Prior to medical school, learning various factoids about human health and physiology was down-right fun. Being force-fed those factoids ad nauseum for two years was not. I've heard it been said that medical education is a bit like attempting to take a sip from a fire hydrant. "Oh...you've got a thirst for knowledge, do you?" Within seconds, you are gasping for air, regretting that you said "yes." And though I have not once regretted my decision to enter medical school, I have frequently wished I was somehow more prepared prior to its start. The truth is, nothing could have possibly prepared me for the non-stop, rapid integration of information, but a few little tweaks in my study habits could have made the past two years a little easier.
Part way through second year, I began using Anki. Anki is a free (on your laptop, but $25 for the mobile app) flashcard program, that does more than most out there. Anki uses an algorithm for spaced repetition to help you memorize far more than you think you can. There is a great little website by Piotr Wozniak, PhD, that talks about spaced repetition in learning theory if you are interested in reading more about why a program like Anki makes sense for the overwhelmed med student. I started my first year of medical school with a different (and pricey) flashcard program that was honestly too much for me to work through. My learning became a ton more active and more efficient as I began creating my own cards (from lecture PowerPoints) or editing pre-existing decks to meet my needs. If there was just one resource to begin with, using Anki to help you plow through class lectures would have to be it. Fortunately and unfortunately, there isn't just one source! The fortunate part is that there are many great tools that can help you master the material. The unfortunate part is that med school is so fast-paced that you will probably waste precious time trying to figure out what works best for you.
As I got closer to taking Step 1, I opted to use the Doctors in Training program to guide my study time. Like most teaching tools, bootlegged copies are floating around on the Interwebs. DIT has put in considerable effort to revamp and improve their program. The 2015 version was engaging and (no...really...I'm not lying...) enjoyable. It was like having good company in the midst of my misery. I relied heavily on Pathoma and SketchyMedical to fill in the blanks and reinforce what I was reviewing in First Aid. (P.S. Subscribe to Sketchy when you are in microbiology; the payoff is huge.)
So what did the six weeks prior to Step 1 look like? In short, hell. Some days were spent speeding through 16 DIT lectures, and others were spent feeling like I could barely keep my focus long enough to get through four. I attempted to follow a more predictable, constant study schedule, but that just didn't seem to agree with my life. My friends and I would set aside times to meet up and review practice tests together. It was an invaluable part of my learning process, but that also meant each test entailed taking an 8-hour "break" from my scheduled lectures: 4 hours of questions and 4 hours to discuss our rationale on those questions. Oh yeah...and then there were those other little things like taking care to an allergic reaction that my son had, and getting my daughter settled-in at her summer internship out of town, and all those other little mommy moments that are delightfully unpredictable. But I got through it, and if you are determined enough to land your butt in medical school when others tell you that it's a selfish thing to do, and you're capable of cramming your brains into oblivion before each and every freaking exam, then you can certainly do it too!
A few weeks ago, I found out that I passed that awful thing. Having Step 1 of the United States Medical Licensing Examination behind me is a glorious feeling. Yes, I still have the two-part Step 2 exam to take before I graduate next year and Step 3 awaiting me during my first year of residency, but knowing that I've conquered the beastly Step 1 gives me the confidence to know I can see this thing through to the end. Which really means I'll soon be seeing a new beginning.
Wednesday, July 29, 2015
Monday, July 6, 2015
Day 1 of Ob/Gyn Rotation
Cozying up to my copy of Case Files last night was like catching-up with a friend I haven't seen in a while. In anticipation of my obstetrics and gynecology rotation, I pulled out the book for bedtime reading. I've been so nervous about this second phase of my education (from lectures to clinic) that I thought the reading would be a way to busy my mind until sleep took over. That wasn't what happened.
The Case Files series of books, as you might guess, starts each chapter with a new case, asks what the next step of evaluation or treatment is, elaborates on the answer, and then ends with a short quiz. I found myself reading the first page, formulating a response, and turning the page to discover the answer. You know when you fly into town and see a friend that first night? Your plane was late. You're tired. You've got a full-day on your itinerary in the morning, but you and that friend get to talking. The banter is so free and easy. "Oh, my goodness! I bet you totally..." "Yes, I remember that!" And time passes so quickly.
