In three short months I will be starting my residency. I will be Dr. Vieve, the lowly intern,with a batch of third- and fourth-year medical students to supervise every day. My job will include serving as their instructor while keeping up with the notorious, over-sized workload given to physicians in their first year of practice. I'll be evaluating my students' performance and making comments that shape the Dean's Letter they will use when applying to residency. Most importantly, I will have the opportunity to model what professional behavior can look like. They will inevitably hear me misspeak or say something that is incorrect. They will watch me be corrected by my seniors and attendings. And there will most definitely be times when I will need to correct them. Medical training is known for hazing--for instruction edged with humiliation. I hope to rise above it.
Dr. Pamela Wible is a family physician who has found herself in the unintended role of physician advocate. She speaks directly of the culture of humiliation in her recent TEDMED talk Why Doctors Kill Themselves. It is sobering to listen to, reminding me of the need to watch-out for my coworkers and students while also safe-guarding my own mental health. There is a stigma associated with depression, and it seems to be even worse for those whose are entrusted to care for other people's health. Unfortunately, there are systems in place that perpetuate that stigma and stand in the way of physicians seeking treatment for themselves.
My unpleasant experiences with difficult physicians has been limited. Part of that has to do with the good-hearted people I work with, and part of it has to do with having a well-formed identity prior to starting medical school. No doubt about it, med school is a beat down! I count it a blessing that I have endured enough challenging experiences in my life that have taught me resiliency. Not all of my peers have yet mastered this. For many of them, it is the first time that they have been publicly challenged. Situations that have left me mildly embarrassed, have made others feel utterly humiliated.
Life is challenging enough without getting a little endemic humiliation handed to you.
My divorce was an "easy" one, but it still made me feel hurt beyond belief. I knew that I wanted it, but that didn't stop me from grieving the loss of the if-not-happily-at-least-not-sadly ever after I dreamed of. I knew that something would have to give, and I so desperately didn't want that something to be my sanity. I saw a psychiatrist and was treated with antidepressants for a few lonely months (and appropriately for a few more months after those lonely feelings disappeared). I'm so grateful to be on the other side of it and recognize that I weathered that storm more easily than others.
As I began the process of applying for a provisional medical license, I was shocked to discover that seeking treatment for my episode of depression could have required me to sign over my right to privacy. I was confused then I read the line on the application that asked "In the past 5 years have you been treated for schizophrenia, alcohol or other substance abuse, bipolar disorder, pedophilia, or major depression?" Which bureaucrat determined that these disorders were similar enough to be lumped together in one question?
I asked my residency coordinator what would happen if someone said yes. She just shrugged her shoulders. "Yeah, you probably should just send the state office your entire medical file." And then she added, "I don't really know. No one's ever been treated for mental health stuff." If that's true, then countless physicians are struggling with untreated depression in an effort to save face and preserve their privacy. Perhaps unknowingly, that question sends the message that getting help for depression is similar to seeking treatment for pedophilia. And placing your privacy before the review of Ms. Baker at the State Office Building is an insufferable humiliation.
What would the repercussions have been if my depression was more serious than adjustment disorder? After all, when I was in the midst of depression, it simply hurt, and I didn't find myself thinking, Gee, I'm so lucky that I have a 'legit' external cause to blame all this on and I bet the pain will end super-duper soon so as to qualify as acute. No. I was simply depressed. But the question didn't even ask if I was depressed or if I used alcohol or if I had schizophrenia. The question asked if I sought treatment.
It frightens me to think of how my decision might have been different if I had known that two years ago. Would I have had the courage to take care of myself? Would I have told myself that seeking help was "weak" and I needed to suck it up? I knew Medicine's reputation for putting trainees through public embarrassment. I never imagined that a physician's personal medical records could be put on the line.
Tuesday, March 29, 2016
Monday, November 2, 2015
Ten-Hut! (Or "The Order of It All and Why I'm Probably Going to Continue to Get into Trouble")
There are some folks who should never enter the military. Often, those are the same folks that need the discipline and structure the military provides. I am one of those people. Compared to most flowcharts, chain-of-command hierarchies never impressed me. Too linear! (Yawn.) But the well-oiled machine known as the American Health Care System relies on such hierarchies to ensure care is given in an orderly and predictable manner. I understand that. I even appreciate that. The structure and hierarchy that I've stepped into is both instructional and protective. For this, I am grateful.
