Picmonic: A Cursory Review

When I heard about Picmonic, I actually let out a little yelp of excitement and anger. Excitement because I wish I had such a tool while I was in the first and second year of medical school; anger because I thought about building just such a company about a hundred times but never went through with it. Picmonic was developed too late for my first years of medical school, but I keep hearing great things about it from our medical students. Because of all the buzz, I recently downloaded their trial software to test it out and I am impressed. The idea behind Picmonic is to develop absurd images in order to help memorize difficult to understand concepts. Each Picmonic image contains a number of important pearls that should be memorized. Picmonic walks the learner through the image to highlight each pictoral 'mnemonic'. The staff at Picmonic were kind enough to send us their image for clindamycin [shown below]. In this way, any time a student is placed in a situation (in the hospital or on an exam) where he/she must remember these important concepts, the absurd image will pop right into their head, increasing memory recall.


Increased memory retention using absurd images is actually a well-known phenomenon in teaching organizations. In fact, the best memorizers in the world often use abstract and absurd imagery to memorize lists of random words and numbers. The developers at Picmonic openly state that their software increases memory retention by "300%" and may increase scores on exams by "50%". These numbers are unlikely to hold up in a peer-reviewed journal, but their data, nonetheless, appears somewhat convincing. Thousands of medical students are using their software and I have never heard anyone unhappy with the purchase. Some use it far more than others, but everyone who purchases the resource appears to be quite happy. Of course, the utility of this type of device is likely more useful to those students who are more visual, but its effect on memory retention is likely to be universal.

If you haven't tried it out, go to their website, www.picmonic.com, and download their free trial. This is a great resource.

Top Ten Books for Ophthalmology Residents

This list is part of a series of articles about the best books for medical students. Click on the Med School Books Main Page to see other lists including the best books for each year in medical school, the best books for each clinical rotation, and the best books for USMLE Steps 1, 2, and 3.

No one outside of ophthalmology can truly appreciate the breadth and depth of this specialty. Most doctors assume that it must be quite simple to learn everything you need to know about one small organ. Though I had been told this many times prior to ophthalmology residency, I was still shocked but the amount of pathology that occurs in the eye. With a few years of residency under my belt, I will try to answer the most important question: what are the ten best books for ophthalmology residents.

Let me preface this list by saying two things.

  1. To do well on exams (OKAPs, ABO Board Exam) I can not rely on books, but rather I rely on questions. I have previously written a review of Ophthoquestions, which I think is a fantastic online resource and has helped me prepare very well for OKAPS. So while the following books are important, I would not recommend studying for OKAPS without a question bank, either online or in print.
  2. Your attending physicians will tell you that you can not ignore the current literature. For a while I convinced myself that I did not have time or desire to read current journals. However, the longer I am in ophthalmology, the more I realize how effective it is to read through the top ophthalmology peer-reviewed journals. As a resident you will get the "Blue" Ophthalmology Journal at your home. It takes no more than 10-15 minutes to read the abstracts. You will learn a ton and stay up-to-date on what is important in ophthalmology
  • Updated May 2015

1. The Wills Eye Manual:

A great reference manual is a must for all ophthalmology residents. The Wills Eye Manual, or as I call it, The Bible, always has everything I need to complete a workup or start a treatment regimen. Some residents also enjoy The Massachusetts Eye and Ear Infirmary Illustrated Manual of Ophthalmology. Both are good, just make sure one of them is in your bag when you take your first call.

2. The Basic and Clinical Science Course (BCSC):

I know what most of you are thinking…What? The BCSC is second? Sacrilege! It is true, the BCSC is a great resource, but I must put the Wills Manual first because of its universal utility. You can carry 15 BCSC books to the hospital with you every day. Most of you will get these from your residency program; if not, you should seriously consider spending the money for them.

3. Friedman's Review of Ophthalmology:

Friedman's is like the "First Aid Series" for ophthalmology. The book is full of high yield facts and pearls. It is surprisingly thorough and is a great resource to study prior to a subspecialty rotation or OKAPs. I have found, however, that reviewing the lists of facts presented in Friedman's is not very useful until you have a grasp of the concepts…something that will come from time in clinic and the BCSC series.

