The following was an email from a blog reader.  I think the reply I gave should answer questions for some prospective students.

I just wanted to know if you could tell me the challenges applying for residency that come with being a caribbean student. I know the obvious issues but what can you do to get around it besides having a good score?

Hello,

Unless you graduate from the offshore schools of Ross University, St. George University, or American University of the Caribbean, you may run into a good amount of obstacles to gain residency. Most Caribbean medical schools are not approved in all 50 states. My school Saint James School of Medicine, is about to reach 15 years in which the school will apply to big states like Texas and Florida for licensing. Usually it's a case-by-case basis for license approval in those states. Luckily my school has not been disapproved in any states. A good number of states follow the California approval list and so some Caribbean medical schools may not be approved.

Another issue is if you are Canadian then some program will not accept you unless you are also a US citizen or a US green card holder. Some residency programs will not sponsor visas for foreign grads, that's where US citizens who went to offshore schools have the advantage.

At the end of the day, the Step 1 and Step 2 CK scores matter. Some programs look at your Step 1 score and some programs look at your Step 2 CK score, and others may look at both. So it's a good idea to score high in both tests with Step 2 CK score being higher than Step 1 score.

Another issue could be your letters of recommendation. Some schools have good rotation posts in which students get good LORs but others may not so it depends on the school and what rotation spots they have.

Also, with more American medical schools being built and more American medical grads are applying to primary care, IMGs will have high competition since residency spots have not increased significantly. Therefore, it's better to go to a US med school, the second option would be to attend the top three Caribbean medical schools which I listed: Ross, AUC, and SGU.

I’m in my fourth year of medical school; I recently took a small vacation trip. On my trip I reminisce on how far I have come. With my parent’s prayers and God’s blessings I was able to overcome the challenges that I faced.

What I learned from my experiences is that thinking about what motivated you in the beginning and holding on to that thought helps. I’m a strong believer of God and that kept me going just by believing in him and knowing that with time things will get easier, and it did.

Don’t Seclude Yourself
Whenever you get a chance, try to be around people. Don’t think that you will loose study time if you take a break to hang with few friends. If you isolate yourself then you will actually loose study time in the long run. The seclusion will get to you and it will slow you down while you study. Instead of helping you studying and keeping you going, seclusion will diminish your momentum of studying. And let’s face it, it takes a while to really study this USMLE stuff and we don’t want anything to stop the study mood.

Always talk about the next step. Talking to others about your goals help a lot. When you talk to others, you are reminded of why you chose this field and it should help you further in your goals.

One of my friends is considering to go to a Caribbean medical school.  He is a business major with concentration in finance so he loves to analyze numbers in different applications.  He sent me this last night to compare and contrast the different accredited Caribbean medical schools that is worth looking into.  When I looked at the chart I knew he is thinking long and hard of the long term costs and benefits. He went to each school's website and looked into which school is approved in which states.  I thought this is an interesting find and it would very useful for prospective medical students who are considering going to a Caribbean medical school; Universidad Autónoma de Guadalajara is actually not located in the Caribbean, it's located in Mexico.

The chart involves the factors the differentiates one school from another including:

1. FAFSA eligibility and school code
2. OSAP (Ontario Assistance Student Program)
3. Establishment dates for each school
4. Approval for the states of NY, CA, TX, and FL.
5. MCAT requirements
6. Basic Science cost, as of January 2012
7. Clinical Science cost, as of January 2012
8. The foreign country/island each school is located at
9. And finally the estimated total cost, minus the junk fees, for each school

In the following school list, I put a * next to the so called "big four" medical schools which medical students talk about on forums.  The big four Caribbean medical schools are supposed to be approved in all 50 states, but according to the chart Saba is not.

