The first enormously frustrating moment of my medical training came in my biochemistry course – specifically, learning the breakdown and synthesis pathways of amino acids. There are 20 amino acids, so that’s 40 pathways, and there are numerous more ways in which those little buggers can be converted from one to another. I remember asking a relative and current physician when I would ever need this knowledge for the rest of my career. Her response: “Doctor cocktail parties.”

Bottom line, medical biochemistry brought about the first of many moments in my medical career when I had the following crisis-inducing thought: Why, oh why, am I learning this mountain of useless information?

Click here for the podcast with Enrico Scarpelli, a medical student who nailed his biochemistry course.

It’s a mental battle you fight a lot in medical school. In many first-year curricula, this battle starts with biochemistry and cell biology, where you are flooded with stepwise pathways that seem largely irrelevant to clinical practice. You memorize the reactions of glycolysis and the Krebs cycle; you learn, in excruciating detail, how DNA is synthesized; you hear the names of a hundred enzymes, and then are told a hundred more ways those enzymes are enhanced or inhibited. All the while, you’ll wonder: is this knowledge really going to help treat my future diabetic patient?

I firmly believe that learning biochemistry is mostly about learning the language of molecular medicine, which in turn informs your knowledge of pharmacology and treatment. You can’t know how Viagra works without knowing about the phosphodiesterase enzyme. You can’t understand the impact of Vitamin B12 deficiency in alcoholics without knowing DNA synthesis. You can’t truly understand phenylketonuria without understanding the metabolism of the amino acid phenylalanine.

Oh, and when your future diabetic patient gets ketoacidosis, biochemistry explains that, too. So, as frustrating as it is, I have grown to appreciate biochemistry as an important foundational background for understanding clinical medicine.

If you still don’t buy what I’m selling, then let’s just leave it at this: you can’t graduate medical school without learning biochemistry. Here are some tips on how to do it – and if you want guide from an expert, check out the podcast here.

1. The most important steps to learn in a pathway are the ones that are regulated or clinically significant. If you haven’t gathered this already, biochemistry is about learning stepwise pathways, where each step is a chemical reaction. Following the above guideline in learning these pathways can help at least chop off the cap of that mountain of useless information. In most biochemical pathways, there is a step or set of steps that determines whether all the others will happen.

Podcast: glycolysis as an example of how to focus on the big picture for a given biochemical pathway.

For instance, let’s propose an analogous pathway in which I “hypothetically” want to trip my older brother so he falls flat on his face. In order to do this, I first need to get him to look away while I stick my foot in front of his shins; without that, the rest of this joyous process can’t move forward. But once I get his eyes diverted and my right foot in position, the subsequent trip, fall, and face-plant will occur without hesitation. In other words, the initial step is the only one that’s “regulated”; as a student studying this process, it’s really only important that I learn that initial step. I should generally understand the subsequent steps that lead to the resulting face-plant, but the details of those steps aren’t important.

Congratulations, you’ve just learned glycolysis. (OK, not really, but a lot of biochemical pathways are regulated at the front end in a comparable fashion.)

Podcast: adjusting to med school.

In an analogous biochemical pathway, if there’s a step that’s clinically relevant (e.g., if you have a genetic anomaly that screws up Step 7, you get this common disease), or if there’s another step that’s regulated, you should know those well, too. Beyond that, you probably only need to understand the function of the pathway as a whole, which will save you a ton of time and a whole lot of furious temple-rubbing as you try to cram a jumble of other reactions into your head.

2. Don’t expect to understand what’s happening in a lecture hall. Every student in every discipline has been there: You walk into the lecture hall feeling confident and excited, you walk out feeling dumber than when you walked in. This will probably happen to you in biochemistry.

Podcast: taking in a biochemical pathway as it's presented in a lecture hall.

Walking into lecture and trying to absorb a complicated pathway from a professor in a 50-minute session is no easier than passively listening to Einstein explain relativity. And, even worse, if your head is in the clouds as Professor Johnson explains Step 2 of a 12-step pathway, you might as well forget about understanding Steps 3 through 12.

The point is this: however you decide to study biochemistry, listening to a lecturer probably won’t be front and center. Your study method for biochemistry gets back to the theme of finding what study method works for you. For me, part of my method was not going to most biochemistry lectures; by watching it on the video recording, I could easily pause, take notes, and rewind if something was unclear. That doesn’t mean that’s how you should approach it, but showing up to lecture hall with a blank piece of paper will probably frustrate more than inform.

Podcast: lecture attendance.

3. Understand enzyme nomenclature. If you fell asleep before reaching the end of that sentence, then you really should consider sitting out the biochem lectures.

If there’s anything nice that can be said about enzymes, it’s that there are a finite number of names, and these names tend to repeat themselves because they are usually coupled with what they do. So, it’s vital that you couple the names of enzymes to their function right off the bat. For instance, you must know that a kinase adds a phosphate group, while a phosphatase removes it. And you should know that these enzymes are different from a phosphorylase, which usually displaces something with a phosphate group (as opposed to merely adding or subtracting).

Podcast: test-taking strategy.

Knowing the names of these enzymes and what they do will make your life much less stressful when it comes to memorizing pathways. If you know the enzyme involved and what it does, it's much easier to deduce the reaction it’s catalyzing.

Plus, there’s nothing more fun than knowing the mechanism of Galactose 1-Phosphate Uridylyltransferase Deficiency in all its glory!

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