4. Nerad: Techniques in Ophthalmic Plastic Surgery

I will list a number of subspecialty texts in this Top Ten list, but not have I turned to more often than the Nerad text. This is the perfect book to prepare for oculoplastic surgery patients in the clinic and the OR. The night before every oculoplastic OR day I would read through the techniques of the upcoming surgeries and I was always very well prepared to learn in the OR and to answer most pimp questions that came up. I HIGHLY recommend this book. 

5. Last Minute Optics:

I previously wrote about Dr. Hunters free optics lectures. This is the text that parallels his free lectures. If you prefer written text over video lectures, this is the best optics book available. You can read it in a few hours and you will learn a surprising amount of clinical optics. It is perfect for last minute OKAPs studying or if you actually want to learn clinical optics but don't have much free time.

6. Chern: Review Questions in Ophthalmology

There are many great resources for ophthalmology residents looking for good questions. I have already written about the online questionbank, Ophthoquestions, which I highly recommend. There are also 50 questions at the end of each BCSC book, which are very good. As far as printed question books, the Chern book takes the cake. It has hundres of great questions and great explanations.

7. Chang: Phaco Chop and Advanced Phaco Techniques:

Every ophthalmology resident wants to become a safer, faster, more efficient surgeon. Dr. Chang is world renowned in his phaco technique and his ability to teach his phaco tecnique. I found this book to be incredibly useful as I approached my third year surgical rotations. It discusses general techniques and also advice for getting out of difficult situations. You really need to read about everything that can happen in the eye, because you will not see everything as a resident. 

8. Cornea: Krachmer, Mannis, Holland:

The last three suggestions I will make are large, dense, subspecialty textbooks. The BCSC series is simply not robust enough to help with difficult cases. A good cornea text or atlas is a must for all clinics as a reference. I have been very impressed with the organization and clarity of the Mannis text, though there are a few others. For a less dense option with beautiful photos, Krachmer has also put out his Cornea Atlas, which is full of great cornea photos.

9. Ryan's Retina:

A retina reference text is another must-have for residents and clinics. Most of you will have access to these reference books in your libraries or clinics. If not, consider purchasing one early in training so you can familiarize yourself with it and bring it with you to your private clinics after training. The Ryan text is very well known, but another great option is Gass' Atlas of Macular Diseases.

10. Walsh and Hoyt's Clinical Neuro-ophthalmology:

A final must-have reference is a great neuro-ophthalmology text. Remember, these are the issues that can kill ophthalmology patients. You will not always have fellows and neuro-ophthalmologists in the room next door and you will need a great reference book. The Walsh and Hoyt text is the favorite of most ophthalmologists. 


ophthoquestions.com: A Review


I realized early in medical school that, for me, the best way to learn is by doing questions. USMLE World and Kaplan's QBank got me through Step 1, Step 2, and Step 3. When ophthalmology residency started, I was relieved to hear about www.ophthoquestions.com. A much smaller pool of buyers (US and maybe UK ophthalmology residents) means the company can not have nearly the same profit margin as USMLE World and Kaplan. Nevertheless, I was quite surprised to see that the product was still very good. I have been VERY please with my experience, here are my thoughts…



  • The online format is unique in the field of ophthalmology. There are many great review books and question books to prepare for the OKAPs and the American Board of Ophthalmology (ABO) Exam, but nothing as portable and technologically savvy as ophthoquestions.
  • The questions are well written and parallel very well the questions on the OKAPs. I am told they also parallel well the questions on the written ABO Exam. Having not taken the ABO Board, I can not verify this.
  • For the most part, the explanations are detailed enough to learn the finer points of the pathophysiology without being overbearing. If anything, ophthoquestions errors on the side of being to succinct. They can do better at having more robust explanations. In this regard, USMLE World and Kaplan's Q-Bank are superior products. 
  • The questions are obviously written by subspecialists with knowledge in the specific fields, making the answer explanations very reliable.
  • If you do all the questions in the database you will be VERY well prepared for OKAPs
  • The price may seem steep (~$150 per year) compared to question books, but with 3,500+ questions nothing has the same amount of content