I knew that I'd be thrilled to attend births again, but I had no idea how giddy I would be to flip through our orientation material today. We got our individual schedules for the eight-week rotation this morning. A friend leaned over and asked me what I'm starting with. "Reproductive endocrinology," I squealed in a not-quite whisper. My excitement surprised me.
I've been worried about doing OB as a med student. During my career as a midwife, I have met some wonderfully helpful OBs. That said, I've met many more who would like nothing more than to abolish midwifery. And that mistrust of midwives is inculcated early on in medical education. I've had standardized, board-written questions about Erb-Duchenne palsy caused by a midwife. With well over 90% of babies in this country delivered by physicians, there are undoubtedly more cases of this condition caused by the hands of a physician than a midwife. I've even had case presentations of a baby with a genetic defect who was born at home. Why add that detail? How does knowing the baby was born at home help me differentiate the signs and symptoms of Trisomy 13 from Trisomy 18? The whole premise of tacking on to the case "born at home" is the unstated assumption that all genetic defects are detected prenatally. It perpetuates the myth that interpreting an ultrasound is just as clear-cut as an X-ray of an open femoral fracture. It also implies that midwives never order lab work or ultrasounds for their patients, and they don't believe in risk-assessment and referral. I understand why obstetricians are wary of a profession whose training model is so very different from their own, especially when exam questions reiterate that a midwife-attended birth is the source of most obstetric nightmares. And, yes, I literally shook my head as I read the midwife-attended birth questions on my licensing exam. Of the 308 questions I was asked, I'd estimate that a dozen of them had to do with embryology, pregnancy, reproductive anatomy, and the neonate. There were only three questions that specifically mentioned "birth," and of those, two were a doctor needing to clean up after a midwife.
I'm certainly not without my biases. I love that family doctors have less than half the cesarean rate of obstetricians. I'm not a fan of elective inductions, and I think newborn nurseries need to stop handing out formula samples. (It pains me a little that my hospital isn't designated Baby-Friendly.) I long to be one of the few family physicians in this country that still practice obstetrics, and I appreciate that desire will limit the places that I can work. I also love the breadth of work family doctors do! Because I had a longitudinal family medicine rotation throughout my entire second year of medical school, I was able to see a woman prenatally and then visit with her again at her baby's six-month well-child visit. My favorite days in the family medicine clinic were the ones with a diabetes check-up followed by a joint injection...followed by a 18-month well-child check-up...followed by a new OB physical...followed by a geriatric patient. (Ah! The variety of it all!)
The ob/gyn clerkship and residency directors at my school have been fantastic. They are bright, approachable, and eager to teach us. I have no doubt that I will learn a phenomenal amount over the next two months, just as I did during my family med rotation. My education and training as a midwife focused exclusively on low-risk OB. I was taught how to monitor the normal course of the reproductive year and ensure a quick transfer of care as needed. I'm ready to park my own biases at the door and learn from a new perspective. And there is just so much to learn! When a friend asked me if I was going to study tonight, I just smiled. "There are only two rotations that I truly want to Honor. Family medicine, because that's where I want to go, and this one because....well....just because."
The Case Files series of books, as you might guess, starts each chapter with a new case, asks what the next step of evaluation or treatment is, elaborates on the answer, and then ends with a short quiz. I found myself reading the first page, formulating a response, and turning the page to discover the answer. You know when you fly into town and see a friend that first night? Your plane was late. You're tired. You've got a full-day on your itinerary in the morning, but you and that friend get to talking. The banter is so free and easy. "Oh, my goodness! I bet you totally..." "Yes, I remember that!" And time passes so quickly.
I knew that I'd be thrilled to attend births again, but I had no idea how giddy I would be to flip through our orientation material today. We got our individual schedules for the eight-week rotation this morning. A friend leaned over and asked me what I'm starting with. "Reproductive endocrinology," I squealed in a not-quite whisper. My excitement surprised me.
