Internship can be used as a great stepping stone to preparation for AIPGE, arguably one of the toughest exams on the

Planet! This article is for those AIPGE aspirants who've just started their internship, or are about to start with it, and more importantly, going to treat their first attempt at AIPGE as a "trial attempt" rather than a do-or-die one...

A vast majority of AIPGE aspirants think of their first attempt during internship only as a warm-up or test flight. Considering the very tough competition, theres nothing really wrong about this approach. The prime-most reason for my saying this is that if one gives a full throttle try during their internship, and then doesnt perform well, then, that can be very disheartening. Picking up ones ropes once again can be very demanding on ones morale.

But, this article does not deal with the merits or demerits of treating ones first attempt as merely a testing the waters one. Its for those who have decided to do so. Ive a few tips for those whore about to begin their internship or have just started it. I myself had not been able to study much during my internship.

What follows is like a check list of what all I feel should be at least done during ones internship (though, Im not claiming that Id done all that :wink: as hindsight is better than foresight):

1. The so-called short subjects: These include physiology, anatomy, biochemistry, FMT, etc.

1.a. Among these, Id most strongly recommend going through the first chapter of Ganong, the first thing as it is a very good repository of all the fundamental information required. Itd make one aware of basics like osmolarity, osmolality, a bit of cell biology, gene regulation, all of which are very useful topics in themselves, and also serve as foundation to understand other things.

1.b. Ganongs first chapter is best followed up with the chapters related to pharmacodynamics and pharmacokinetics from Katzung. The various types of receptors, the second messenger systems, etc. A

1.c. The chapter on intermediary metabolism from Ganong. It serves as a very good summary of all the metabolic processes in the body. Studying metabolism should be just like zooming into a map. First one should get a good overview of what is the role of a particular cycle, meaning where does it fit in homeostasis, e.g., if it is largely catabolic or anabolic, or if it is required to produce metabolites necessary for other reactions in the body (e.g., the HMP shunt for producing NADPH).

1.d. The major metabolic pathways, according to me, are best reviewed from Lippincotts review series. It is concise, and serves the exact purpose of a good introductory guide without burdening the uninitiated mind with too much detailed information. Also, the book

is very good for studying the genomics part (DNA replication, expression, and regulation, etc.)

1.e. Now, the student is well set to understand any daunting sounding terminology like gene upregulation, or receptor downregulation, etc.

1.f. Ive never been good at anatomy, so cant really recommend much, but, would say that, if possible, one should compile a list of major muscles, and their innervations, blood supply, origin and insertion, etc. and keep close by. And, whenever one reads about a particular muscle in any context (say, if it is retracted in a particular operative step, or if it gets paralyzed in one or the other condition), or nerve, it should be looked up in the list. How this is different from the dedicated time given to learning about a muscle or nerve is that it doesnt seems redundant, meaning, one doesnt get the feeling of why the heck do I have to learn about some obscure nerve or muscle! And, plus the advantage of learning something in context. If one finds it difficult to compile such a list, one could download it from here, though Id point out that it is not very detailed, but it indeed is very helpful for the purpose at hand. List of muscles of the body from Wikipedia (click here) or A PDF file with table of muscles from Physical Therapy "Central" (click here).

1.g. Internship is a period, when one actually comes in contact with so many drugs. So, one should make it a point to try to learn about one drug a day, preferably, a drug one wouldve seen on a particular day. During surgery-related postings, if one gets to get in touch with

anesthetists, one should try to make best use of their knowledge. In my experience, I realized that theyre one of the best sources of knowledge in physiology, pharmacology, nerve supply, etc, and definitely, the anesthetic equipments. They also tend to have a good knowledge of the various OT practices like sterilization techniques. And, most importantly, during routine procedures, theyre a bored lot, so for them an intern interacting with them is a most welcome thing. But, Id point out that this was my personal experience, and cant vouch for its repetition elsewhere!