Like all good hierarchies, each wrung in the ladder knows her place. I am keenly aware of mine. I am there to be stepped on when convenient. Fortunately, that's not a daily occurrence.
For those of you unfamiliar with the hospital hierarchy, let me elaborate. The attending physician sits at the pinnacle. When things go wrong, this person is the one who bears the brunt of all "official" action. Sure, attendings are know for being demanding, but it's her license on the line when an underling screws up, so that edginess is somewhat understandable. Next in line is the senior resident, the person who paid the dues of being an over-worked lackey just one or two short years ago. The intern resident is lackey to both his senior resident and his attending. He's the one who has to carry the most pagers and document the majority of clinical interactions--a task which has proven to be far more time-consuming than I ever imagined. (Yes, they make us practice writing "notes" ad nauseum.) The intern is fresh out of medical school, newly anointed with the title of "doctor," and terrified of messing up. And then there's the medical students. We've passed Step 1, which means we've ingested volumes of medical knowledge. Of course, most of that knowledge seems to have disappeared once we regurgitated it during our licensing exam. And to remind us of how little knowledge we've seemed to digest in the learning process, residents love to ask us questions preceded by the statement "Step was more recent for you, so you should still know all these details."
Luckily for me, I'm blessed to have a few good interns who've got my back. The Family Medicine class ahead of mine has been there for our little group, offering support and encouragement throughout med school. I'm grateful to know that these are the people I will be lackey to next year!
After wrapping up my week in the medical intensive care unit (MICU), one of the Family Med interns checked in on me. (Pardon the typos.)
Like all good hierarchies, each wrung in the ladder knows her place. I am keenly aware of mine. I am there to be stepped on when convenient. Fortunately, that's not a daily occurrence.
For those of you unfamiliar with the hospital hierarchy, let me elaborate. The attending physician sits at the pinnacle. When things go wrong, this person is the one who bears the brunt of all "official" action. Sure, attendings are know for being demanding, but it's her license on the line when an underling screws up, so that edginess is somewhat understandable. Next in line is the senior resident, the person who paid the dues of being an over-worked lackey just one or two short years ago. The intern resident is lackey to both his senior resident and his attending. He's the one who has to carry the most pagers and document the majority of clinical interactions--a task which has proven to be far more time-consuming than I ever imagined. (Yes, they make us practice writing "notes" ad nauseum.) The intern is fresh out of medical school, newly anointed with the title of "doctor," and terrified of messing up. And then there's the medical students. We've passed Step 1, which means we've ingested volumes of medical knowledge. Of course, most of that knowledge seems to have disappeared once we regurgitated it during our licensing exam. And to remind us of how little knowledge we've seemed to digest in the learning process, residents love to ask us questions preceded by the statement "Step was more recent for you, so you should still know all these details."
Luckily for me, I'm blessed to have a few good interns who've got my back. The Family Medicine class ahead of mine has been there for our little group, offering support and encouragement throughout med school. I'm grateful to know that these are the people I will be lackey to next year!
After wrapping up my week in the medical intensive care unit (MICU), one of the Family Med interns checked in on me. (Pardon the typos.)
Earlier in the week, Dr. MICU had asked the senior resident if he remembered what Abraham Lincoln had said. (Hello? Abraham Lincoln said a bunch of stuff!) When the senior resident said, "No, sir," Dr. MICU shared a beautiful and inspiring quote which I seemed to have forgotten. As we walked out of the room, I leaned towards my senior resident and said, "I wouldn't have guessed that quote either. I thought he said, 'Gee, Mary! Do we have to go to the theater tonight? I've got a headache.'" Dr. MICU heard my not-adequately-whispered comment and shook his head. Yes, I have got to learn to shut up.
