Chapter 113

The textbook I chose was the KMK, a book which had listed all the syllabus of the NBEO and for which was named after the founders Kyle, Melissa and Kevin. Previously, I had already gotten a textbook from them, the KMK NBEO part 2, for which I used to study for the Canadian written board exam. Seeing as how that went, you may wonder why I chose to go back to KMK for their NBEO part 1 review. The answer to that is pretty simple. I didn’t really use the KMK NBEO part 2 material to its full potential. 

The part 2 textbook I had was bought off of a classmate of mine. Not only was it a secondhand book, it was just the book. With the proper KMK purchase, you get more than that. With the NBEO part 1, since I decided to buy it online and new, it came with the physical book, an app, online modules and online lectures. Furthermore, there were mock tests included, a critical tool for cramming. The added fact that I got access to the online components on day 1 was a nice bonus too.

The cost of the course for KMK was almost a thousand dollars CAD for everything (in 2020 money) but honestly, I probably would’ve paid way more (emotionally speaking). This is because with the KMK notes, optometry started to make sense to me. In the last chapter I mentioned two big hurdles ahead, one was the endurance test of cramming for 27 days straight and the other was how concepts would likely get harder as I got further along the textbooks. Well…with the KMK, the second hurdle never really manifested much. This is due to the way that KMK presented all the topics.

In optometry school, I felt like I was just memorizing everything. Our curriculum during school was always presented in a way that was chopped up. Usually, by the time exams came around, I found myself memorizing hundreds of different conditions individually, burning out my brain. This method of teaching was not just difficult, it was inefficient. I always felt like there must be a better way to learn about these topics and with the KMK, I found it. It was simple. The KMK taught all the topics like a story. 

Before I go on further to kind of compare the amazingness of the KMK to the very subpar education Waterloo provided for me just know a few things. First, Waterloo’s curriculum has changed after I graduated and from what I gather, it is better now. That is to say, I am comparing a relic to the KMK. Second, you know that I didn’t have the best time at Waterloo so just know that I am biased in this comparison. With that said, let’s just get a little technical shall we? 

To be a good doctor, I would argue that you must understand the mechanism of action at the base of each disease. This is likely even more important than the disease itself because it is with the mechanism of action that we decide how we can intervene and fix things. In most optometry schools (US or CAN), the curriculum splits up all of these aspects into different classes. In general, the schools teach anatomy first, sometimes alongside physiology, then you would learn the disease in another class. Somewhere down the line, you would get some information on the pharmacology of drugs. But this kind of compartmentalizes things like they’re all separate pieces of information. In reality? It’s all connected. 

While I do understand why school taught it this way, seeing as how it is more organized for each topic, it isn’t very good for retention nor understanding. The KMK didn’t teach the facts this way. They did it in a logical and clinical way. Instead of learning anatomy from one class then disease from another, the KMK taught me the anatomy, physiology, diseases and pharmacology all together. All the information I crammed? It was now an overarching story that started at the simple level and built on top of itself. 

The beauty of this? A lot of tissues of a similar area act in a similar way just like a lot of the medications in the market today act in a similar way. If you learn the story fully once, you can easily just fine tune it a bit to make the story work for another tissue or medication. This means, instead of cramming for hundreds of conditions, you just really need to cram once and then fine tune the information a bit. Oh and icing on the cake? Even if you forget a particular middle part of the story, you can reason it out using the preceding event and the after event.

The two biggest examples that exemplify this which also sort of blew my mind when I went through the KMK NBEO part 1 was learning one; about retinal detachments (rhegmatogenous and non-rhegmatogenous) and two; learning about pharmacology broken down into parasympathetic and sympathetic. 

*warning: technical optometry jargon (mildly simplified) incoming*

For the retinal detachment module, KMK first teaches you about the anatomy and physiology of the choroid. Then it lays out how CNVM (Choroidal Neovascular Membranes), a condition at the choroid, forms. After that, you are given a mnemonic of CHBALA, which tells you about 6 different diseases that each disrupt the function at the back of the eyes and form CNVM. Anatomy, physiology and disease. Information from one level of understanding moving to a second level then a third. Everything is set up in a logical way like a story. 

