Flashcards for the boards

How two frustrated students decided to make studying for the Step 1 exam easier.

By Cathy Shufro

The project began after a bridge game in mid-January 2003, when two medical students were commiserating about preparing for the board exam. Bridge partners Suzanne J. Baron and Christoph I. Lee were frustrated by studying for Step 1 of the United States Medical Licensing Examination—no single source seemed to provide the information they needed about pathology.

To assemble the basic facts about more than 300 diseases covered in the pathology section of the exam, the two second-year students leafed through a half-dozen review books and textbooks. Somebody ought to make the job easier, they reasoned. And so, although they don’t bet on their bridge games, Baron and Lee decided to gamble: they would develop a study aid, a set of flashcards, and they would sell it to a publisher.

Their efforts paid off. McGraw-Hill liked the idea, and three months after Lange FlashCards: Pathology came on the market last summer, more than 3,000 sets had sold. McGraw-Hill may translate the cards into Chinese, Greek, Italian, Spanish and Turkish for students in international medical schools who will take the Step 1 before applying for residencies in the United States.

Ironically, preparing the manuscript meant even more of the hard work that Baron and Lee had complained about. “I have a stack of review books this high in my apartment,” says Baron with a laugh, holding her hand waist high.

The flashcards cover disorders in 13 systems in the human body, from the heart to the immune system. To put the facts in context, Lee and Baron wrote a clinical vignette for the front of each card, and facts about the disease on the back. As Lee and Baron worked, they realized that students would find the cards useful not only in preparing for the boards, but also for studying pathology when it was taught in class. Two of their professors, John H. Sinard, M.D., Ph.D., HS ’93, FW ’94, associate professor of pathology and ophthalmology, and Deborah Dillon, M.D. ’92, associate research scientist in pathology (now at Harvard), checked their manuscript for accuracy.

To find time for the project, Lee and Baron asked Nancy R. Angoff, M.P.H. ’81, M.D. ’90, HS ’93, associate dean for student affairs, for permission to postpone their clinical clerkships, which their classmates began in June 2003. Angoff agreed that the project was consistent with the philosophy of the Yale System. “Students are encouraged to find the things they’re passionate about and explore them in depth,” she said. “I love the fact that they saw a need and they were going to be the ones to fill it.” (This was not the first effort by Yale students or residents to prepare a study guide. Tao Le, M.D., HS ’03, co-wrote First Aid for the USMLE Step 1 while a Yale resident, with the help of students Antony Chu, M.D. ’02, and Esther Choo, M.D. ’01, who worked on the 1999 edition of the study guide.)

“We owe a lot to the Yale System,” says Lee. Still, when they saw their friends begin work in the hospital, Baron recalls, “we felt a little left behind.”

They have something to show for their time: a stack of 286 four-by-six flashcards, which retail for $29.99. (The authors receive royalties of 10 percent.) As they apply for residencies in internal medicine (Baron) and diagnostic radiology (Lee), they’re also working on flashcards for pharmacology and for biochemistry and genetics.

Recently, Baron spotted the cards on a shelf at the Barnes & Noble bookstore near her home in suburban Boston. “I said, ‘That’s me!’ That was a huge thrill.”

Bookshelf is a column in Yale Medicine focusing on matters related to books and authors at the School of Medicine. Send ideas to Cathy Shufro at cathy.shufro@yale.edu.

A Women's Guide to Menopause & Perimenopause book cover

Healthcare for Children on the Autism Spectrum book cover

Cancer: Principles and Practice of Oncology book cover

Group Psychotherapy and Recovery From Addiction book cover

Book notes

The Optimist: Meditations on Medicine
by Howard M. Spiro, M.D., professor emeritus of medicine (Science & Medicine) This compilation of essays by Spiro, which have appeared regularly in the pages of Science & Medicine since 1994, ranges broadly in subject from patients to technology to the state of medicine. Spiro addresses some recurrent themes: the importance of listening to the patient, consolation of the patient and the role of the physician as mediator between technology and patient.

A Doctor’s Visit: Three Novellas & Five Short Stories
by Siegfried J. Kra, M.D., associate clinical professor of medicine (Lorenzo Press) These fictionalized stories, based on the author’s personal history and experiences, explore the emotional lives of doctors and their patients and bring the realities of the medical profession to life.

