Philadelphia University + Thomas Jefferson University

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Guide to the Second Year


Introduction

The following is a guide to the second year courses and some tips to approaching these classes. Studying in medical college is different for each individual and we encourage that each student develops his/her own system of learning. Please remember that free tutoring is available through Jefferson's AΩA Chapter, and we encourage you to contact us with any questions or concerns that you may have regarding any aspect of your curriculum.

The year is broken into several different blocks. During the first block you will have Foundations of Pathology and Foundations of Pharmacology. The second block will be a course called Immunity, Infection, and Disease. You then have a mini-block (which is about 1.5 weeks long) called Physical Diagnosis. The rest of the year falls under the class title Foundations of Clinical Medicine (FCM). FCM is divided into several sections based on organ system. You can look at the breakdown below. Just remember, each block of FCM has an exam that you MUST pass. On your transcripts you will get an overall grade for FCM and a breakdown of how well you did during each organ system block.

Second year can seem overwhelming at times, but you will without a doubt succeed if you use all of your available resources, don't fall behind, and don't panic. You need no reminder that at the end of this year, you will be taking the USMLE Step 1. Again, don't panic. If you work hard this year for your courses you will be well prepared when you start reviewing for the boards. Again, we want to remind you that the Jefferson AΩA Chapter also provides a Guide to USMLE Step 1 which is a great resource.

Best of Luck!

Foundations of Pharmacology

Books

Dr. Beck prefers Katzung. She will give you information regarding other reference books and review aids and point out how old they are. Books are VERY optional. Pharmacology is always changing so do not buy a book that is out-of-date. A lot of students like the Pharm Cards which are pre-printed flashcards. These are also useful for Step 1 prep.

Syllabus

It is pretty comprehensive. Make sure you know Dr. Beck's learning objectives, as this is the source of her exam questions. Know the autonomic nervous system inside and out, it will appear heavily on the exam and the rest of the course. Take time to memorize the extremely high yield table provided in the syllabus that explains the locations and functions of the adrenergic and cholinergic/muscarinic receptors by organ (you will see this for the pop up numerous times throughout the rest of the year and Step 1).

Workshops

Easy way to get extra points. Dr. Vogel will call on people in his workshop.

Exam

Straight forward. For the past couple years the class average has been in the 90's.

Foundations of Pathology

Books

Reading in Rubin's Pathology is required. The syllabus is all-inclusive, however, so you might just want to read if you like textbooks to clarify some points. Some students used the Rubin's Essentials of Pathology, which is about a third of the size as the Rubin's Pathology book and most felt that this was sufficient. Others decided not to read and still did well. You have to decide what you feel comfortable with in regards to how fast you can read large amounts of material and retain the information. You should definitely make sure you have access to the required Rubin's Pathology because most exam pictures come from that book. You will need to review these pictures before the Pathology exam.

Many students also use BRS Pathology at this stage. It has quite a few introductory chapters that are very beneficial. You will use it often later in the year so it is a good investment now to help you out. Lippincott's Illustrated Q&A Review of Rubin's Pathology (coauthored by Jefferson's own Dr. Fenderson and Dr. Strayer) is a great, quick source for question and case-based learning.

Syllabus

Relatively inclusive, though definitely designed to be used while going to class. Some lectures are just PowerPoint slides printed out and they may be in outline form (similar to the structure of Anatomy lecture notes). Glance through the lectures the day before just to see if it looks like you'll need to go to class or supplement your reading (if you don't go to class).

Exam

Prepare yourself for a new testing style. Questions are typically clinical vignettes and not as "straight forward" as your first-year exams. These still provide multiple choice format questions without "negative terms" (e.g., which of these is NOT seen in…). Throughout second year, you will begin to have "choose the BEST single answer" questions (different from first year's "only one answer choice is right" approach). In these types of questions, multiple answers choices may be plausible, but there is a notably "more right" answers. Knowing the syllabus well seems to be the best way to differentiate the answer choice that the many of these questions will be looking for.

Immunity, Infection & Disease

Books

There is a simple book that is recommended for summer reading entitled, How the Immune System Works. Some people bought this and read it because it is simple and easy to use. It is a bit basic, but a nice intro.