  • In my opinion, the current (May 2015) content on the site does not properly reflect to proportions of subspecialty content on exams. For example, and huge proportion of the ophthoquestions content is devoted to refractive surgery, while very little is devoted to uveitis. This does not reflect the content on exams, and certainly does not reflect the content that ophthalmologists should know.  Of course, you can simply not do all the refractive surgery questions, and this would solve the problem. 
  • The writers occasionally become defensive and personal when defending their questions and answers. I respect their opinions but I really don't think that a question bank is the place for defensive answers. 
  • If you do NOT complete all the questions in the database, the price (~$150 per year) is certainly very high. If you are only going to do a few hundred questions, you might as well purchase a question book like Chern: Review Questions in Ophthalmology


I am very pleased with my ophthoquestions.com experience and recommend it to all new residents. It is the best product on the market for OKAP and ABO board preparation. It has some faults, but to be honest, not that many. I am not someone who will read the whole BCSC series, because I will never remember chapters and books. But the content in ophthoquestions is presented in a memorable and organized way that has CERTAINLY helped me do well on the OKAPs exams.


Some other ophthalmology review tools:

The Anti-vaccination Movement, According to The Daily Show

I try not to touch on too many hot-button issues on this website; vaccines are the exception. In my few years as a medical student and resident I have already personally witnessed too many terrible things that could have been easily prevented with vaccines. No matter your political affiliation, this bit by John Stewart is incredibly funny. Thank you, Daily Show, for finding a way to make me laugh out loud about something that I find so not funny most of the time.




Hunter Optics Lectures and Last Minute Optics

David Hunter md phd

If you are a current or future ophthalmology resident, you should become familiar with the lectures produced by Dr. David Hunter MD PhD. He is the Chief of Ophthalmology at Boston Children's Hospital and has produced four, one-hour lectures that are incredibly high yield. I heard about these lectures before I took the OKAPs in-service exam during my first year of ophthalmology residency and I haven't looked back. Optics was, by far, my best score on the OKAPs my first year and I credit Dr. Hunter's lectures for the success. 

You can find all of his lectures on video, for free, on the Boston Children's Hospital website (link).  He has specifically said that he would love for everyone to have these lectures for free. Therefore, I will link to each of his lectures below. I have found that the above link occasionally does not work (usually in early March of every year, because we are all downloading from it). If you have issues, let me know and I can send you the files from my computer.

I really like the video lectures, however he has also published a book with the same content. Most of the residents in my program actually prefer the book because they feel like they can get through it faster and things are more clear when they read the book.  Whether you use his lectures or his book, the content is the same and it is fantastic. Take a few hours before the OKAPs to really learn this stuff, it will pay off in the long run.




Top Ten Books for Surgical Interns

This list is part of a series of articles about the best books for medical students. Click on the Med School Books Main Page to see other lists including the best books for each year in medical school, the best books for each clinical rotation, and the best books for USMLE Steps 1, 2, and 3.

The surgical internship is unique in that you will care for the full spectrum of patients: acute surgical patients, post-operative patients, patients with chronic illness, and very sick patient in the ICU. The surgical intern is truly a "Jack-of-all-trades" physician and must be able to reconcile huge med lists, manage diabetes, identify an acute abdomen, and take care of acute electrolyte changes in the ICU.

These are tall orders for a newly minted doctor. And don't forget, after 7am you will likely be the only one on the floor while the rest of your team heads to the operating room. Having the right books is one easy way to calm some of the inevitable anxiety. After much discussion with interns and residents at my last two hospitals, I have compiled the following Top Ten Books for Surgical Interns. These books are also great resources for preliminary surgery residents, or other surgical supspecialistis completing a general surgical internship. Most of the general surgery residents I spoke to agree that this list remains the same into their entire residency. Good Luck!

