Studying for Step 1: Yoga as Meditation & Study Tool

Janel Feliz Martir
uvmmedicine blogger Janel Feliz Martir ’16

When most medical students are still in lecture halls and library nooks completing their second-year classes, UVM College of Medicine students are already steeped in the exciting fray of clinical rotations. It’s a fact: UVM students have more clinical training under their belt by the time they graduate compared to most medical students in the nation! The unique medical curriculum, lovingly called “The VIC,” encourages students to sit for their USMLE Step 1 Boards examination in February rather than June, allowing more time to devote to clinical pursuits. This focus on clinical training is what inspired me to choose the UVM College of Medicine. While my peers and friends in other medical schools complained of the compartmentalized nature of their coursework – of how they dreaded taking a pharmacology midterm the day before their clinical microbiology final – I sat in ease, grateful that UVM COM students take only one class at a time. By emphasizing “integration,” the knowledge I gained during my first two years of medical school felt undeniably cohesive.

The union of basic medical science (biochemistry, anatomy, microbiology) and clinical science comprise the heart of the Step 1 examination, so I was thankful that UVM had drilled this approach into us. As I studied for my boards, I devised ways to assimilate my study into my daily life. After all, this is the ultimate act of integration – allowing the material to find use in my daily experience. The most unique and engaging expression of this integration of medical knowledge into my life manifested in the form of my daily yoga practice. During my boards study, I enrolled in a Jivamukti yoga class in New York City. Initially, I came into Jivamukti with the intent of assuaging the anxieties and stress of board prep. I soon realized that my yoga practice could also serve as a vehicle for my boards review. Below is an excerpt from my yoga journal after a particularly “integrated” practice, documenting the thoughts that danced through my mind during class.

Sitting on the yoga mat, I close my eyes and take a deep breath. The smell of lavender and eucalyptus lingers in the air. I imagine tiny fragrant particles diffusing through the candlelit studio, latching onto olfactory receptors in my nose. “Let the air fill your chest” the instructor says. I crinkle my eyebrows. “She means lungs,” I think to myself. I can trace the physiological changes happening in my body: my diaphragm dips, creating space for air to fill. My lungs inflate like a balloon, and the delicious distention is sensed by stretch receptors embedded in smooth muscle cells that line my airways. The receptors fire away and send information to parts of my central nervous system, causing a reflex decrease in breathing frequency. I already feel my breath soften; each expiration feels longer. I had just unknowingly reviewed the Hering-Breuer reflex, and I smile.

When we are finally instructed to open our eyes, the light shoots photons straight my retina, and it burns. I blink, squint and focus my sight on the big bronze Ganesha statue in front of the studio. I take that as my cue to review the anatomy of vision. My mind begins: Pigment epithelial cells, receptor cells, bipolar cells, but before I can continue, I feel the instructor’s warm hand on my shoulder as she urges me to into virabhadrasana I, or warrior one. “Oh right…I’m doing yoga now…,” I think, and I ease my body into proper position.

“Clear your mind,” the instructor says in a voice as soft as a hummingbird. Her words reach me through invisible air vibrations, climb into my middle ear, and beat the small bones inside. In my mind, I review the auditory pathway, mentally drawing a picture of the fluid-filled inner ear where the bony labyrinth lives. I try to envision the Organ of Corti, a hairy structure that transduces air waves into information my brain can interpret as sound. Before I can continue reviewing, I feel the instructor’s gentle weight on the wooden floor as she walks around the studio, eyeing us for proper alignment. I wonder if she could see the thought bubble sprouting above my head like a stringless balloon. My mind is overflowing with blocks and pieces of medical knowledge – knowledge I hope will take root in my brain and grow fruits of success on my upcoming Boards examination. After all, it is Ganesha – The Remover of Obstacles, The Lord of Success – in the front of the room who so divinely presides over me as I practice today.

Yoga had always been a way for me to relax, to soothe my overactive mind, but today was different. In less days than I can count on my fingers, I would be taking my medical boards examination, the first part of three exams that would allow me to become a U.S.-licensed physician. The day of my exam approaches like an unstoppable natural birth, and soon the labor will begin. I calm my mind enough to enjoy natarajasana, or Lord of the Dance pose. I like who I am when I do yoga. I am calmer. I am still; I am fluid; I am becoming something beautiful. At this moment, my mind thinks, “Don’t pollute my happiness. This oceanic experience is wonderful.”

As we flow into a vinyasa, I can feel my weight on my carpal bones. I sing to myself: scaphoid, lunate, triquetrum, psisiform, trapezoid, trapezium, capitate hamate. If you say it quickly enough, it rhymes. I lower myself into a half plank. I imagine a lightning bolt running through my radial nerve as I flex my triceps into urdhva mukha svanasana, or upward dog pose.

Sometimes, my yoga practice becomes a lesson in anatomy and musculoskeletal physiology. During class, I close my eyes and actually envision muscle fibers. I suddenly feel deep gratitude for my muscles. I revel in each extrafusal muscule contraction, imagining strong robust alpha neurons. As I stretch and lengthen, I imagine the spindles of my infrafusal muscle stretch as well, and as they do so, they stimulate Ia afferents in the dorsal horn of my spinal cord.

Soon we prepare for shoulder stand: With the help of the ulnar nerve, I make two fists. The median nerve allows me to flex my wrist toward my chin. As I do this, I see the faint bulge of my palmaris longus tendon beneath my skin. “Wouldn’t it be cool if I could also see my flexor carpi radialis?” I think to myself. Near the end of class, the instructor nudges us into a seated position with our legs outstreated in front of us. “Point your toes to the sky,” she says softly. What she really means is dorsiflex the foot at the ankle. My deep peroneal nerve (a.k.a. deep fibular nerve) responds to her command and my toes shoot toward the ceiling, expanding like an oriental fan in extension. “Point your toes like a ballerina,” is the instructor’s next command. While still seated, my tibial nerve is activated as my gastrocnemius, soleus and plantaris contract my toes into a beautiful ballerina point. I reach for my toes on this position but I only make it as far my ankles. Here, my fingers find their way to my dorsal pedis pulse, which is throbbing in a steady healthy flow. This pulse, the most distal manifestation of the anterior tibial artery, is an indication of peripheral cardiovascular health.

My mind is alive and alert. Suddenly, I think of beta-waves on an EEG. During deep mediation, our brain waves actually exhibit a unique waveform called alpha-waves. Okay, at this point, I fully realize that my months of boards studying have invaded every recess of my life and mind. And I smile myself into savasana, or corpse pose.

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