Medicine, Health Policy, Education

Step 1 Preparation

Education Technology- It’s Here, But Will it Last?

This is a guest post from WesternU medical student Evan Yates

Since the first days of kindergarten, we have become accustomed to a typical style of receiving information- a teacher rattles off facts, we digest it, and regurgitate it on a Scantron. Fast forward 20 years to my second year of medical school, and aside from the Starbucks cups now glued to my hand, the teaching methodologies have remained constant.

While sitting through my 6th hour of lecture one day, I thought to myself- should these orthodox teaching methodologies eventually evolve? Is the way we learned the alphabet the most effective way for us to learn which class of anti-hypertensive medications can also cause ototoxicity? Or is there an untapped market out there for novel tools to better integrate complex information into manageable bites to bed drawn upon later on? Continue Reading

COMLEX Viscerosomatic Reflexes Made Easy

Viscerosomatic reflexes (VSR’s) account for up to 20% of Osteopathic Manipulative Treatment questions for COMLEX examinations [1]. While VSR’s for the head and neck (T1-4), heart (T1-4), and respiratory tract (T2-7) may make intuitive sense for most DO students, the rest of the visceral organs and corresponding spinal level are easy to confuse. However, these points can be easily memorized with a little effort in order to boost COMLEX Level 1 scores. Continue Reading

An Evidence Based Method to Acing the COMLEX and USMLE

With the New Year rolling around the corner, many second year medical students are readying themselves for an intense few months of studying in preparation for the USMLE step 1 and COMLEX level 1 exams. For a profession that prides itself on evidence-based practices in real-world clinical scenarios, medical education is certainly lacking when it comes to evidence-based board preparation strategies.

In my first post for the First Aid team, I dive into two studies that analyzed the study habits of high-scorers on the USMLE and COMLEX exams. More specifically, these studies address the correlation between early initiation of board preparation and number of practice questions with test scores. Continue Reading

On Board Studying And Clinical Rotations

In late June I took my first set of licensing exams, the USMLE Step 1 and COMLEX Level 1. Scores from these exams play a large role in the residency match process, and as a consequence, most second-year medical students are obsessed (to put it lightly) with exam preparation. A future post will have more details on how I studied for these monster 7+ hour exams, but the short of it is that I used the popular “UFAP” protocol: UWorld, First Aid, Pathoma. I wasn’t alone in finding success with this strategy either, a recent r/medicalschool survey had a respondent average of 243 (~80th percentile) with these three resources being the most widely used.

Following the social isolation that was studying for those exams, my schedule turned to clinical rotations in Family Medicine and Surgery. Jumping from twelve hour study days to twelve hour rotation shifts has been equally exhilarating and terrifying. The exciting part is getting to finally do all the things I’ve been studying for the last two years. Seeing patients, scrubbing into surgeries, hearing heart murmurs, giving shots to crying infants, working on treatment plans, doing procedures, it’s been a blast putting all those hours of studying into use. The terrifying part has been what seems to be a Grand Canyon sized gap between my clinical knowledge and everyone else’s at the hospital. In a way I feel like all the tidbits I learned the first two years formed this giant framework and now all the holes are being exposed and (slowly) filled.

After two years of medical school, I can finally say this is what I signed up for.

From Around The Web

Podcast interview with College Info Geek: “Hardcore Studying Advice”

r/medicalschool Step 1 Survey 

AOA House of Delegates supports single GME accreditation

[Photo via flickr user peterras]

Learning by Osmosis: A Better Way to Study in Medical School?

Studying in medical school is an inexact science, to say the least. While the concepts and therapies we learn are rigorously backed by evidence-based studies, the way in which we learn is still largely trial and error. With the sheer volume of information to learn, students are often left cramming material for exams and subsequently forgetting it all when moving onto the next block.  Sure, I could draw the brachial plexus blind-folded during Anatomy class, but I couldn’t tell you a single branch of the celiac artery during Neuroscience. Academics call this binge-purge cycle “academic bulimia”.

Born out of this frustration with the status quo is a new learning app called Osmosis. Launched in July 2013 on iOS (web platform and Andriod app in the works), Osmosis is the brainchild of two medical students at Johns Hopkins. The app is bringing next-generation ideas and concepts such as crowd-sourcing and “smart” algorithms to traditionally slow-moving medical education. I recently had a chance to interview the two co-founders of Osmosis on their product, their vision, and the student-led revolution of medical education.