The book that is 'required' or 'heavily recommended' is Basic Immunology by Abbas and Lichtman. It is relatively well-written and can clear up some confusing topics from class. In addition, there are some very good graphics that summarize main topics. For microbiology, Clinical Microbiology Made Ridiculously Simple is a must! It provides easy ways of remembering all the bugs and the corresponding pharmacology. Many reread this book for the boards!

Syllabus

Very comprehensive. The syllabus will be broken up into three major sections each with an associated exam: Exam 1: Immunology and Virology (First Aid has some great tables for this!), Exam 2: Bacteriology, and Exam 3: Mycology and Parasites. Dr. Jungkind's notes are very long, but go to his lectures or get a copy of his PowerPoint because he puts a star on the slides that contain the exam information.

Use Microbiology Made Ridiculously Simple to supplement the antibiotics lectures. It gives useful ways to memorize the drugs and their applications. The Microbiology Section of First Aid is also extremely useful!

A good way to approach the material is to create your own charts/table, listing the organism, defining characteristics, treatments, etc. - you will learn a lot making this and it condenses the material for ease of studying later.

Lab

In most of the labs, you are required to identify an unknown (i.e. determine the sample bacteria given different culturing procedures, etc.). It's usually quick, and there are a lot of lab assistants to help.

For some of the labs, if necessary, the instructors will supply protective coats that are intended to be reused for multiple labs. They should collect them after each use, so make sure that you don't throw them out.

The flow sheets in the lab manual are useful for the exams. This is the easiest lab course ever and should prompt no anxiety. Hand in all of the lab assignments (which are mostly fill-in-the-blank) and you will do fine.

Medical Letter Online Quizzes (Mandatory)

These assignments are short online quizzes testing your knowledge on the pharmacological interventions described in the various short (less than five pages) Medical Letter articles. They factor into a small percentage of your grade (traditionally, less than 5%). They are nothing to stress about. Simply read the article(s) beforehand and answer approximately ten straightforward questions related to the material. Keep an eye on which quizzes it says you completed (usually on a website within the Microbiology pulse site).

Exams

There are three exams. The third exam is not cumulative, but does review some material from the first two exams. This is good because there is not a lot of new information and it is a good review. If you know your syllabus, you should do well. Also, there is an NBME Subject Exam on Immunology and Microbiology.

Physical Diagnosis

This course is a little different because you have eight days of lecture as a sort of "primer", and then the course is continued through FCM. After your eight days of lecture you will have an exam on the material. Then when you start FCM you will have some Physical Diagnosis lectures mixed in with all of the other FCM lectures. The information you learn for Physical Diagnosis during the FCM part of the year is double-tested. You will need to know it for the FCM exam you are taking (e.g., You will learn about heart murmurs during cardiology), and you will need to know it for a Physical diagnosis final exam. The final exam at the end of the year tests you on all of the information you have learned throughout the entire Physical Diagnosis course. Your grade for Physical Diagnosis is based on the exam before Thanksgiving break, performance at the affiliate hospital visits, a scenario-based, focused history and physical exam using standardized patients at the clinical skills lab, and the final exam.

Books

The course recommends A Guide to Physical Examination and History Taking by Bates. Not many people used this.

Syllabus

Don't be overwhelmed by the syllabus they give you at the beginning of the course. You are not tested on all the information in there. Don't spend time on the obscure historic facts, but do know the pertinent physical diagnostic points.

For the week before Thanksgiving, if the PowerPoint lectures are included in the syllabus, follow them. If they're not, take notes and then print out the PowerPoint after the class. Unfortunately, the PowerPoint is usually not available until after lecture. If you learn the PowerPoint and anything extra in class, you'll be fine. Don't worry about all the information in the syllabus. Also, make sure you either buy a copy, or find a way to listen to Dr. Mangione's heart and lung sounds CD and the information included with it. There are sounds on your exams and they come from the CD and lecture.

As for the FCM lectures, they usually hand out the PowerPoint in class, which is then available later online. The best strategy is to go to lecture and follow along. Then, get the PowerPoint after class and review it. By the end of the year, all of the information in the original syllabus should look familiar, though still it has extra information you will not be tested on.

