Doesn’t Matter thinking). The challenge is that I’ve got 4 other courses that require a similar level of dedication f they are to do their job (change me and my thinking) rather than just become easily forgotten regurgitation material.
In essence, how do you partition your time when you’re facing ‘it’s-all-new, hard to estimate required time for mastery’ material ? It’s STEM, so willpower and decision fatigue also must be factored in.
Fighting Chaos