At the end of my Internal Medicine rotation, one of the attendings wrote on my evaluation that I needed "a thicker face to handle criticism." That same physician ranked my performance as "honors." I'm fairly certain that it was Dr. MICU.
Friday, August 7, 2015
Welcome to the Floor, a.k.a., Why Can't You Read My Mind, You Idiot!
The third year of medical school is when the rubber hits the road. The first two years of basic sciences are all about learning to recognize (1) what can go wrong and (2) how to fix it.* Third year is when you begin rounding on the hospital floors and commence the nonstop testing of that information. I knew that I would feel a bit on edge in anticipation of questioning from the resident physicians, but I hadn't planned on the constant confusion that comes from repeated failures at mental telepathy. Apparently, being a good clerk entails not only having solid clinical knowledge, but also a keen ability to read minds.
After a couple of weeks in, I felt like I was doing a fairly decent job of shrugging it off. Yes, it is challenging to work with a dozen different doctors in one week that have a different style of doing things, but it wasn't that hard to remind myself that these same folks had the challenge of working with two new students virtually every day.
Clinic Week
After a couple of weeks in, I felt like I was doing a fairly decent job of shrugging it off. Yes, it is challenging to work with a dozen different doctors in one week that have a different style of doing things, but it wasn't that hard to remind myself that these same folks had the challenge of working with two new students virtually every day.
Clinic Week
Day One: Resident A, "You did well by going in to see the patient. When the card is on the door, you know they are ready. Don't keep them waiting. Bring one of us the card when you are done."
Day Two: Resident B, "Why is the card not on the door?" Me, "I took it off when I went in to see the patient." Resident B, "Always leave it on the door."
Day Three: Resident C, "Why did you go in to see the patient without me? That's inappropriate."
Day Four: Resident D, "Yes, go ahead and start a clinic note while I'm seeing the next patient."
Day Five: Resident E, "Medical students are not supposed to write notes. You can for practice, but I won't read it. It's a waste of time."
I just accepted that fact that I would do something in the first 10 minutes of each shift that annoyed the physician I was assigned to. No big deal; adapt and move on.
During week four, I was fortunate enough to work with just one chief resident with two junior residents and four attending physicians. By late Tuesday, I was in a good rhythm. I had a sense of what I could do to be helpful to the chief and how to not irritate the attendings too much. I found myself looking forward to beginning my night rotation in labor and delivery. The other student and I would work with the same two residents the entire week. It seemed like life as a clerk would become monumentally more simple. But I was wrong.
L&D Week
Day One: Resident F, "I'm not going to tell you when I'm going into a room, so you should just follow me." I nodded, despite finding this statement a bit bewildering. There were over a dozen delivery rooms. Half of the patients during any given night were in the care of our team, the others were not. We also had triage rooms to manage. To improve patient comfort, the other student and I divided the caseload so that the patient wouldn't have to deal with unnecessary people involved in her care. Follow the resident everywhere, but not into the rooms of private patients, and not into the rooms of the patients the other student was working with. It seemed as though simply saying "triage two" or "room six" could make things run a little more smoothly, but this doctor was committed to not telling us where he was going.
Later: Resident F, "Where are you going?! Don't go see a patient in triage without pulling up and reviewing her chart."
Later: Resident F, "You don't need to follow me everywhere...I'm just getting coffee."
Later: Resident F, "I'm not going to warn you again. It's not my job to tell you who I'm going to see. You'll just need to follow me."
Day Two: Resident G, "Go into her room and check on her Pit." Me,"She is a private patient; is that ok?" Resident G, "Yes, of course."
Later: Resident F, "You're a midwife?" This question has plagued me since one of my friends casually mentioned it to the Department Chair during week two. Me, "Yes, sir." F, "Oh."
Later: Resident F, "No, no...stay out; this patient is private."
Even later: Resident F, "Why are you keeping the patient in triage waiting?" Me, "I was looking at her chart for her dating ultrasound." Resident, "You don't need to do that--hurry and see her."