Hospital Visits

You will either go to Jefferson or an affiliate hospital for an afternoon during each block of FCM. The experience depends upon your assigned physician. Some people get assigned to Delaware or New Jersey. They provide transportation to Delaware, so if you're worried about time, you can study on the bus. Some students choose to drive, and that usually cuts down on time because the bus runs on a schedule and you might end up sitting around doing nothing for awhile.

Usually the afternoon consists of meeting with your doctor, performing a history and physical on a patient and then reviewing with your doctor. You will be required to submit some form of written documentation, usually to your preceptor. It may be a history and physical, or just some of your notes. This can be a valuable look into what 3rd year is like. Some demand more than others. If you have any problems with a preceptor tell Dr. Mangione immediately. He will always help you. Also, the preceptors tend to grade rather harshly because they only see you 4 times and they are more used to grading students in the 3rd year who are there for weeks at a time. Don't stress too much about it.

Clinical Skills Center

You will spend one afternoon at the clinical skills center during each block of FCM. The afternoon will consist of exam instruction, performing a physical exam on a standardized patient, and reviewing exam skills with a physician. These sessions are required and are very helpful. You will get a checklist at each visit that you should save. One of the standardized patient final exams will be based on these checklists.

Final Exam (Standardized Patient)

Each time you examine a standardized patient they will review a checklist with you. For your final exam you will examine a standardized patient using these checklists (from memorization). If you do everything on the checklist, you get 100%. Easy! If you don't save the forms, they are available online.

Final Exam (Written)

Again, just try to review the PowerPoints from the lectures throughout the year and you should be fine. Review Dr. Mangione's Heart and Lung sounds CD (know these very well). Most of the information in the syllabus that was handed out in November should look familiar now. It still has a little extra detail than needed, so stick to the PowerPoint presentations from throughout the year and you should be fine. Student-made study guides from previous years (often posted on the course discussion board) can also be very helpful at consolidating necessary information. Also, be prepared because this exam will be stuck somewhere in or around the end of another FCM block. You will likely have to take this exam a few days after another FCM exam. Students try to complain about this block every year; it never works, and it just makes you stressed. The test can be difficult and you should not expect honors unless you really know your stuff. Of note, to honor the Physical Exam course, you need to independently receive an honors grade for BOTH exams (an honors average will not suffice).

Foundations of Clinical Medicine


This course begins in the Fall and runs through the end of the year. It integrates clinical medicine, pathology, pharmacology, and physical diagnosis. The material in this course is dense and it is one of the more rigorous classes Jefferson has to offer. A great overall attitude to take when approaching this material is to take the time to understand the material, not just memorize. Each topic, section and system build on each other and the course prepares you very well for the boards. Really try and master the material presented to you in the next six months because through this course you will gain the core knowledge that will guide you through Step 1, your clinical clerkships and your entire medical career.   

Resources - The Standard Set of Material

  1. Syllabus and Lecture Material
    These are key. Many students used the lecture slides daily. The syllabus is longer and often it is less efficient to use it as a primary resource.
  2. Pathology Text - Pathoma
    This is a high yield resource that many students used daily during FCM. There is a lecture series found online with an accompanying textbook. The material is presented in a very logical way that reduces the need for memorization.
  3. Upper Year Outlines
    Many students take notes during lectures using the framework of outlines created through upper years. Many students find the outlines to be easier to learn from and more succinct than the syllabus.
  4. Anki
    Many students use Anki to incorporate active learning into their studying.
  5. Sketchy Pharm
    Many students use these visual aids to help memorize pharmacology.
  6. Lippincott's Review of Pathology by Rubin/Fenderson    
    This is a review book written by our own Dr. Bruce Fenderson and is a great resource to test yourself at the end of each section. It is easy to read with many good questions that simulate the FCM exam experience and each question is followed by in depth answer explanations.
  7. Rubin's Pathology
    This is the textbook from which all of the pathology images, notes and lectures are derived. This text can be cumbersome but ultimately understanding the pathology is key to developing your understanding of a disease process. You are not expected to read this cover-to-cover but it is a great resource. It is a big, bulky textbook and as a medical student you will have free access to it online (via The Point) and in the library (in print). Some students would be sure to skim the images and captions in the book before the exam since they are a good representation of images used for the pathology questions.
  8. Physical Diagnosis    
    You will be given a written syllabus from the Bergs. It is very thorough and all of their exam questions are derived from the given material. Focus on what is covered in class.