  • Updated May 2015

1. The Mont Reid Surgical Handbook:

The Mont Reid Handbook is a great reference tool to keep in your pocket or on your phone. It was written by a group of surgical residents and is very high yield. It will cover the majority of issues you run into while managing the floors during a surgical internship. It is also great for reviewing for OR cases…if you get to see any during your first year.

2. Surgery On Call:

Surgery On Call is another great pocket reference. The goal of this book, however, is more in the initial evaluation and treatment of surgical patients. The quick-reference format is great for a quick consultation. Some interns also suggest Surgical Recall , which has a similar format but is geared more towards 3rd and 4th year medical students. 

3. A Textbook: Cameron, Current Surgical Therapy:

Every surgery resident, even surgical interns, will benefit from a great surgery text. Many of you will be provided a text at the start of residency, so ask your department before investing hundreds in one of these books. Cameron's Current Surgical Therapy is the highest rated by surgical residents. However, there are other great options. Greenfield's Surgery is well-regarded and cheaper than Cameron's. There are also many people who swear by the Sabiston Textbook of Surgery

4. Tarascon Pocket Pharmacopedia:

While we all have access to online pharmaceutical indexes during residency, I agree with most interns and residents that a pocket manual like this great Tarascon book is far faster and more reliable than most online resources.

5. The ICU Book:

You really should get an ICU book. You can get through your first month as an intern in the SICU or MICU without one of these books, but they make your life so much easier that it is just not worth it. Even if you just read through it a few weeks before starting in the ICU, the information will be fresh on your mind and will help you a lot. This is the ICU book I used, it addresses both medical and surgical intensive care issues. Many residents also like The Little ICU Book

6. The Washington Manual Internship Survival Guide:

This is a lesser-known internship manual written by the same people who developed the highly rated medication reference, The Washington Manual of Medical Therapeutics. Not as well known as the Mont Reid manual, this is a book from a similar mold with a small but vocal cult-following.  

7. Zollinger Atlas of Surgical Operations:

A surgical atlas is the best way to learn the anatomy and prepare for pimping in the OR. A great surgical atlas will become one of your most important references during residency. If you are a general surgery resident, Zollinger's is the go-to atlas for most residents. 

8. Operative Dictations in General Surgery:

Dictating operative notes is a necessary evil. It has to be done, and it has to be done well for documentation purposes. As the low man on the totem pole, the job of dictation will fall on you. This is a highly recommended book to help interns and residents early in their career. I have a number of procedure note templates available on this website.

9. The ABSITE Review (FISER):

Many surgical interns will complete residencies in specialties other than general surgery. For those of you moving on the general surgery after your internship, you should start studying for your ABSITE early. I know you are incredibly busy in the hospital, but when you have a minute you should keep an ABSITE review book and/or question book handy. The Fiser review comes highly recommended. Another book that many residents recommend is ABSITE Slayer.

10. Old-School and Out-of-Print:

After discussing books for surgical internship and residency with many people, there were two books that were mentioned many times but are no longer in print: The Cleveland Clinic Guide to Surgical Patient Management and The Surgical Intern Pocket Survival Guide . These two books come as high or more highly recommended than every other book on this list. Some residents say these were the most used books in their white coats. Unfortunately, you can no longer buy either of them new, but there are many used options.  


Video: Empathy as a Physician

Studying your brains out for USMLE Step 1? Are you trying to keep your head above water on your surgery rotation? Are you an intern and can't remember why you ever chose medical school in the first place?

You need to watch this video put out by the Cleveland Clinic. It will help you remember.

Which Residents Work the Hardest?

No one will ever agree on which residency is the hardest, or which residents work the most. However, with some new data from the FREIDA website, we get a better idea than ever before.  (For more information about the FREIDA website, read my previous article) FREIDA reports diverse variables about each specialty including the average of numbers worked per week, the average number of days off per week, and the average vacation time of each specialty.  I have compiled these into one database so that for THE FIRST TIME EVER you can compare objectively which residencies work the hardest.  (Well, at least you can compare which work the longest).