Osmosis Mobile App Demo from Knowledge Diffusion on Vimeo.

What is the Osmosis app? How did it get started?

Shiv Gaglani: Ryan and I were in the same anatomy team-based learning group. Less than two months into med school we found ourselves repeatedly talking about how inefficient the cram-forget cycles of medical education are; one of our professors actually called these binge-purge cycles “academic bulimia.” We became obsessed with finding ways to improve the way we learn and retain information and, like any good scientists, started with a literature review. There were a lot of evidence-based learning principles (e.g. spaced repetition, testing effect, associative memory, etc) that were just not being applied through “modern” education technologies. Think about it: right now, the tools medical students use for social networking and entertainment, things like Facebook and Netflix, are managed by more sophisticated algorithms than the tools we use for our education. Ryan and I realized that our engineering and neuroscience backgrounds had prepared us to do something about it.

Ryan Haynes: Initially, Osmosis was a tool for crowd-sourcing practice questions & resources and eventually it grew into both a web platform and mobile app. The web platform makes learning more relevant and engaging by bridging the gap between the official curriculum and the secondary curriculum – that is, open educational resources as well as publisher content. The mobile app makes reviewing easier by literally pushing out practice questions and resources via an intelligent algorithm that learns about the student’s preferences.

When we began, Osmosis was a side project that we gave our class access to in January 2012. Soon, med school became the side project because we realized that we were passing our exams simply by learning through Osmosis. In a little over a year, the Johns Hopkins students contributed over 1,500 images and videos, wrote 5,000 practice questions, and answered those more than half-a-million times. Here’s the kicker: that was only 240 students. We now have over 6,000 medical students signed up for Osmosis so over the next few months we expect to be delivering millions of practice questions and resources to our peers and future doctors.


Where are you both in the medical education journey? How did you get to this point?

Ryan Haynes: Shiv and I just finished our second year of medical school at Johns Hopkins in March. We have been on the medical school path since college, where we both majored in biomedical engineering. After graduating from Georgia Tech (’06), I completed a PhD in neuroscience at the University of Cambridge because I’ve been interested in the brain, behavior, and learning for as long as I can remember. For example in high school I programmed a 3D game to teach students math and in college I built a site to create and share free textbooks. I found that Shiv had similar interests at the intersection of medicine, education, and technology. After graduating from Harvard (’10) he wrote a science education book and became editor of a popular med innovation blog called Medgadget before beginning at Hopkins with me. Coincidentally, we both had deferred our admission to medical school an extra year after graduation, and if we hadn’t inadvertently synchronized our academic schedules Osmosis likely would not have come to fruition.

How does the Osmosis app differ from the status quo for medical education?

Shiv Gaglani: Right now medical students are forced to manage two curricula: the official one from their institution and the unofficial one that includes test prep companies and publishers. Only the most driven students have the time and willpower to manage both consistently, not to mention all of their other activities including research, volunteering, and socializing. During my first two years, the last thing I wanted to do after 6 hours of lecture and small group was open First Aid to review. The Osmosis mobile app aims to make reviewing a passive activity, as easy as answering a text message. The web platform aims to bridge the divide between the official and unofficial curricula through our machine learning algorithms. I’d be more likely to review First Aid consistently if my official course documents were automatically tagged with info about my unofficial curricula. Say for example that you had a lecture on the brachial plexus. Osmosis will automatically present the popular YouTube video that demonstrates how to memorize and draw the brachial plexus as well as the page reference in books like First Aid (FA 2012, p. 408). In this way, students can spend less time managing their learning and more time actually learning.

On the issue of cost of medical education, there’s no reason that the unofficial curriculum has to be so expensive: $100 per month for a question bank?! That’s six Netflix subscriptions! We hope to help make high quality review material accessible to a larger population of medical students, and help publishers avoid the widespread class bootlegging that occurs on class Facebook pages, email lists, and Dropbox accounts.

We’re really excited by the feedback we’ve been receiving on our web and mobile platforms, and broader vision, and are working tirelessly to improve medical education.