American University of Antigua
American University of the Caribbean*
Atlantic University School of Medicine
Medical University of the Americas
Ross University School of Medicine*
Saba School of Medicine*
Spartan Health Sciences University School of Medicine
St. George's University*
St. James School of Medicine Bonaire
St. Matthews School of Medicine
Universidad Autónoma de Guadalajara School of Medicine Mexico
University of Health Sciences Antigua
University of Medicine and Health Sciences St. Kitts (UMHS)
Windsor School of Medicine
Xavier School of Medicine Aruba

(Click on the chart to enlarge)

Obviously it took him a while to do this, he has the time that I don't so I give him, Sean, the credit. Also if you liked this post and find it helpful then please Google+ it and Tweet it, thanks.

1. Don’t become a doctor if you are in it for the money.
Money is the biggest factor that leads people to pursue the field of medicine. Whenever a girl looks for a guy to go out with, a physician is whom she seeks most of the time. Money is power; and people have this false notion that being doctor will equal money which will further equal happiness. Money should not be the driving factor if you want to be a physician. If you tell the medical school you want to be a doctor because you want to be rich, they’ll just slap you and kick you out. No they won’t slap you but they will reject you without question.

2. Don’t become a doctor if you are lazy.
Any doctor or any student doctor will tell you that it takes a lot of dedication to be a physician. Those who are lazy will not be able to cope with the strenuous workload that medical schools demand. In my undergrad years I was laid back; however, when it comes to getting something done with full focus I would do it without any distractions. In medical school I had to turn up the notch on my study habits to keep up with the amount of materials my instructors throw at me.

3. Don’t become a doctor if you are not discipline in studying.
This was a problem in undergrad for me. I can stay still and focus on many things but when it comes to studying it was hard. I forced myself to stay seated and focused and after a while I got used to it. It takes time to get into the study phase; and when I started medical school it took me about 3 months to fully change my study habits. Now, I study practically every single day.

4. Don’t become a doctor if you study only by memorizing.
They’ll tell you that med school is all about memorizing. The answer is no, it’s about understanding medical concepts. The biggest topic to understand is Physiology and it deals with little memorization with more focus on understanding how things work in the body on cellular level.

5. Don’t become a doctor if you hate seeing blood.
My dad is an engineer and he told me he didn’t want to be a doctor because he wants to stay away from blood. A lot of my peers in undergrad had the same reason to choose a field other than medicine. To me blood is blood as long as it’s not from a virus-infected person. If the sight of blood scares you then I suggest you avoid medicine because you will have to use needles and blood will be in your view.

6. Don’t become a doctor if you have to have 8 hours of sleep every night.
Majority of the time a medical student will get a maximum of 5 hours of sleep. One of the hardest thing about medical school is not the studying part, but sacrificing the sleep.

7. Don’t become a doctor if you are not a people person.
If you are just book smart and you hate people then you may reconsider studying medicine. Doctors have contact with patients all the time whether it’s by phone or by person. In clinical clerkship as a student doctor you will be exposed to all sorts of patients from various backgrounds and if you can’t get along with different people then look elsewhere for a career.  And if you are a racist, you definately should not be a doctor beause you have to treat a person regardless of the person's age, sex, language, skin color, origin, ethnicity, legal status, sex orientation; you have to do it because it's the law.

8. Don’t become a doctor if cannot bend your ego.
In rotations if a nurse says you’re wrong then you’re wrong regardless of if you really are wrong. Nurses have more experiences and you’re fresh out of medical school without ay clinical experiences so it’s better to lower your ego and listen to the nurses because you’re not a full doctor yet.

9. Don’t become a doctor if you are not a team player.
In medical school students help each other. Medical schools promote peer-to-peer help and they do their best to enforce it. For example, the grading system in Yale and other medical schools abandoned the numeral and letter grading system to eliminate competition in classes. Instead, they introduced the pass/fail system which eliminates the cutthroat ways the medical students practice among each other to get a top place in their classes.

10. Don’t become a doctor if you can’t suffer.
An important question you should ask yourself before becoming a doctor is, can you suffer physically, mentally, or emotionally? I am in Bonaire, I struggle from time to time every week walking in the hot sun sweating and dehydrating. In America, medical students struggle like me in eating habits; there are times when I can’t even cook so I have to eat Ramen Noodles or a can of beans which are not satisfying. I eat it because I’m going against time, time that I can use to study.