Resources - Review Books (The Extra Help You Might Need)

Disclaimer: The following resources are Step 1 study guides and by no means are they required. Ultimately, you are only responsible for the material presented in class. However, it has been found by previous students that these resources can help to augment and clarify your understanding of complex topics.  Do NOT get yourself involved in too many review books as they can get overwhelming. Looking through a few and deciding on one per section will serve you well.

  1. First Aid for the USMLE Step 1
    This is another favorite book to have around during FCM and will be your primary resource to use during board studying. Remember that studying hard for FCM is your  main goal. However, using this book now will help you organize your study material later and give you another way of looking at the material. If desired, a useful approach would be to briefly look through the associated First Aid systems section(s) for each FCM block for helpful learning mnemonics and to better conceptualize topics that are the most high  yield. Most students will glance at the sections before and during the block, taking notes in the margins when they begin to understand the topics of the section.
  2. Rapid Review Pathology (by Edward Goljan)
    The book is easy to read, has great pictures and truly takes you through the   pathophysiology of disease processes.  In addition, Goljan has an audio lecture set that many students recommend.
  3. BRS Physiology
    It is a very helpful text because each section quickly reminds you of how each system functions. This is key to understanding how things become disordered.
  4. First Aid for the USMLE Step 1 CASES    
    This is the companion book to First Aid and may help those who enjoy learning via cases  and practice questions. It focuses on some of the key disease pathologies and the questions are structured similarly to the exam questions.
  5. BRS Pharmacology
    Similar to the other BRS family of books. Broken down into sections and can be used as an easy reference if needed.
  6. Pharmacology Flash Cards
    Many students like reformatting the material in the pharmacology section to make it easy to understand. Some students like seeing this material in a flash card form to use for easy repetition, others like seeing it in a table format. Use what is best for you.
  7. BRS Pathology 
    This is a great resource. It is concise but hits on all of the key facts. As it is based off of Rubin's text, it follows the same outline and uses the same images.    

In general, if students decide to use review books during FCM, they go with First Aid alone or add a pathology and physiology source as well. The later resources listed (Cases, BRS Pharm, and flash cards) are not used nearly as often but you should know that they are out there. Please refer to the AOA Guide to Step 1 for a more complete listing and description of the review books that are out there.

The Sections

Here are some tips for each specific topic. This is where everything comes together and you must take the time to work through the specifics of each system based on the physiology/pathology/pharmacology. Learning to integrate these aspects in your mind will serve you well for the boards and for life.

Cardiovascular

  • This is one of the harder blocks. There is a strong focus on physiology in the section, so you should make sure you understand Starling forces and the pressure volume loops. The syllabus is thick, but there is a lot of overlap. Understanding the concepts will be very helpful for both boards and third year.
  • EKGs:  a difficult, conceptual topic that can be challenging for many students to grasp. Dr. Pavri's lectures are excellent and can help you understand the basics of EKGs.  Some students used Rapid Interpretation of EKGs by author Dale Dubin as an additional resource.
  • Valvular diseases are heavily tested. Know the murmurs, causation, and physiologic changes.
  • Pathology is not emphasized in this block. Know the changes seen post-MI and the timeline of when these changes occur, both heavily covered in First Aid for Step 1 and Pathoma.  Make sure you understand the difference between hypertrophic, dilated and restrictive cardiomyopathy.
  • Cardiovascular pharmacology in general is high yield both for the FCM exam and for Step 1, so be sure to learn it well. Antiarrhythmic pharmacology is difficult to master but - be sure you know the main drugs and their main side affects—sketchy pharm videos are a great resource for these.

Female Reproductive

  • The female reproductive system lectures are straightforward. Really focus on understanding the hormonal interactions in the menstrual cycle as this will help you in later parts of the block.  Learning this material well will also help you on your third year Ob/Gyn clerkship.
  • Fenderson's pathology questions are a good guide for this section. There is a lot of pathology for ovarian and endometrial tumors. Pathoma will be a helpful supplement. 
  • Remember: A young female with abdominal pain/vaginal bleeding has an ectopic pregnancy until proven otherwise!
  • Understanding the relationship between the components of the hypothalamic-pituitary-gonadal axis is crucial.
  • Understand the functions and hormones associated with the different cells of the reproductive system and to draw comparisons between the two genders (i.e., FSH stimulates both Sertoli (Male) and Granulosa (Female) cells to secrete estrogen, etc.).
  • Strive to develop an understanding of basic steroid sex hormone production and which cells are necessary during this process both in the adrenal gland as well as the gonad.    