What can you tell us about the next steps for Osmosis?

Ryan Haynes: We look forward to making our web platform available to the thousands of students who’ve signed up for our mobile app. A number of institutions have approached us asking to use our web platform for curricular mapping and content delivery. Furthermore, we’re still forging relationships with publishers like the American College of Physicians and BioDigital Human to present their content right at the point of learning, when students need it the most. In terms of other fields, we’ve received a lot of interest from international medical students, pre-meds, practicing clinicians, dental students, and even law students who want to learn through Osmosis. Right now we’re hyper-focused on medical students – after all, we want to build the best tools for our classmates and ourselves so that we can return to med school and learn more efficiently!

Why do you think there has been a sudden rise in medical-student driven medical education apps such as Osmosis and Picmonic?

Shiv Gaglani: There is generally widespread interest in education technology because new development tools have allowed us to create systems that incorporate evidence-based learning techniques with sophisticated data collection and analysis. I think medical education technology is really exciting because nowhere are the stakes for improving learning and retention higher; in most fields forgetting means frustration, but in medicine it could significantly impact someone’s life – say for example if you forget to test the pulmonary function of a patient you prescribe bleomycin to.  Medical students recognize this so it’s natural that many of us are driven to solve the problem. It’s exciting to see so many new approaches, and we look forward to collaborating to design the best possible educational tools for med students.

The Osmosis iOS app launched in July 2013 with a web platform and Andriod app on the way as well.

Related Posts

5 Questions With Picmonic Co-Founder Adeel Yang 

Blogging in Medical School: The Hero Complex

[Featured image via Flickr user A.K. Photography]

5 Questions With DIT Instructor Dr. Mike McInnis

This edition of “5 Questions” is with Doctors in Training (DIT) physician educator Dr. Mike McInnis. Besides being a mini-celebrity to the sleep-deprived 2nd year medical students who use the DIT course for Step 1 prep, Dr. McInnis is also the Director of Production for the wide-variety of services offered by DIT. You can also follow him on twitter for occasional pearls of wisdom and verbal jousting with fellow DIT instructor, Dr. Chris Lewis.

1) How did you get involved with teaching at Doctors in Training (DIT)? What products are you involved with at DIT?

I met DIT founder and president Dr Brian Jenkins at church several years ago, when he was in residency and I was first starting my practice.  At the time, he had a little side business teaching live USMLE Step 1 review courses, but the entire company consisted of Dr Jenkins and his wife working out of their home.

We kind of lost touch with one another when he finished residency and went into practice in another part of the state, but then we reconnected in 2010 and he invited me to come on as his Director of Production.  By this time, DIT was offering online video courses for USMLE Step 1/COMLEX Level 1 as well as USMLE Step 2 CK/COMPLEX Level 2, and Dr Jenkins was just beginning to branch out into other products (such as Solid Pharmacology and the OMM Review for COMLEX).

As Director of Production, I am involved in all of our products to some extent, whether it be teaching, planning the curriculum and developing the Study Guide materials, supervising guest educators, or reviewing/editing videos. Not that I do all of the work myself.  We have a team of medical professionals, professional videographers and video editors, and support staff.  But I’m “involved” in all of it, to some extent.

As far as teaching goes, I teach parts of the Step 1 and Step 2 CK Review Courses, and parts of the Solid Pharmacology and Solid Internal Medicine series.  I also make some ‘cameo’ appearances in the Solid Anatomy videos, adding clinical correlations and hosting quizzes.

2) Is there a reason you’re teaching through DIT as opposed to at an academic institution? Do you feel there’s more flexibility in how and what you can teach through DIT?

I’ve never really explored teaching at an academic institution.  Academics are often researchers first and teachers second.  In fact, many academics only teach because their institutions require them to do so, not because they are passionate about it (or any good at it).

Teaching with DIT allows me a huge amount of creative freedom, which makes it exciting and fun.  There are things we can do on a video that simply aren’t possible in a live lecture—like video effects and animations.  Plus, I get to play dress up.  On a video, I can wear a tuxedo and sip a martini when discussing alcoholic liver disease.  I can put on a Hawaiian shirt and give a lecture on a tropical island when talking about tropical sprue.  We have a lot of fun with costumes, goofy props, and general  silliness, which keeps it fresh for us, and hopefully keeps the students focused and engaged.