Clinical Nuclear Cardiology: State of the Art and Future Directions, 3rd ed.
by Barry L. Zaret, M.D., the Robert W. Berliner Professor of Medicine, and George Beller, M.D. (Mosby) This book describes the most recent developments in technology, instrumentation and radiopharmaceuticals used in nuclear cardiology applications.

Invisible Cities: A Metaphorical Complex Adaptive System
by Chloé E. Atreya, Ph.D. ’04, M.D. candidate (Festina Lente Press) This work of creative nonfiction explores the principles of complex adaptive systems to demonstrate how art and science inform each other.

Academia to Biotechnology: Career Changes at Any Stage
by Jeffrey M. Gimble, M.D. ’82 (Elsevier Academic Press) This book evaluates the abstract and practical aspects of moving from a university laboratory to a position in the biotech industry. It shows the parallels and contrasts between a postdoctoral fellowship and a job at a biotechnology company, and it provides “how-to” guides for the preparation of manuscripts, patents and grants.

Viral Encephalitis in Humans
by John Booss, M.D., FW ’71, professor of neurology and laboratory medicine, and Margaret M. Esiri (ASM Press) The authors provide guidelines for diagnosing and treating viral encephalitis. Their recommendations reflect advances in molecular virology, imaging technology and molecular pharmacology.

Acid Related Diseases: Biology and Treatment, 2nd ed.
by Irvin M. Modlin, M.D., professor of surgery (gastroenterology), and George Sachs, D.Sc. (Lippincott Williams & Wilkins) This textbook explores the history, biology and treatment of acid-related diseases, including gastric and duodenal ulcer disease, gastroesophageal reflux disease, and the role of H. pylori.

Principles and Practice of Radiation Oncology, 4th ed.
by Carlos A. Perez, M.D., Luther W. Brady, M.D., Edward C. Halperin, M.D. ’79, and Rupert K. Schmidt-Ullrich, M.D. (Lippincott Williams & Wilkins) This text is designed to provide a better understanding of the natural history of cancer, the physical methods of radiation application, the effects of irradiation on normal tissues and the most judicious ways in which radiation therapy can be used to treat cancer patients.

From Neuroscience to Neurology: Neuroscience, Molecular Medicine, and the Therapeutic Transformation of Neurology
by Stephen G. Waxman, Ph.D., M.D., professor and chair of neurology, pharmacology and neurobiology (Elsevier Academic Press) Containing chapters by more than 29 internationally recognized authorities, this book reviews the development of new therapies in neurology from their inception in the laboratory to their introduction into the clinical world. It also explores evolving themes and new technologies that offer hope for even more effective treatments and, ultimately, cures for currently untreatable disorders of the brain and spinal cord.

A Woman’s Guide to Menopause & Perimenopause
by Mary Jane Minkin, M.D. ’75, HS ’79, clinical professor of obstetrics, gynecology and reproductive sciences, and Carol V. Wright, Ph.D. (Yale University Press) Drawing on new information from recent research, this book offers advice for women dealing with physical and emotional health issues surrounding menopause. Topics include the pros and cons of hormone replacement therapy; controlling the symptoms of PMS; and treatments for menopause-related hot flashes, insomnia and depression.

Cut Your Cholesterol: Featuring the Exclusive Live It Down Plan
by David L. Katz, M.D., M.P.H. ’93, associate clinical professor of public health and medicine, and Debra L. Gordon (Reader’s Digest Association) With advice about nutrition, physical activity, supplements and stress-management techniques, this book provides a plan to reduce cholesterol and lower blood pressure.

Cancer: Principles & Practice of Oncology, 7th ed.
by Vincent T. DeVita Jr., M.D., HS ’66, the Amy and Joseph Perella Professor of Medicine, Samuel Hellman, M.D., HS ’62, and Steven A. Rosenberg, M.D., Ph.D. (Lippincott Williams & Wilkins) Acclaimed as “the ultimate authority on cancer,” this volume reflects the latest breakthroughs in molecular biology, cancer prevention and multimodality treatment of every cancer type.

Healthcare for Children on the Autism Spectrum: A Guide to Medical, Nutritional, and Behavioral Issues
by Fred R. Volkmar, M.D., the Irving B. Harris Professor of Child Psychiatry, Psychology and Pediatrics in the Child Study Center, and Lisa A. Wiesner, M.D., HS ’82, FW ’83, assistant clinical professor of pediatrics (Woodbine House) This book offers parents of children with autism spectrum disorder information on issues such as sleep problems, unusual eating habits and impulsive or aggressive behaviors.