Day Three: Resident F, "Go get the ultrasound." I head back to triage and push the power button on the machine. Ten seconds later, F appears, "What is taking you so long?" Me, "I'm sorry. I was told to let it power down before unplugging." F shakes his head, "This is urgent." He pulls the plug, hurries down the hall, plugs it in by the patient's bed, and then begins a conversation about increasing her pitocin or maybe going into the OR for a cesarean. A bit later, he scans her and walks out of the room.
Later: F, "Where did her ultrasound say her placenta was?" Me, "I didn't look at that before seeing her in triage, but I can look that up." He rolls his eyes at me.
Day Four: While walking out of triage room 3, F tells me, "Go plug the ultrasound in so we can scan her." Fifteen minutes later he asks, "Where is the ultrasound?" "I plugged it in for the patient in triage 3." F then rolls his eyes at me, unplugs the machine and moves it into triage 1 with the patient we had seen an hour ago. Again, highlighting his unyielding commitment to not telling students where.
Day Five: Resident G, "Sorry. Sometimes things just work out that way and you don't get a delivery." This came after I reminded her that I still needed to do a delivery and this was my last night there. And then fortune smiled upon me. The clerkship director happened to be the attending on call that night. As we were leaving a patient's room, I swallowed hard and spoke up. "Dr. Clerkship Director, I haven't been able to do a delivery yet and my shift ends in an hour. I understand that these things are beyond anyone's control, but I just wanted to make sure that was ok since a delivery is a requirement." She looked appalled. Resident G tried to explain to the director that I really shouldn't go into the next one since she was the patient I was following last night and not tonight (yes, it was a very long pitocin induction). The director scoffed, "Of course we want you to do a delivery." I stayed past dismissal time and waited for it. I stood there, with F on my right-hand side and the director on my left, each whispering different and sometimes conflicting instructions to me. But after the baby's head emerged, I naturally stepped to my right to facilitate the delivery of the shoulders and serendipitously caused F to take a single step backwards. I was in that moment...that wonderful moment when a baby takes her first breath. The world just seems to stand still and all is right. It was a beautiful ending to one of my ugliest weeks as a med student.
Day Two: Resident B, "Why is the card not on the door?" Me, "I took it off when I went in to see the patient." Resident B, "Always leave it on the door."
Day Three: Resident C, "Why did you go in to see the patient without me? That's inappropriate."
Day Four: Resident D, "Yes, go ahead and start a clinic note while I'm seeing the next patient."
Day Five: Resident E, "Medical students are not supposed to write notes. You can for practice, but I won't read it. It's a waste of time."
I just accepted that fact that I would do something in the first 10 minutes of each shift that annoyed the physician I was assigned to. No big deal; adapt and move on.
During week four, I was fortunate enough to work with just one chief resident with two junior residents and four attending physicians. By late Tuesday, I was in a good rhythm. I had a sense of what I could do to be helpful to the chief and how to not irritate the attendings too much. I found myself looking forward to beginning my night rotation in labor and delivery. The other student and I would work with the same two residents the entire week. It seemed like life as a clerk would become monumentally more simple. But I was wrong.
L&D Week
Day One: Resident F, "I'm not going to tell you when I'm going into a room, so you should just follow me." I nodded, despite finding this statement a bit bewildering. There were over a dozen delivery rooms. Half of the patients during any given night were in the care of our team, the others were not. We also had triage rooms to manage. To improve patient comfort, the other student and I divided the caseload so that the patient wouldn't have to deal with unnecessary people involved in her care. Follow the resident everywhere, but not into the rooms of private patients, and not into the rooms of the patients the other student was working with. It seemed as though simply saying "triage two" or "room six" could make things run a little more smoothly, but this doctor was committed to not telling us where he was going.
Later: Resident F, "Where are you going?! Don't go see a patient in triage without pulling up and reviewing her chart."
Later: Resident F, "You don't need to follow me everywhere...I'm just getting coffee."
Later: Resident F, "I'm not going to warn you again. It's not my job to tell you who I'm going to see. You'll just need to follow me."
Day Two: Resident G, "Go into her room and check on her Pit." Me,"She is a private patient; is that ok?" Resident G, "Yes, of course."
Later: Resident F, "You're a midwife?" This question has plagued me since one of my friends casually mentioned it to the Department Chair during week two. Me, "Yes, sir." F, "Oh."