3) You’re quite active on Twitter- do you find interacting with medical students online has influenced how you teach in your videos?

Without a doubt!  My primary reason for creating an “official” Twitter profile about a year ago was to engage with students, to stay in touch with them, and to be available to answer questions.  (I have had a ‘personal’ Twitter account—mostly abandoned now—for a few years.)

I love being able to interact with pre-meds and med students on Twitter and keep my finger on the pulse of today’s students, to make sure that my teaching stays relevant and fresh.  It pains me to admit it, but I’m pushing 40, and every year I’m farther and farther removed from the average 20-something medical student.  Students today have a different frame of reference than I do.  You are much more comfortable with electronic books and syllabi than I am.  You can watch class lectures online (back in my day, to watch videotaped lectures we had to borrow a VHS tape and watch it in the library).  We actually used to check out physical slide projector carousels to review.  And I certainly can’t make jokes and pop culture references to stuff that was popular when I was 25 and expect today’s students to relate.

And I love to see students tweet “I don’t understand this brachial plexus lesion” or “These antiarrythmic drugs are killing me!” and being able to respond, “We have a Solid Pharmacology video that might help you out,” along with a link.

4) From your view as an educator, what are some common misconceptions you see medical students have about Step 1 prep?

Some students seem to think that they can ‘cram’ for Step 1, the way they might ‘cram’ for a block exam or a final.  There’s no way that will work for the USMLE (or COMLEX); there’s just too much material.  It’s crucial that you make a long range study plan over several months, and that you focus on really learning the material well during your first two years of med school.  The better you learn it (and truly understand it) the first time around, the easier it will be during the last 4-6 weeks of intensive test prep, because then you are just going back over familiar territory, and knocking the rust off your synapses.


5)   Finally, what do you think makes DIT stand out from the rest of the products offered for Step 1 prep?

There are tons of review products, aren’t there?  And it seems that new ones come out every year.  When I was a student, we only studied for 2-3 weeks, tops.  And very few of my classmates used any commercial board prep products, beyond First Aid. (It was only about 250 pages at that point, too!)  But Step 1 has become more and more important, and the stakes are higher and higher, and residencies are more and more competitive.  The average USMLE Step 1 score is about 15-20 points higher now than it was in 1998, when I took it!

Doctors In Training has over 10 years of experience preparing students for this exam.  We’ve taught more than 18,000 students.  We have a really good understanding of what topics are important for Step 1, and what topics students are already comfortable with.  We don’t waste time covering low-yield facts, or stuff that is so simple and so basic that 99% of students have already mastered it.  We try to teach in a simple, straightforward way, making connections between different disciplines, and reinforcing what you’ve already learned through quizzes and reviews.

We also try to make it somewhat entertaining, and fun.  We use humor to make things memorable.  We try to engage students on an emotional level (through humor, fear, anger, and even occasionally sex appeal), because that makes the learning stronger.  We try to engage students on a kinesthetic or tactile level, by having students take out a piece of paper and write something down with us, or by using props and visual aids that serve as a “hook” that you can hang bits of information on.  We’re adding more onscreen text, and graphics/charts/illustrations/animations—anything and everything we can do to help students get every possible point on their exam.

Our company motto is “Better Doctors. Better World.”  And we really believe that.  If we can help students learn more and become better physicians, those better physicians will have a positive impact on the health of hundreds of thousands (if not millions) of patients over the course of their careers.  That’s our passion.  Better doctors create a better world.

Have a question for Dr. McInnis? Send him a tweet!

5 Questions With Picmonic Co-Founder Adeel Yang (And Free Course Giveaway!)

Edit: Congratulations to Thomas W. who won the give-away! Thanks to everyone for entering the drawing. 

Mnemonics have been used by medical students for decades to memorize details on the everything from the Krebs cycle to arterial branches. Those who have used mnemonics know that the more absurd the mnemonic, the more likely the idea is to stick (just look at this list of cranial nerve mnemonics).  With that in mind, the team behind Picmonic has brainstormed a program that uses audio-visual driven mnemonics to help medical student prepare for the USMLE Step 1 board exam. For a quick look at how their system works, here’s their quick video on how to learn Niemann-Pick disease in under 2 minutes.