In this post I would like to point out my mistakes from MD1; I learned lessons which I learned through experience while staying in Bonaire.

Room Mates
The people who I roomed it were not the people who they claimed to be. The Chicago office does a good job in pairing people, but once you live with them then it’s whole new story. People who I roomed with talked about studying and getting serious, but after a month or so, they got caught up with island parties. Not only that, I had stay with sport fanatics, who would keep up with scores the night before the exams. I’m not saying I’m perfect; I have my flaws of paranoia which pissed them off. I met my roommates on Bonaire so, I had to deal with them. One thing you’ll learn, never room with your friends, because you will loose friendship with them.

Showing Desperation
In Bonaire, my roommates showed desperation in getting a place to stay. For that, the landlord charged 3 times the normal price for rent. Never show desperation to the landlords, because they don’t care that you’re a student with limited money; they’ll do their best to suck out all the money out of you and leave you stranded. However, I’m sure it’s the same anywhere else in the world, but this relates to Bonaire only.

Don’t Wait for Anything or Anyone
In Bonaire, you would think people are laid back, which is true, but you shouldn’t be laid back. You’re a foreigner, and a student; therefore, don’t ever wait till last minute to do anything because you may suffer for it. If a payment is due at a certain date, don’t worry about any grace period, just pay it off ASAP.

Which school should you go to?
This is a question I see over and over again in medical school forums. SJSM and Xavier are walking distance from each other. The Xavier campus is literally right behind the SJSM Anatomy lab. And students from both schools come together and do events.

Both Xavier and SJSM students will tell you that when it comes to aesthetics and the administration of the school, Xavier is way better. Xavier medical school helps their students with immigration and finding a place to stay. SJSM students have a lot of trouble deal with when it comes to immigration; few SJSM students do transfer to Xavier because of that. And Xavier medical school classes are over 50% smaller than SJSM, with a maximum of 25 students per class. But why do SJSM have more students? The answer is that Xavier has been around for few years and SJSM has been around for 10 years. Therefore, SJSM has more accreditation than Xavier. As for immigration, most SJSM students don’t even apply for residency, they just get a re-entry permit when they need to visit family, and then they finish basic sciences and leave without getting any residency.

I said my goodbyes to the previous MD4s. I congratulated them for their completion of basic sciences, wished them good luck for the USMLE Step 1, and bid them farewell. To some, especially couples who are part of two different classes, it’s heartbreaking since they spent a lot of time together. One thing I observed is that, if you’re not married or not already in a relationship, then don’t initiate one while studying in med school. Keeping up with a relationship can be very stressful while studying medicine.

I’m not going home this break because it’s very costly to go back and forth from Bonaire to USA. Not only is it pricy, but also because getting a cheaper flight is a headache with 12 hour traveling time with connecting flights. A lot of people are planning to have fun this break but I think a day or two to rest one’s mind is enough with light review of the previous semester’s materials. Reviewing should always be done in between semesters because one cannot recall all the concepts of MD1 after he or she is done with MD4; therefore, review is mandatory.

MD2 is finally completed and ¼ of medical school is done. MD3, which is known to be nightmare, is rumored to be the most challenging semester. It’s challenging because the amount of content taught is overwhelming. The subjects taught are Pathology I, Psychology, Microbiology, and Pharmacology, with Pharmacology to be the toughest. However, I’ve spoken to alumni and other senior students who have already gone through MD3, and they said MD3 has some of the best teachers. MD1 and MD2 does not have good teachers, for me it was basically self-taught. I’m going to get into detail on how they taught the classes for MD2, because it was very disappointing to me.  I'm sure I can compare the MD2 classes with classes taught in Ross.