Endocrine

  • It is a lot of material, but this really is one of the best-taught blocks!
  • Know the workup pathways for various diseases—for example, know what to do for a patient who presents with signs of excess cortisol. The lecturers often have a pathway slide for management which will serve you well during the exam.
  • Spend time on the hyper/hypocalcemia lectures as these concepts tend to come up a lot and calcium metabolism is complicated. The same applies for hyper/hypokalemia, and hyper/hyponatremia (although these topics will be taught in more depth during the renal block). Make sure you understand how PTH, calcium and phosphate levels change in the different disease entities.
  • Recognizing the different presentations of the various endocrine disorders will serve you well in the future.
  • Take time now to learn the complications, treatments, and pathophysiology of conditions like Diabetes (HHNK, DKA), Cushing's, and the different thyroid disorders as you will continue to see these topics come up throughout the year and on Step 1.
  • Make sure you know all of the MEN syndrome associations and the causes of hypo and hyperthryoidism, as well as how to work up a thyroid nodule.
  • For pathology, you need to listen to the lectures because Dr. Kenyon adds extra information which will be tested. These are very dense lectures, but do not get too overwhelmed, focus on what the lecturer emphasizes. Again, use Pathoma as you feel necessary, but this was one block where the syllabus and lectures were sufficient.
  • As with the reproductive system (typically these are taught together during one FCM block), be able to recognize the relationships between the hormones/target organs in the hypothalamic-pituitary-adrenal axis and what diseases could result if a defect were to occur during this pathway.    

Pulmonary

  • It is very helpful to review the physiology and get a good understanding of important concepts: obstructive and restrictive lung diseases, lung volumes, flow volume loops, Ventilation and perfusion (V/Q) ratios, and the A-a gradient. These concepts are very heavily tested on the boards and on the FCM test so it will serve you well to learn them well during this block.
  • High yield conditions include Deep Vein Thrombosis/Pulmonary Embolism, Asthma, COPD, and Acute Respiratory Distress Syndrome (know diffuse alveolar damage is associated with hyaline membrane formation in the lungs).
  • This section is also heavy on pathology. The slides from the path lectures are great, and should be enough to get you through this. Again, Pathoma and Goljan are great supplements for FCM pathology studying and will make studying for the boards easier later on.
  • For Interstitial lung diseases, know the main exposure risk factors and significant clinical outcomes.

GI

  • The GI section of the course was recently changed to incorporate at TBL format. Many students find that with the TBL formats they rely more heavily on Pathoma.
  • Do not be overwhelmed with the new format—take one day to figure out how you want to study and stick to it! You know what works well for you.
  • The syllabus and slides are not nearly sufficient for this block as both are significantly abbreviated.
  • Have a good understanding of hepatitis serologies (especially Hep B), understanding liver function tests, GI hormones and their function, and pancreatitis.
  • Colon cancer is an important topic and hereditary colon cancers are common topics on Step 1. This is likely going to be more of a focus in the Oncology block, but anything introduced here is high yield.
  • Going through Dr. Fenderson's book of questions is a great way to prepare for the test. This is a must for this block as GI pathology is a very short lecture and incorporated into TBLs.
  • Also, be sure to spend some time with the presentation of esophageal motility disorders (i.e. which ones which cause progressive vs. acute dysphagia to liquids vs. solids and liquids), the causes of peptic vs. duodenal ulcers, and GERD for the test.
  • Historically, liver conditions seem to be more heavily represented.

