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-Kim Moscatello

The most asked question with the most varied answers! While there are numerous variables to consider in this question, ranging from personal preferences to the instructor's teaching style (a good professor can make all the difference in a boring class, as seen in Biochemistry-LOL), there are definitely some frontrunners. The first course that always comes to mind is Gross Anatomy. There are many reasons for this. This subject is typically one of the first courses in the medical curriculum that many matriculating students have not encountered in their undergraduate years. On top of that are the actual cadavers (in most schools) that students must learn to dissect respectfully and get over the ick factor of cutting through human tissue. And while a novice instructor might tell you that "it's all memorization", there is way more to it than that. Learning the anatomical pieces and parts is the first step, but determining which lymph nodes a cancer in an organ will metastasize to requires more than just memorization—or figuring out which nerves might be impinged with various injuries. These concepts require higher-level thinking, which, let's be real, is what is expected of you as a future physician of living humans. Studying Anatomy requires a multifaceted approach that involves repetition using tools such as flashcards, as well as drawing, coloring, and other means to help conceptualize some topics that aren't prone to simple memorization, the brachial plexus being a good example. Then there is the entire lab experience, which requires time spent in the lab examining your cadaver. On top of all of that, Anatomy usually carries a large credit load, which can effectively make or break your GPA. And while more schools have adopted a Pass-Fail curriculum, this remains a stressor. So yes, all of that is hard. However, let's now discuss the most challenging class in medical school: Immunology. 

Immunology is a highly conceptual and rapidly evolving discipline, which can be challenging for many students to grasp. Additionally,  Immunology is generally taught in a whirlwind of 15-22 contact hours, which means it has fewer credits than many other courses. However, Immunology is arguably one of the most important subjects in the curriculum, despite its limited space and credits. OK, yes, I am an Immunologist, so you might call me biased, but hear me out. Immunology is emerging as one of the best (and expensive) treatments for many diseases that are difficult to treat. Cue the malignancies and autoimmune diseases. To effectively treat these debilitating diseases with immunotherapy, it would be beneficial to understand how these immunotherapies work, allowing for a clearer understanding of potential side effects and contraindications.

Additionally, immune disorders affect every body system and will keep coming back to haunt you if you don't nail down the basics. So, how do we tackle a conceptually complex subject in such a short period of time? I am so glad you asked. The subject of Immunology tells a story like a good old spy novel, a superhero tale, or an old-fashioned western, with both good guys and bad guys. The immune system generally falls into the 'good guys' category, fighting to keep their "person" alive while combating pathogens. Like any good story, the immune system has several characters and weapons in its arsenal to fight off nasty pathogens, including large worms (WHAT?!). Let's take a look at a few, shall we? 

Phagocytes, like neutrophils and macrophages, are part of the innate immune system and are your first line of defense against pathogens. They get angry quickly and kill quickly, much like the Incredible Hulk. They employ a range of weapons, from cytokines to reactive oxygen species, to eliminate the bad guys. This is great; however, some bad guys are truly malicious and manage to evade this initial line of defense. Come on, it wouldn't be a good story otherwise. The next level of the immune system, which is waiting in the wings, is called the adaptive immune system. They take a while to get started, but once they see the bad guy, they never forget a face. If a pathogen (a bad guy) returns for another round, the adaptive immune system is generally ready quickly and with a vengeance. So let's meet some of these heroes!

Helper T cells are the boss of all. Think of them like the Sheriff. They spend their time directing the other deputies to catch and kill the bad guys, but they don't do the killing directly. Likewise, helper T cells don't kill anything directly, but they release messengers, called cytokines, that instruct other cells on how to kill pathogens. Helper T cells have a whole department of cells (B cells, cytotoxic T cells, and macrophages) that they instruct on which bad guys to target. The B cells take care of extracellular pathogens like bacteria, the cytotoxic T cells handle virus-infected cells, and the macrophages try to kill pathogens that like to hide within our cells (think tuberculosis). Each of these cell types is directed by the helper T cell to perform a specific function in combating the various types of pathogens. 

See how easy that was? Creating a story and even mapping it out is the best way to tackle complex subjects in medical school, such as Immunology. In addition to learning these processes, be sure to incorporate self-assessment questions to ensure you are retaining the information and haven't missed any of the major concepts. Now your faculty is busy juggling many important jobs and is often too busy to write many practice questions. But don't worry, that is where the Middle Child Question Bank, MCQ, comes to save the day! We have got you covered with 1500 questions in Anatomy, Biochemistry, and Immunology, and more subjects are in the works!