Yes I know, I haven’t blogged in a while. There is so much to do and I didn’t have time to blog. I’ve talked to some people regarding the rides for this weekend for the new students. I know many of the new students are coming in this weekend from US/Canada. If you are a new student and if you haven’t done so, contact someone to give you a ride from the airport to wherever you’re staying.

This will be my first short break. The vacation is about 1.5 weeks, so that’s enough time to study a subject for the USMLE, if I don’t get distracted with the beach.

Today, I have spoken to a representative from the Accreditation Council for Graduate Medical Education (ACGME) regarding green book hospital rotations. To my surprise the lady didn’t know what I was talking about. She just looked up residency programs for internal medicine but she had no idea about green book approved hospitals for rotations. I looked online and I can’t find any list regarding green book approved hospitals. If any of you readers have any idea regarding this matter please let me know because I have no clue.

Accreditation Council for Graduate Medical Education (ACGME)
Main Office:
Suite 2000
515 North State Street
Chicago, IL 60654
Telephone: 312-755-5000

This is a Google Analytic map of the people who come and read the content of this site. As you can see a good number of students come to this site from Illinois, Florida, New York, and New Jersey. Majority comes from Chicago, Illinois because most of the core rotations are located there.

I forgot to mention the medical supplies which are required. Thanks “lovecloud” for reminding me.

Dissection Kit
You can get one from University Book Store Online. They are $35, but we have new ones here for $20. You don’t really need to get one, because most likely you won’t be using yours. You will be in a group for anatomy class and that group will be assigned a cadaver. And in a group onye 2 or 3 dissection kits will be used while the rest of them will not be opened.

White Coat
You will wear your white coat every time you go in for anatomy lab. In some semesters we will hold a heath fair to prove the Bonairian community free medical services, and as a future doctor you will have to wear it. And you will also need it for your white coat ceremony which will be held in your MD4 semester.

I'll be honest with you and tell you that you DO NOT need all the books for the basic sciences.  Every book the school recommends you to get are available in digital format (pdf version) from other students on the island.  But if you require to buy books then you can do so from senior students who have them here; they usually sell their books for $20/book.  On the other hand if you are like I was, better to be safe than sorry, then buy all the books for MD1 from USA/Canada.  Sometimes all the books will be sold out but the teachers don't follow the books instead, the books are used as a supplement.  I have the names of the books and the link to Amazon.com to purchase them.  I took the time after a test to organize them and write this post so it'll be easy for you to look through which books you need.  Also, if you do decide to buy books from Amazon.com then please purchase them through the links I provided here because then I'll gain commission.  Anyways the list below provides the names of books and the asterisk next to the names indicates that I recommend you get.

The classes you'll be taking are Histology, Medical Ethics, Human Gross Anatomy, and Embryology. 

Histology
Basic Histology: Text & Atlas

Gross Anatomy
Clinically Oriented Anatomy, Sixth Edition*
Atlas of Human Anatomy, 4th Edition*
Grant's Dissector (Tank, Grant's Dissector)

Medical and Legal Ethics
Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical Medicine, Sixth Edition

Embryology
The Developing Human: Clinically Oriented Embryology With STUDENT CONSULT Online Access

Board Review Series
BRS Gross Anatomy (Board Review Series)*   
BRS Cell Biology and Histology (Board Review Series)
BRS Embryology (Board Review Series)

USMLE Step 1
First Aid for the USMLE Step 1, 2010 (First Aid USMLE)*

There’s about a month left till the next semester and I know all of you prospective students from USA and Canada are eager to come to Bonaire and I know you are nervous also. The Chicago office can tell you so much but what I tell you is first-hand experience of what I have seen and what I have been through. A reader emailed me about couple days ago and asked to post pictures of the area the school, apartments, stores, etc. I will do so in the next post.

Settling Down Will be Difficult
Moving to a new country for education can be tough. I’m not going to sugar coat anything because I tell you directly that first semester will be hard to adjust to for most of you from North America. I would say about 70% of the new comers will find a place to live in the first semester and then move to a new place after three or four months for the second semester to the rest of the year.