The first figure demonstrates the average number of hours worked by each specialty. As expected, the surgical sub-specialties work the longest hours with neurosurgery leading the pack and general surgery following closely in second.  Of the medical specialties, suprisingly, neurology works the most hours, with pediatrics and internal medicine following close behind. And at the bottom of the list… you guessed it, Dermatology. I wish I loved skin!

The results of the average number of days off per week and the average vacation time during residency follows closely with the trend seen in the graph above. For your viewing pleasure I have the entire compiled dataset posted below.  






Hours worked per week

Days off per week

Vacation weeks per year





Nuclear Medicine




Medical Genetics




Radiation Oncology
























Emergency Medicine




Transitional Year




Colon and Rectal Surgery








Family Medicine




Internal Medicine




















Orthopaedic Surgery




Obstetrics and Gynecology




Plastic Surgery




Vascular Surgery




Thoracic Surgery




General Surgery




Neurological Surgery






Video: Outside Hospital

Check out this hilarious video about Outside Hospital (a.k.a OSH)


Best Books for Anatomy Class

This list is part of a series of articles about the best books for medical students. Click on the Med School Books Main Page to see other lists including the best books for each year in medical school, the best books for each clinical rotation, and the best books for USMLE Steps 1, 2, and 3.

This list of books was specifically created to help medical students. However, I would suggest the same books to anyone taking an undergraduate course in anatomy, to dental students, optometry students, podiatry students, physicians assistant students, advanced nursing students, etc. etc.  When you are studying anatomy there are a few things you have to focus on: 1- Learning the name and location of the structures, 2- learning to identify the important anatomic relationships in the body, and 3- learning the clinical correlations related to the important relationships. Your tests will focus on each of these areas, so you must focus on them as well.

  • Updated April 2015

1. An Atlas:

Your first goal when starting your anatomy class will be to find the atlas that will help you learn. I created a separate list of the best available anatomy atlases a few months ago.  I am partial to Netter's because I like bright colors, but each atlas has its own advantages and disadvantages. Below are a few links to the best known atlases.

Grant’s Atlas of Anatomy

Gray's Anatomy

Clemente’s Anatomy

Rohen’s Color Atlas of Anatomy

2. An Anatomy Textbook:

An atlas is essential for learning WHERE anatomy is, but you must also learn WHY anatomy relationships are important; you will be tested on both paradigms. An anatomy textbook will teach you the pertinent anatomical/clinical relationships. I prefer Clinically Oriented Anatomy because it is brief and very high yield.  I have also heard good things about Saladin Anatomy and Physiology.

3. A Dissector:

A 'dissector' is a manual that will guide you through dissection in the anatomy lab. Your class will likely suggest a specific book for the lab itself. Let me also recommend purchasing an extra copy from which to study. Grant's Dissector works just fine. You will want to know all the important structures that you dissected, but you will NOT want to study out of your anatomy lab book! Gross.

4. Flashcards:

To do well in an anatomy class you do not need to think, you only need to memorize. Flashcards are a must. Use them on the bus, trains, waiting in line, brushing your teeth, etc. Don't waste time making your own, you can buy a used box of beautiful flashcards for around $15.  Again, my favorite are the Netter's Anatomy Flash Cards, they are bright and color coated for easy memorization.

As an aside, I have heard of a few people using 'coloring books' to study for anatomy. This actually sounds intriguing to me and I wish I heard about it earlier. Many companies make these books, here is a link to Netter's Anatomy Coloring Book .

5. Anatomy Review Book:

I have raved about the BRS Series of review books before and I will again. The BRS Gross Anatomy review is concise (albeit 500 pages) and high yield review of everything to do with anatomy and its clinical correlations.  The best book for high yield review, however, is likely the First Aid for the Basic Sciences, General Principles. This will include review of many other subjects, but it is very high yield and a fantastic resource. 

6. Other Books:

Depending on the course structure, you may also be required to learn embryology and histology during your anatomy class. If so, let me suggest Langman's Medical Embryology and Ross Histology Text .



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