I've been worried about doing OB as a med student. During my career as a midwife, I have met some wonderfully helpful OBs. That said, I've met many more who would like nothing more than to abolish midwifery. And that mistrust of midwives is inculcated early on in medical education. I've had standardized, board-written questions about Erb-Duchenne palsy caused by a midwife. With well over 90% of babies in this country delivered by physicians, there are undoubtedly more cases of this condition caused by the hands of a physician than a midwife. I've even had case presentations of a baby with a genetic defect who was born at home. Why add that detail? How does knowing the baby was born at home help me differentiate the signs and symptoms of Trisomy 13 from Trisomy 18? The whole premise of tacking on to the case "born at home" is the unstated assumption that all genetic defects are detected prenatally. It perpetuates the myth that interpreting an ultrasound is just as clear-cut as an X-ray of an open femoral fracture. It also implies that midwives never order lab work or ultrasounds for their patients, and they don't believe in risk-assessment and referral. I understand why obstetricians are wary of a profession whose training model is so very different from their own, especially when exam questions reiterate that a midwife-attended birth is the source of most obstetric nightmares. And, yes, I literally shook my head as I read the midwife-attended birth questions on my licensing exam. Of the 308 questions I was asked, I'd estimate that a dozen of them had to do with embryology, pregnancy, reproductive anatomy, and the neonate. There were only three questions that specifically mentioned "birth," and of those, two were a doctor needing to clean up after a midwife.
I'm certainly not without my biases. I love that family doctors have less than half the cesarean rate of obstetricians. I'm not a fan of elective inductions, and I think newborn nurseries need to stop handing out formula samples. (It pains me a little that my hospital isn't designated Baby-Friendly.) I long to be one of the few family physicians in this country that still practice obstetrics, and I appreciate that desire will limit the places that I can work. I also love the breadth of work family doctors do! Because I had a longitudinal family medicine rotation throughout my entire second year of medical school, I was able to see a woman prenatally and then visit with her again at her baby's six-month well-child visit. My favorite days in the family medicine clinic were the ones with a diabetes check-up followed by a joint injection...followed by a 18-month well-child check-up...followed by a new OB physical...followed by a geriatric patient. (Ah! The variety of it all!)
The ob/gyn clerkship and residency directors at my school have been fantastic. They are bright, approachable, and eager to teach us. I have no doubt that I will learn a phenomenal amount over the next two months, just as I did during my family med rotation. My education and training as a midwife focused exclusively on low-risk OB. I was taught how to monitor the normal course of the reproductive year and ensure a quick transfer of care as needed. I'm ready to park my own biases at the door and learn from a new perspective. And there is just so much to learn! When a friend asked me if I was going to study tonight, I just smiled. "There are only two rotations that I truly want to Honor. Family medicine, because that's where I want to go, and this one because....well....just because."
Sunday, July 5, 2015
Disappearance
If it seemed as though I disappeared from the face of the Earth for a while, that's because I did. I entered the deep, dark place known as "Step studying." Oh, sure, the name sounds innocuous enough, but for those of you who appreciate Star Wars references, it was much like heading into the Dagobah System. I spent six concerted weeks honing my medical knowledge surrounded by a gloomy cloud of dread. Pass or fail. Not happy with your passing score? Too bad; no retakes.
Most of my time was spent in my tiny back office, ever-so-slowly pedaling away on my recumbent bike while annotating First Aid with the hints, reminders, and clarifications I gleaned from review lectures. Never in my life have I studied so concertedly and consistently. My kids were shocked. "No, guys, for real. This is the big one I've been talking about. Give me some time." They dealt with my sequestration well, knowing that the longest stretch of attention I could muster usually lasted less than two hours and then I would listen to their stories or resolve a conflict or watch a YouTube video with them. My 10-year-old wisely told me one morning, "Mom, you should study hard today, but not so hard that you get tired and grumpy. But you need to study enough so that you don't get all nervous and mean." I smiled and thanked him for the advice. He just shrugged his shoulders and added, "I don't really know what I'm talking about. I've never really studied before. Hope it helps." My wild and crazy life with my children is what has kept me sane these past two years.