Complete Your Paperwork
Before you come to Bonaire make sure you are squared away with all your paper works. I wrote a previous post regarding that, please read that through. The most important papers you should have are the notarized Police report and a doctor’s letter with the physician’s header on the letter saying you are healthy with all your immunization shots. Make sure the physician writes a “letter” and not a note approving that you are healthy. I got a hepatitis B shot before coming here which was a precaution advised by my doctor and she said she wouldn’t give me the letter until I get one. As for the police report I ordered one for Chicago and I ordered another a week before coming to Bonaire. Please remember to have two copied of everything, especially your birth certificate.

If you are not born in the United States and you are just getting your papers taken care of, you will most likely have difficulty getting things done because there are so many things that are required and you have about 40 days left. The required things that needed to be fulfilled took me about 4-5 months because I was born in another country; basically due to the birth certificate.

I couldn't find any pdf forms from SJSM but I did find them from Xavier's website.

Netherlands Government Does Not Control Bonaire
Keep in mind this is Bonaire, an island, a Caribbean colony of The Kingdom of Netherlands; therefore things will not be the same as a Western nation. Recently, citizens of Bonaire voted for a party which decided that they want almost an entire autonomy from the Dutch; therefore; the modernization process may slow down to a stop because Dutch money won’t be pouring into the island treasury anymore. So I’m guessing the Bonarian government will increases prices because they won’t get free money from their colonial administrators from the Netherlands.

Arriving at Flamingo International Airport in Bonaire, Netherlands Antilles
When you are at the airport you won’t be impressed, trust me. The airport is small and students usually fly in the weekends. The flights that most students take are the connecting flights on Continental Airlines from George W. Bush International Airport from Houston, Texas. Students also take Delta Airlines from Hartsfield-Jackson International Airport from Atlanta, Georgia.

If you haven't done so, book your ticket from KAYAK.com; they give the lowest airline fare prices I have come across.

At the Flamingo International Airport you will stand in line to check in to customs. Make sure you have your passport, your letter of acceptance to SJSM, and an enrollment certificate in your hand. The letter of acceptance is important because it has SJSM’s address and the administration’s phone numbers. Chicago probably didn’t give you an enrollment certificate so, just call them up and get them to send you one; you won’t need it, but it’s better to be safe than sorry. The officer at the counter will give you a visitor’s pass and if you turned in all your paperwork by the deadline the Chicago office gave you then your picture will show up on the computer at the counter. If your picture shows up on the computer then that means your residency in the process. What the airport officer will give you is a visitor pass which gives you permission to stay on the island for 90 days and within that 90 days you should get your residency permit from the school.

The Chicago office should have helped you in pairing up with a travel buddy. Keep in mind this is the summer semester so, your class is the smallest out of all the classes. The largest class comes in the Fall semesters and the smallest class comes in the summer semesters.

Transportation from the Airport
Whatever you, do take the taxi as a “last resort” from the airport. The reason I say this because the taxi drivers may take advantage of you and charge you more than they’re supposed to. Native people over here charge a lot from foreigners while giving the same service to locals less than 50% of the price. SJSM group is on FaceBook and many students from the school are on it I recommend you arrange a ride with SJSM students from the airport to your hotel. SJSM students are very helpful especially our SGA, you asked them for help and they will help you. Each semester our SGA gets better in doing fund raising and in coordination.

Graduates of Caribbean medical schools have tremendous success in obtaining residency positions, even in competitive specialties. It helps to attend a well-established Caribbean school, perform well on the USMLE Steps 1 and 2, and obtain strong letters of recommendations. (See my previous articles: Getting Into Residency Part 1 and Part 2 for more information.) Before applying for the residency match and early in medical school, students should strategically plan their clinical clerkships in the US, ideally arranging rotations in the settings where they prefer to match.  In recent years, Caribbean students with strong academic and clinical performances have been able to obtain competitive residency positions at an increasing rate.  However, the largest number of students pursue less competitive specialties, such as internal medicine or family practice.  Some students are also able to ”prematch” into residency positions outside of the National Resident Matching Program (NRMP).
When evaluating the success of a Caribbean medical school’s graduates, it is important to find out specifically where and in what specialties students match. Also determine what percentage of fourth year students match into categorical programs. This information may not be easy to obtain. While schools typically publish their match results, it is unclear if these lists are truly comprehensive.