1.h. I highly recommend going through a book written by Tortora and Grabowski (a combined book for anatomy and physiology) for neuroanatomy. Its the best source getting initiated into neruoanatomy as it has vivid beautiful pictures of various CNS structures, and provides exactly the amount of information required for PG-entrance exams. Its greatest advantage is that, it provides information about both the structure and functions of the various parts of the brain without burdening with unnecessary details.

1.i. One should try to read about HLA from Harrisons. It gives one of the best info about the HLA. And, believe me while preparing hardcore for AIPGME, thered be a lot of HLA to bang ones head against. So, knowing about the arrangement of HLA, and its nomenclature would make it sound less of Latin and Greek. The same holds true about chromosomal nomenclature. Like, what 16p4.23 means (Ive just given a random example). Everyone knows that 16p means the short arm of 16th chromosome, but what about the 4.23 part; what does that signify. Well, its about its banding pattern when treated with particular dyes and fixed (I think) in

metaphase. A very good source is this very short description: Chromosome nomenclature from Human Molecular Genetics (click here).

2. Microbiology, Pathology:

2.a. In microbiology, Id recommend, reading the chapters related to bacterial structure, and sections dealing with cell wall metabolism (yes, indeed theres such a section) from Jawetz. These serve as a good source for ones foundation. And, the section about cell wall metabolism is very likely to be asked in pharmacology, as the many drugs like beta-lactams, vancomycin, polymyxins, they all act at different levels.

2.b. Pathology: sections about inflammation, apoptosis, neoplasms, composition of extracellular matrix and basement membrane, wound repair. Basically, all that that could be clubbed under general pathology.

3. ENT and Ophthalmology:

3.a. One should try to learn the basic anatomy of eye. Somehow, learning the embryology of the eye helps a lot in understanding the histology of the eye, and more importantly, why certain disorders that tend to affect various parts of the eye in contiguity.

3.b. Likewise, its a very good idea to learn the basic anatomy required in ENT. Also, if possible, along with it the various paths of cranial nerves.

4. Surgery/Medicine/Pediatrics/OBG:

4.a. I recommend, trying to complete one or two fundamental topics like bronchial asthma, MI, etc.

4.b. Id like to point out that Harrisons can almost serve as one-point reference for most of physiology, pathology and microbiology. Physiology of some topics like the respiratory system has been dealt with so well that its almost better than even the physiology books.

5. Trying to solve a few MCQs ever week, say around 100-150. What this will do is that, it will sensitize the student as to what kind of info to retain while reading text. Also, one would be able to start seeing a pattern in questions that have been asked in the past. As reading without solving MCQs is just like sailing away in a totally uncharted sea.

In the end, Id just like to state that a lot of recommendations Ive made are to achieve what one could call formation of files about important topics in the brain. They will not directly help solve many MCQs, but will form a foundation for assimilating important information gathered during the more serious second attempt. For example, if one reads about bronchial asthma in the internship, then anytime one comes across any info even distantly related to it (say, a certain drug, or the role of certain inflammatory mediator), this info will get added to a file on bronchial asthma already formed in the brain, and it wont jostle for space with other info as isolated and irrelevant info to be forcefully memorized.

And, if ones chosen to treat this first attempt as just a stepping stone attempt rather than the ultimate, last ditched attempt, then its also very important to not get too ballistic (worked up) in the weeks leading up to the exam, because if one does that, and then doesnt get a good seat, then itd be real hard to motivate oneself to prepare yet again for the exam, and subconsciously, the aspirant will look for short cuts (like just studying from MCQ-books) rather than continuing to study the systematic way one would like to. So, in the last week, one should just try to solve a few previous year papers, and give exam in a relaxed mood. Most important thing is to NOT feel at the end of the exam that one simply whiled away one's time during internship, which could've otherwise been put to some good use.

But, then, all this is my personal opinion, and as the results of AIPGME-2009, which was my second attempt, are not yet out, I cant claim how successful this approach would be. And, moreover, I could come up with these recommendations, not because I did things the way I pointed out, but rather, because there was no one to guide me, and I felt I SHOULD have done these things during my internship.

All the best!