Hematology/Oncology

  • This block was changed to be a TBL format within the last few years. Many students find Pathoma to be an excellent resource for this block, as he logically organizes many of the concepts to reduce memorization.
  • Start early in understanding how to work up anemia, and knowing the most common causes of different types of anemia. Know what to expect on the peripheral blood smear for different types of anemia. First aid is very helpful for this section and organizes information into neat tables with images. Also, being able to differentiate between the causes of macrocytic, normocytic, and microcytic anemia is invaluable (refer to First Aid as well as the helpful chart provided in the syllabus and try to know it cold).
  • The coagulation cascade comes up a lot in this section so try to memorize it as best as you can. The coagulopathy and platelet disorders are heavily tested on this test as well as on Step 1 so learn them well now.  
  • For the malignancies you should try to organize the information in a way that makes sense to you. For the leukemias and lymphomas, focus on important translocations, key pathological findings and buzz words to be able to recognize different leukemias (example: huge spleen and dry bone marrow tap= hairy cell leukemia; starry sky macrophages= Burkitt's lymphoma). Also focus on the cancers that are uniquely treated (like Promyelocytic Leukemia with Retinoic Acid or CML with Gleevec).
  • There are great outlines for the leukemias/lymphomas from Dave Reilly on the class google drive for those who prefer an outline format of concepts.
  • Also be sure to know how to recognize, prevent and treat the most common oncologic emergencies such as tumor lysis syndrome.
  • In addition to the liquid tumors, you will be introduced to many solid tumors during this block. This includes colon, lung, breast, pancreatic and urinary tract just to name a few. The lecture material is very good, but it is very helpful to supplement it.
  • It is important to be able to recognize key pathological patterns that help you identify different tumors (example: butterfly appearance of tumor on brain MRI= glioblastoma). Of note, many of the brain tumors will be discussed separately in the Neuro block.
  • However, be careful in becoming too reliant on buzz words (as has been stressed in the Step 1 Advisory talks, the boards do not use buzz words). Epidemiology and risk factors will be stressed in lecture, so try get a good handle on these concepts.
  • For the chemotherapy lectures, it is very helpful to start organizing the information into tables or flashcards as early as possible. There are a ton of drugs to be learned, but the specifics are not a focus on the FCM exam or on the Step exams. An early start on learning the chemo drugs is recommended and make sure you know "ChemoToxMan." (see First Aid) for common adverse reactions.    

Renal

  • This is a very difficult block—there is quite a bit of information in a short period of time. Try to keep up with the material as the week goes on.
  • Acid-base physiology is extremely heavily tested (and clinically relevant). Listen to all acid base lectures and review sessions until you are confident of these concepts (there are good flow charts presented in the syllabus that will also be useful for Step 1 studying).
  • Dr. Vaid does an excellent job with acid/base lectures. Listen to them and it will help you immensely for the exam and Step 1 studying.
  • Other heavily tested and important concepts are electrolyte imbalances: hypo/hypernatermia, hypo/hyperkalemia, and hypo/hypercalemia.
  • Work on becoming comfortable with differentiating between concepts like SIADH and DI. First Aid and BRS physiology is a good resource for consolidating the larger number of concepts.
  • The pathology section in this block is also notoriously challenging, but Pathoma does an excellent job organizing the different syndromes. Understand the basic differences between nephrotic and nephritic syndrome - both clinical presentation and pathology of these different disease entities are highly tested in not only FCM but also in Step 1 and Step 2.
  • It will also be important to make associations between some glomerular conditions and certain diseases (i.e. the collapsing variant of FSGS and HIV). These can make for some easy questions on the exam.

Musculosketetal

  • The clinical components to this section are fairly straightforward.
  • The muscular pathology lectures are pretty detailed.
  • Connective tissue and autoimmune diseases are also taught in this section. Start learning the antibodies and characteristics of these diseases as they are heavily tested all through medical school and your boards. This cannot be emphasized enough!
  • Also, know the reflexes and sensory distributions associated with the different nerve roots (these will help with both this test and physical diagnosis).

Skin and Connective Tissue

  • Dermatology is a little difficult because the time devoted to derm is short.
  • Listen to the lectures and focus on the syllabus and you should be fine.
  • There is a lot of pathology in this section so pay close attention to the pictures of rashes and skin biopsies.
  • Know everything about skin cancers!
  • The review sessions are great - you should go to these. 