Read more >>

You may wonder what does a Caribbean medical school look like. Here is a pic of one of the classrooms.  I took it from my camera phone on lunch break.

Now the picture on the left is self-explanatory; the school has all the required equipment to teach the basic foundation of medicine.

Currently, studying physiology got me interested in cardiology. The overall physiology of the heart is very interesting and I crave to learn more about it. Cardiology is not simple, it is very sophisticated but it becomes simple to those who know the material inside and out. I looked into what’s the requirement to be a cardiologist after medical school.

1. 3 Years residency in Internal Medicine, which is the pre-requisite for cardiology specialization.
2. Acquire a physician license at the state of residence.
3. Then get certified by the American Board of Internal Medicine
4. After being certified as an internist, complete a 3 year residency in cardiology
5. Then take the American Board of Internal Medicine in cardiology specialization to be a cardiologist.

There are several sub-specialties of cardiology but I think after 6 years of residency I’ll get sick of training. I also looked into the pay scale for cardiology.

Starting off after cardiology residency, cardiologists make around $250,000 to almost $900,000 per year. That’s a big chunk of money, but then again, that pay is before the malpractice insurance and income taxes. The pay increases with time as the physician gains more experience, and with $250k that’s at least $21,000 per month.

The pay is good but the doctor should not go for the money. I’m in medical school currently and money hardly comes to me. Cardiology seems very interesting, as in how to solve problems and figuring out the symptoms like a puzzle. But let’s see how it goes in rotations and my chance to get into a cardiology residency depends primarily on my USMLE Step 1 score.

Check out what Dr. David Cathcart has to say about cardiology.

Overall SJSM is an OK medical school; however the material few of the classes provides us is really weak when it comes to being medically relevant. I’m going to go through the second semester classes and provide insight on the strength of the class based on its materials and the teacher.

Medical Genetics class is taught by our dean. It is a difficult class because the instructor challenges us so we would learn the materials inside and out. I compared what he teaches and what Kaplan teaches and not to my surprised it’s the same material but he teaches to a greater extent when it comes to details.

Journal Club class; this is a new class they added to our curriculum. It’s more work for us but in general it’s not bad. Each student can work by his or her self or be in a small group and find a medical journal and present the journal to the class. This is medically relevant because it keeps us updated on the latest research or what’s going on in the medical field.

Physiology class is very weak to what needs to be taught so we can grasp the full knowledge of the material. The instructor is very knowledgeable and very friendly; however, the entire class agrees that he does not do a good job in teaching us what needs to be taught so we can be prepared for pharmacology class next semester. For that reason the entire class except for the first row does not pay attention. If anyone walks around during Physiology class they’ll see that, unlike the first row, everyone else is studying for something else, playing games, or watching videos. I’ve talked to enough medical professionals to know that physiology is the basis for being a physician because a doctor has to do than just memorization he also has to know how things work. One of the doctors, I forgot his name, said Physiology is the foundation for medicine. Apparently there was an announcement that there will be a Physiology lecture from Chicago. I don’t know why headquarters is doing that but I think they know of the weak teaching of Physiology and so they want to try something new.

Biochemistry class is not so much is a weak class but what is being taught is not quite medically based. What’s being taught in that class is more college based biochemistry than the medical school version. There is no complete clinical side to the materials.

Neuroanatomy class is now another weak class. The teacher we previously had was very good and he taught well. He made sure we learned the materials inside and out. I busted my butt studying for his last test and I passed with an A. However, there was a change in classes and our instructor was assigned to teach MD1 Gross Anatomy class. In exchange we got another teacher, who is too quiet, and his voice does not project well in our class. So, just like Physiology class, over 90% of my classmates do not pay attention.