Locating Medical History: The Stories and Their Meanings
edited by Frank Huisman and John Harley Warner, Ph.D., professor and chair of the Section of the History of Medicine (Johns Hopkins University Press) At a time when the study of medical history is facing choices about its future, these scholars explore the discipline’s distant and recent past in order to rethink its missions and methods today.

Group Psychotherapy and Recovery From Addiction: Carrying the Message
by Jeffrey D. Roth, M.D. ’78 (Haworth Press) This book examines recovery, demonstrating the elements of the group process, including free association, resistance, transference and boundary management, and lets readers compare and contrast participation in a psychotherapy group and in a Twelve Step group.

Experiences of Depression: Theoretical, Clinical, and Research Perspectives
by Sidney J. Blatt, Ph.D., professor of psychiatry and psychology (APA Books) Using clinical examples and empirical investigations, Blatt demonstrates the value of considering the psychological dimensions of depression. He identifies two primary sources of depression: feelings of loneliness and abandonment and feelings of failure and worthlessness. Understanding these differences helps to elucidate the nature, etiology and treatment of the disorder.

Field Guide to Internal Medicine
by David S. Smith, M.D., associate clinical professor of medicine, Lynn E. Sullivan, M.D. ’96, assistant clinical professor of medicine, and Seonaid F. Hay, M.D., assistant professor of medicine (Lippincott Williams & Wilkins) This volume offers an overview of internal medicine, including discussions of pathophysiology, clinical presentation, diagnosis and management of medical emergencies and the most common diseases encountered among hospitalized patients.

The descriptions are based on information from the publishers.

Send notices of new books by alumni and faculty to Cheryl Violante, Yale Medicine, P.O. Box 7612, New Haven, CT 06519-0612, or via e-mail to cheryl.violante@yale.edu.

In Circulation

Library keeps a watchful eye on what works on the Web

In days of yore—before the year 2000, that is—libraries generally set up websites for their patrons “and assumed everyone could use them without a problem,” recalls Richard Zwies, M.L.I.S., Web services librarian at the Cushing/Whitney Medical Library.

Those days are over. A new research genre, based on usability studies, reflects libraries’ growing interest in streamlining their websites. Usability studies test how easily users can navigate a site, whether their aim is to scan the contents of the latest issue of a journal, track down an article or find out if a book is on the shelf. If a study shows that users are confused, librarians can change labels or reconfigure links.

The new approach has caught on fast. When the Association of Research Libraries offered an interactive Web-based class on usability studies last fall, 72 of its 123 member libraries, including Yale, signed up for the 90-minute session.

“The virtual front door of the library is becoming more important than our actual, physical front door,” says Zwies. In the 2003-2004 academic year, researchers, physicians, students and other users knocked on that front door—the Cushing/Whitney home page—more than 4.4 million times. In comparison, people walked into the library 329,000 times that year. Zwies says people use the Web for research because it’s accessible from almost anywhere, day and night.

Zwies just completed a small usability study of the medical library home page. He timed five volunteer testers as they tracked down several types of information. Zwies also counted the number of visitors to the “front door” for a week: users clicked on it 30,000 times. The most popular link? Webmail. Zwies actually finds that encouraging, as it suggests that many people at Yale set their browsers to the library home page. The second most popular link was to electronic journals.

The study showed that the site is generally easy to navigate, so Zwies plans only small changes. Even for this minor redesign, which eliminated redundant links, he sketched a new “wire frame,” Web parlance for the site’s “bone structure.” He then passed that on to Web designer Patrick J. Lynch, director of the MedMedia Group at its-Med, saying, “... it’s like a rough skeleton and Pat puts flesh on it.” (The home page already has some flesh on it, by the way: a woodcut of a cadaver, taken from the 16th-century anatomist Andreas Vesalius’ De Humani Corporis Fabrica. Visit http://info.med.yale.edu/library/.)

Usability testing will be a perennial task, says Zwies. “As Web technologies arise that might be useful to our patrons’ research, we will want to test them on human beings. We will be testing and tweaking, testing and tweaking.”