The very next chapter, the KMK talked about preretinal neovascularization. Another finding near the choroid. It’s not a coincidence that these two chapters were back to back because with the location so similar to the CNVM, you don’t really need to review everything. Then, same thing as before, review of the anatomy (just briefly), followed by physiology and then finally, diseases that can affect it. This time there are 5 conditions that all influence the same location in the mnemonic DRVOS. 

For both of these modules, I had a great time. I liked how clear and how simple the conditions were when built on top of anatomy and physiology. By bringing in all disciplines of knowledge, the understanding of the whole is much easier. Like I said, it read like a story. BUT THEN! Just when I thought that I had finished with the modules, the next chapter told me that both preretinal neovascularization and CNVMs led into retinal detachments and combined both stories into an even larger story. It blew my mind. There was another level of understanding above all of the previous levels and learning it this way solidified all the information together as a large cohesive narrative. Learning it this way, I knew everything from the smallest cog of the machine up to the biggest picture. 

A part of me became sad after the retinal detachment modules. I never had revelations when I was in school and crammed through most of it. It’s hard to say if my school intended for me to really learn the entire mechanism like this and maybe I just missed the point but just from the way our courses were structured alone, I never thought about it like a story. 

However it came to be, I was happy with the way I was learning. I never once had a concept I didn’t understand. In fact, some confusing topics from optometry school that I had learned before were now being cleared up. The ease at which all the fragmented information was being decluttered in my head felt like the wrinkles in my brain were being washed out. With this in mind, I flew through the material. The eye itself felt less like a topic to learn and more like a miracle in the evolutionary chain. I appreciated it more. The mechanisms of action felt beautiful. At some point during the first week, I found myself ahead of a very strenuous study schedule.

Even the worst topics in optometry that required nothing but rote memorization, like pharmacology, felt fine to me. Speaking of which, let’s talk about pharmacology because as I mentioned, it was the second mind blowing thing that stood out to me when doing the KMK. 

In Waterloo, learning pharmacology was as straightforward as you’d imagine. There were a whole bunch of drugs that you had to memorize and that was it. Here’s the notes. Get to pumping it all into your head. With the KMK, sure, it was similar but they went just one step further with it. It was simple and yet, it made a world of difference. The KMK organized the drug list into just 4 simple categories. Sympathetic; agonist and antagonist, and parasympathetic; agonist and antagonist. The KMK decided to classify the medications under whether they were helpful or against the fight or flight or rest and digest processes. This was genius.

From the physiology chapters, how the sympathetic and parasympathetic systems and how they influence the eye at particular areas were clear. Now, you just put some medication names to certain locations and add in a bit of information for which system they affected and how and suddenly, the medications are pretty easy to memorize. It was hard to remember a specific medication and all the effects it can do. It was easy to just say a medication affected a place by helping the sympathetic system at that location. 

Not memorizing specific mechanisms of action of a medication but using previous knowledge of how activating the sympathetic system at a location works is just better. Furthermore, it allowed you to make connections on how these medications could cause side effects and other systems nearby. Or in other words, knowing the physiology first and then how a medication can affect the physiology is much easier than just memorizing individual facts. Just like that, all my pharmacology knowledge suddenly felt accessible and easily understood and in one swift chapter, my biggest fear in all of optometry became tamed.

If you asked me in those first few days of cramming for NBEO how I felt about the KMK, I would have given it the highest of compliments I could give. That’s to say, KMK was able to recreate how I felt as a music major in undergrad. I liked clicking on the next lecture and the next one after that. As I rebuilt my fundamental optometry understanding, I started to really enjoy the topics we talked about.

Sometime around the end of the first week of cramming, I found myself having a blast. I was waking up and looking forward to cramming material into my head. This was not an expectation I had going into this but boy am I glad the first days into cramming was this fruitful. It was like cramming for the KMK was righting a wrong. Optometry information was flowing through me and through every discipline of the eye. I liked studying. 

Unfortunately… Nothing lasts forever.

A friend of mine who was into marathons told me a quote one time. He said that “the first mile is a lie”. This is to say that the first mile of the marathon is rarely a good indication for how the rest of the marathon is going to turn out. I think this applies here. While I was having a blast, in a few weeks, I would soon find myself at the end of my rope. It’s pretty simple to guess as to what the reason was too. 

The reasoning was something along the lines of: “what if the fun never ends?”