Studying for the first "step" of three licensing exams was a bittersweet experience. I'd have an incredible ah-ha moment as to why the drug used to treat cystic fibrosis was also an antidote for Tylenol overdose (those magically pesky disulfide bonds!) followed by a sinking, panicky feeling that I would never remember exactly which cytokine spoke to which cell. Much of the time was spent refreshing my memory of minutiae that had long ago evaporated, but a fair amount of the time was also spent integrating concepts of disease processes and treatment regimens. If I said it was enjoyable, I'd be lying. But it was immensely beneficial and will undoubtedly make me a better physician.
I took comfort in knowing that I was never alone in my study-exile. An occasional group text saying, "Ugh...Can't brain...anymore" from a friend would result in one of us finding enough personal motivation to send a cliche meme to each other. Thank you, Shia LaBeouf, for making the most inspiring speech at just the right time for us to laugh our way out of our drug-mechanism-of-action-and-toxicity-induced stupors. I think at some point, all of these "Just do its!" found their way to my phone. As each of our test-days approached, the unicorns and rainbows and other "I believe in you" messages would appear. We'd remind each other that we've spent two years studying this stuff, and solving 308 cases in about a minute a piece was well-within the scope of possible. (Solving them correctly is still up for debate as our scores have not yet been released.)
Most of my time was spent in my tiny back office, ever-so-slowly pedaling away on my recumbent bike while annotating First Aid with the hints, reminders, and clarifications I gleaned from review lectures. Never in my life have I studied so concertedly and consistently. My kids were shocked. "No, guys, for real. This is the big one I've been talking about. Give me some time." They dealt with my sequestration well, knowing that the longest stretch of attention I could muster usually lasted less than two hours and then I would listen to their stories or resolve a conflict or watch a YouTube video with them. My 10-year-old wisely told me one morning, "Mom, you should study hard today, but not so hard that you get tired and grumpy. But you need to study enough so that you don't get all nervous and mean." I smiled and thanked him for the advice. He just shrugged his shoulders and added, "I don't really know what I'm talking about. I've never really studied before. Hope it helps." My wild and crazy life with my children is what has kept me sane these past two years.
Studying for the first "step" of three licensing exams was a bittersweet experience. I'd have an incredible ah-ha moment as to why the drug used to treat cystic fibrosis was also an antidote for Tylenol overdose (those magically pesky disulfide bonds!) followed by a sinking, panicky feeling that I would never remember exactly which cytokine spoke to which cell. Much of the time was spent refreshing my memory of minutiae that had long ago evaporated, but a fair amount of the time was also spent integrating concepts of disease processes and treatment regimens. If I said it was enjoyable, I'd be lying. But it was immensely beneficial and will undoubtedly make me a better physician.
I took comfort in knowing that I was never alone in my study-exile. An occasional group text saying, "Ugh...Can't brain...anymore" from a friend would result in one of us finding enough personal motivation to send a cliche meme to each other. Thank you, Shia LaBeouf, for making the most inspiring speech at just the right time for us to laugh our way out of our drug-mechanism-of-action-and-toxicity-induced stupors. I think at some point, all of these "Just do its!" found their way to my phone. As each of our test-days approached, the unicorns and rainbows and other "I believe in you" messages would appear. We'd remind each other that we've spent two years studying this stuff, and solving 308 cases in about a minute a piece was well-within the scope of possible. (Solving them correctly is still up for debate as our scores have not yet been released.)
Third year orientation has already happened, and I'm eager to report to my first day of my OB/gyn clerkship tomorrow morning. A couple of nights ago my 17-year-old daughter plopped down on my bed, grabbed one of my books, and began reading PreTest questions to me. I helped her pronounce words like "cephalohematoma" and then we'd break down its etymology. After about a dozen questions, we began talking about which colleges she will apply to this fall. It's so nice to know that Step happens, then life goes on. Right now, I'm simply loving mine.
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