—Cathy Shufro



Berg		Hardiman



Ballard		Cohen

On campus

What role for the states in stem cell research?

When scientists wanted to discuss the safety of recombinant DNA technologies in the mid-1970s, they convened the Asilomar Conference, where they agreed on guidelines that would minimize risk while allowing the research to blossom, said Stanford biochemist Paul Berg, Ph.D. The first researcher to combine DNA from two different species, Berg shared the 1980 Nobel Prize in chemistry.

Berg doubts that a conference could resolve the current dispute about human embryonic stem cell research, because it centers not on science but on politics, ideology and moral beliefs. The Bush administration limits federal funding for research to a handful of embryonic stem cell lines, and Congress may even criminalize some therapeutic stem cell research. The pending legislation, said Berg in a September talk sponsored by the Bioethics and Public Policy Seminar Series, would deny 290 million American people access to potential therapies.

Berg supports efforts such as the recent ballot initiative approved by voters in November in California, which opened the way for state funding of stem cell research. “There is a role for the state to act for the welfare of its citizens,” he said.

—Cathy Shufro

A molecular link between the brain and learning

“When axons send signals that are received by dendrites, learning is taking place,” said Mariale M. Hardiman, Ed.D., the principal of a high-achieving public elementary/middle school in Baltimore and a speaker at a symposium in October celebrating the 35th anniversary of the Yale Child Study Center’s Comer School Development Program (See “Leaving No Child Behind”).

“We know that [making a] connection is important,” Hardiman said, citing the way a teacher and student may connect in the classroom. “What is fascinating is that it is happening on a molecular level.”

Hardiman has developed a “brain-targeted teaching” model that applies neuroscience to teaching. Teaching, she said, is most effective when it builds on what students know and prods them to learn more as they embark on a task.

Unfortunately, said Hardiman, the No Child Left Behind Act favors higher test scores over activities that require higher-order thinking. “What I see across the country is that education is moving back to a time when teaching was primarily test- and textbook-driven. While this traditional style of teaching has a place in our educational system, brain research seems to support more active, experiential teaching and learning,” she said.

—John Curtis

Using revolutionary technology to find “a rusty old ship”

After he discovered the wreck of Titanic in 1985, Robert D. Ballard, Ph.D., heard from his mother. “That’s all they’re going to remember you for,” she said, “having found a rusty old ship.”

Since then Ballard, founder and president of the Institute for Exploration at Mystic Aquarium, where he works with Dean Emeritus Gerard N. Burrow, M.D. ’58, HS ’66, has gone on to find PT 109 and Roman trading ships, among others. But his real accomplishment in finding the Titanic was the validation of a new approach to exploring the 72 percent of the Earth under the sea. Frustrated by the limitations of sending people underwater, he developed a telepresence—remotely operated vehicles with sophisticated digital cameras. “It had all the characteristics of my submarine, except me,” he said in October during the Wayne O. Southwick Lecture for the Department of Orthopaedics and Rehabilitation. “The first application of this new exploratory technology was the discovery of the Titanic.”

When he saw the high degree of preservation on the ship—including a chandelier still hanging in the ballroom—he came to another realization. “It hadn’t dawned on me that the sea was a museum,” he said.

—J.C.

A moral argument for fighting diseases of the poor

Rachel M. Cohen called for a new approach to drug research and development based on need, not profit, in a September talk sponsored by the Justice and the Allocation of Health Care working group of the Yale Interdisciplinary Bioethics Project.

“We have made a societal choice that drug development should be confined to the private sector and that medicines are a commodity like any other that should be developed in order to maximize profit,” said Cohen, U.S. director of the Doctors Without Borders/Médecins Sans Frontières Campaign for Access to Essential Medicines. As a result, most new drugs benefit inhabitants of the world’s richest nations and little is invested in drugs for diseases of the developing world, such as tuberculosis and malaria.

“Well, we’re sick of it,” she said, calling for a global framework that would define a health agenda, commit wealthy nations to contribute to health care internationally and strengthen international mechanisms for exchanging research results. “Our patients are dying, and we need to change the rules. We need a needs-driven global approach to thinking about how to finance research and development, with a general acknowledgement that research is failing poor people.”

—J.C.


			Originally published in Yale Medicine, Spring 2005. Copyright © 2005 Yale University School of Medicine. All rights reserved.