As you can see, the Picmonic system is radical departure from the traditional powerpoint based lecture. For those interested, they currently offer a complete Step 1 prep course that you can find out more about on their pricing page. They even offer an aggressively discounted version of the course for those willing to be a part of their USMLE Step 1 Research special. And if that’s not enough, Picmonic has graciously agreed to let me give out one FREE course to a WhiteCoatDO reader who leave a comment on this post (check the bottom of the post for details!).

For more about the program, here is the interview I had with Picmonic co-founder Adeel Yang:

What is story behind how Picmonic started?

Adeel Yang: When I was a medical student, I was overwhelmed with how much information we were expected to memorize every day on topics like anatomy, microbiology, pharmacology, and pathology. Knowing that pictorial mnemonic was a research-proven technique, my co-founder Ron and I started experimenting with our own drawings and crazy stories to help us study. It was amazing how effective these picture mnemonics worked, so we decided to create Picmonic and work with professional artists, graphic designers, and software engineers to build an interactive learning system.

Picmonic is really the first Step 1 prep resource to have success in using audio-visual mnemonics, why do you think that is?

AY: We attribute a lot of our success to the advancement of technology. Laptops, iPads, and smartphones have infiltrated our lives. Medical students are more connected with one another than ever before. We were able to leverage technology to bring out the true potential of our pictorial mnemonics and effectively deliver them to students all over the world. This could not have been done as easily even five years ago.

Why audio-visual mnemonics? Is there evidence supporting this learning style over methods such as the traditional powerpoint lecture?

AY: Visual mnemonics are proven to outperform traditional PowerPoint lectures and text-based instructions. Research in the past by Dr. Joel Levin demonstrated repeatable results that mnemonic techniques not only enhance memory retention, they also translate into better application of knowledge. As a company that supports evidence-based education, Picmonic conducted a pilot study with its learning system that showed 162% improvement in long-term memory retention compared to text-based learning. We partnered with Midwestern University to continue our research efforts, which has shown promising results that will be published in the near future.

Why do you think traditional medical school curriculum has yet to pick up on the use of these audio-visual mnemonics?

AY: Medical school curriculum is actually modified frequently by leaders in the field. We saw incorporation of new educational principles such as problem based learning (PBL) and case-based instructions (CBI) in recent years. Adoption of audio-visual mnemonics will likely accelerate as Picmonic collects more evidence and improves upon its application. High quality audio-visual mnemonic creation requires creative and artistic minds that are willing to challenge the status quo. Incorporation of a new and alternative resource by conservative academics won’t happen overnight, but as the undeniable efficacy of this solution is brought to light, we believe adoption will shift drastically.

What has the feedback been from medical students who have used Picmonic?

AY: We are so excited to see that students love Picmonic. We’ve been receiving amazing compliments and encouragements from our users. They tell us that we are making the memorization process more enjoyable, saving them time from getting stuck on those tough topics, and helping to answer more Q bank questions correctly. We are also grateful to have constructive feedback from our users, who tell us what features to improve and topics to build. For example, following user feedback, we created a mobile optimized application so students can study on the go.

What is the creative process like when making a new video? How many people are typically involved in helping design a video (content, graphics, audio) from start to finish?

AY: A lot of our students interpret each Picmonic card as a “video,” but in actuality, it’s just a single image with some creative technology around it. A team of creative geniuses, medial students, and top Step 1 scorers conceptualizes each picture. We then develop a transcript for the audio, record it, and our technology platform pulls it all together.  We have a great team of mnemonic experts, illustrators, graphic designers, coders, and medical content specialists on board who all play a role in pulling a final Picmonic together. It’s our technology that really brings it to life. We love that students look at each card and consider it a video—the images don’t move or interact, but it really means that students are letting their imagination take over, really getting into the stories we’ve created, and having a better experience studying with Picmonic than anything else.

To enter the drawing for the FREE Picmonic Step 1 course, please leave a comment below with your current strategy to prepare for Step 1. Be sure to enter your email in the appropriate form. A winner will be randomly chosen on Tuesday, May 7th. Good luck!