After all this I learned that at the end of the day, it's what you make out of it. And if you work hard you'll pass the Unites States Medical Licensing Examination.

On Bonaire there are two companies that provide internet services Telbo and Flamingo Television. One provides DSL internet and the other provides cable internet. In cable technology, the internet speed is shared among anyone in your neighborhood, unlike DSL internet. Last semester we had Flamingo internet, who provides cable internet, and our internet speed was ridicously low. This semester we found out about Telbo so we decided to order internet service from them.

It’s been over a month since we ordered internet service from Telbo. Our landlord went to their office multiple times every single week and even called them. Unfortunately they don’t care much about our business so we’re forced to withdraw our money. Telbo has very high speed internet but unfortunately their customer service is little to nothing which is required for good business. Therefore, my roommate and I decided to go with Flamingo Television’s internet again. I went to Flamingo’s office and they said they can get someone to install our internet the next day after we deposit the installation and first month services payment.

So far I have taken 6 blocks of tests and each time I study for these tests, my studying habits have become more concrete and my studying have become more efficient. The main goal of studying is basically to memorize. Of course memorizing hundreds of facts and concepts isn’t easy so I thought there has to be a better way. Memorizing becomes easier if I read, write, and hear something. So when I get class notes I read them out loud and as I read them out loud I record what I say on portable device. Once I’m done going through the entire notes, I go back and read the notes again, and as I read them again I play what I recorded, along with writing them.

The key to this is listening and writing as if you’re in class. I know for some it’s hard to pay attention to the professors because most of them have monotone voices; therefore, this method helps.

Another method which is good for memorizing is discussing what was taught in class with others. One of my friends came over and we studied for 2 days for one test. We went back and forth explaining to each other what we just read along with explaining the concepts in our own words; by doing so you’re opening more channels of memorization. When a classmate explains a concept to me, he/she will do so in a way which will get me to remember what that person taught based on how that person taught me. During discussion an efficient way of memorizing would be finding a real-world application to which the concept relates to.

After 2 block tests and through listening to other doctors, I found out apparently that physiology is the foundation of medicine. Physiology is the subject of taking what you know and understand how things work. It’s very interesting and I’m always eager to read more about it. Unfortunately the teacher does not do a good job to help us understand the concepts. The worst part is his voice does not project well throughout the class; it’s as if he’s mumbling. On top of that he flies through the concepts and expects people to understand it right away. I had to learn the concepts on my own, and once I understand it, I’m fully relaxed and I get more interested.

The concept of pressure gradient of the heart; why is the pressure of the left side of the heart greater than the pressure of the right side of the heart? The answer is long and yet very interesting. In general physics particle from a high pressure environment diffuses to an environment of low pressure. In the heart, the blood comes from the superior vena cava and inferior vena cava vessels goes to the right atrium through the tricuspid valves to the right atrium. The right atrium is a pump, which pumps blood to the pulmonary artery which transfers deoxygenated blood to the lungs to be oxygenated. The oxygenated blood comes out from the lungs to the left atrium through the pulmonary veins. The blood then comes to the left atrium and goes through the mitral valves to the left ventricle. The left ventricle is a pump and pumps the blood to the aortic arch. The aortic arch carries blood all throughout the body. As the blood is distributed throughout the body it is taken to the feet. In the feet the blood is pulled down by gravity so there’s no way for the blood to be carried back to the heart without a mechanism. That’s where the pressure gradient mechanism comes in. The hi-to-low pressure gradient comes into play when the deoxygenated blood from different parts of the blood needs to overcome gravity and return to the heart.

My explanation of the importance of pressure gradients above was written in 10 minutes. The only reason I was able to write the pathway very quickly because it was very easy once I understood where is what and how things work. Once I understood the concept, it came to me flowing like water.

Over here a student must have a strong foundation of physiology above all the other subjects, because without understanding this subject the individual is not a physician.