Neurology

  • Focus on movement disorders, being able to localize a lesion in the brain (strokes and tumors), the different types of demyelinating diseases, upper versus lower motor neuron lesions, and migraines.
  • The neuroanatomy class is good preparation for this section so review your 1st year notes if you need a reference.
  • Dr. Kremens' lecture on the clinical exam is great and very high yield for the test.
  • The neuromuscular junction and demyelinating disorders (i.e. Myasthenia Gravis and Guillen-Barre) will be important to know for the boards, so spend some time with these.
  • General indications for the epilepsy treatments also are important.
  • Once again, the course lecturers will give you a good indication as which concepts are higher-yield than others, as there is a lot in the syllabus.
  • The anesthetics are difficult to master and not often tested in-depth, so just strive for a basic understanding of their general mechanisms of action for the FCM test. These will become increasingly important though during your clinical years.    

Psychiatry

  • The psychiatry portion is interesting and very useful for the boards as well as your third year clerkship.
  • The psych drugs are very heavily stressed. There are a lot of them so an early start is important. Again, sharing review tables or using flashcards is very helpful.
  • Make sure you know not only the common side effects of the psych drugs, but also about Neuroleptic Malignant Syndrome (NMS) and Serotonin Syndrome (SS); these are high yield Step 1 and Step 2 topics.
  • Know the receptors and nuclei associated with different neurotransmitters and which drugs affect which receptors. It seems like unnecessary detail but it is important, both for your exams and clinical clerkships.
  • Also make sure you know the criteria for common disorders like depression, bipolar, schizophrenia and how long symptoms must be present to make a certain diagnosis.
  • Learn to recognize the different personality disorders and defense mechanisms.
  •  First Aid is a great resource for organizing these conditions and presenting some of the Mature and Immature Ego Defense mechanisms that often come up on the Boards.

Ophthalmology

  • The material in the slides and the syllabus should be able to carry you through the test.
  • Know the key points of the fundoscopic exam for common ophtho conditions like hypertensive retinopathy and diabetes.
  • The oculopath lecture is very good so it is unlikely you will need to look to other resources for this part of the block.
  • The ocular trauma lecture is one you will never forget so make sure you make it to class.
  • Glaucoma drugs are a focus for the pharmacology section.
  • Use cross sections of the eye anatomy when learning the pathophysiology of closed vs open angle glaucoma and how the glaucoma drugs work
  • Know the differences in how to treat various eye conditions!

Nutritional Modules (Mandatory)— It’s covered quite a bit by Dr. Vaid and the liaisons and really felt like more of a “to do” rather than a learning opportunity.

There will be approximately ten nutrition in medicine online sections that need to be completed during the associated FCM blocks (for example, Hypertension during FCM Cardiovascular and Diabetes during FCM Endocrine) found at www.nutritioninmedicine.net. They basically consist of educational tutorials on how to recognize and consult your future patients on their dietary needs and recommendations based on their medical history. After each section there is a graded quiz on the information. They are meant to act as a supplement and can be time consuming, so try to space them out. Generally, these are fairly straight forward, but you need to pass each block's multiple-choice quiz (i.e. at least 70%), so take them seriously so you don't have to repeat them. The moral of the story is do these well the first time around and that way you can avoid the extra work.

FCM is an intense, challenging course that will teach you what you need to know for Step 1 and gives you an excellent foundation for your clinical years. Your hard work will be rewarding with a great Step 1 score and a strong knowledge base for your clinical years. Good luck and don't hesitate to contact the AOA Tutoring service if you need any further guidance.

Introduction to Clinical Medicine II

This course is meant to be the second part of the course you had first year, ICM. Basically, it is your "how to be a well rounded doctor" course. You will again be assigned to small groups with a preceptor (or 2) from the clinical faculty. At the beginning of the year you will have to do some more standardized patient video encounters that the group will watch. They just want to observe your communication skills.

When FCM starts, you will meet more often with your small groups. You will be assigned a number of articles to discuss collectively and most groups will assign a pair of two individuals to lead the discussion with a short PowerPoint. This basically entails following the list of questions provided within each session's handout. These projects will be explained in more detail and are straightforward. As described above, you will work in teams within your group so it does not come out to be that much work.

During FCM, you will also have "Grand Rounds" every few weeks. These are mandatory attendance, so show up and sign-in.

In addition to the questions on the FCM tests, you will have occasional separate ICM quizzes on various topics (statistics (know these well for Step 1), for example). Review the lectures ahead of time, but don't stress too much over these.

You will be graded on the test questions, quiz grades, and also graded by your small group leaders. They have to nominate you for honors. Be sure to be an active part of the group because participation is a mandatory part of this course.