Later: Resident F, "No, no...stay out; this patient is private."
Even later: Resident F, "Why are you keeping the patient in triage waiting?" Me, "I was looking at her chart for her dating ultrasound." Resident, "You don't need to do that--hurry and see her."
Day Three: Resident F, "Go get the ultrasound." I head back to triage and push the power button on the machine. Ten seconds later, F appears, "What is taking you so long?" Me, "I'm sorry. I was told to let it power down before unplugging." F shakes his head, "This is urgent." He pulls the plug, hurries down the hall, plugs it in by the patient's bed, and then begins a conversation about increasing her pitocin or maybe going into the OR for a cesarean. A bit later, he scans her and walks out of the room.
Later: F, "Where did her ultrasound say her placenta was?" Me, "I didn't look at that before seeing her in triage, but I can look that up." He rolls his eyes at me.
Day Four: While walking out of triage room 3, F tells me, "Go plug the ultrasound in so we can scan her." Fifteen minutes later he asks, "Where is the ultrasound?" "I plugged it in for the patient in triage 3." F then rolls his eyes at me, unplugs the machine and moves it into triage 1 with the patient we had seen an hour ago. Again, highlighting his unyielding commitment to not telling students where.
Day Five: Resident G, "Sorry. Sometimes things just work out that way and you don't get a delivery." This came after I reminded her that I still needed to do a delivery and this was my last night there. And then fortune smiled upon me. The clerkship director happened to be the attending on call that night. As we were leaving a patient's room, I swallowed hard and spoke up. "Dr. Clerkship Director, I haven't been able to do a delivery yet and my shift ends in an hour. I understand that these things are beyond anyone's control, but I just wanted to make sure that was ok since a delivery is a requirement." She looked appalled. Resident G tried to explain to the director that I really shouldn't go into the next one since she was the patient I was following last night and not tonight (yes, it was a very long pitocin induction). The director scoffed, "Of course we want you to do a delivery." I stayed past dismissal time and waited for it. I stood there, with F on my right-hand side and the director on my left, each whispering different and sometimes conflicting instructions to me. But after the baby's head emerged, I naturally stepped to my right to facilitate the delivery of the shoulders and serendipitously caused F to take a single step backwards. I was in that moment...that wonderful moment when a baby takes her first breath. The world just seems to stand still and all is right. It was a beautiful ending to one of my ugliest weeks as a med student.
*Any first-years out there? How I wish those two simple concepts were in front of my mind as a first-year! Keep reminding yourself that you need to know (1) what can go wrong and (2) how to fix it, and you will be ahead of the game in figuring out which information is your highest priority to learn.
POST-ROTATION UPDATE: Despite feeling like there were a healthy number of folks in the department hoping to see me fail, I honored this rotation. Elation!
POST-ROTATION UPDATE: Despite feeling like there were a healthy number of folks in the department hoping to see me fail, I honored this rotation. Elation!
Wednesday, July 29, 2015
The Results Are In: Step One
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.
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.
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.
Wednesday, April 22, 2015
Ending all the BS
Today was my last day of class. The first two-years of my medical education comprising the basic sciences (affectionately known as "BS") will end on Friday, when I take my last professor-written exam. From there on out, all my testing will be done through national board exams. Before starting medical school, there is no way I could have fathomed all that I would be capable of learning in 21 months. It's odd, really...simultaneously appreciating that I have learned so much while profoundly realizing that I know so little.
I've attempted a somewhat half-hearted review of all my previous classes while trying to wrap my head around this last bit of BS I need to learn. As the lecture schedule began to wind down over the last few weeks, I've ramped up the Step Prep just a bit. After all, my first licensing exam is less than 60 days away, and I am keenly aware of knowing so very, very little.
Here's how the next two weeks are shaping up:
I've attempted a somewhat half-hearted review of all my previous classes while trying to wrap my head around this last bit of BS I need to learn. As the lecture schedule began to wind down over the last few weeks, I've ramped up the Step Prep just a bit. After all, my first licensing exam is less than 60 days away, and I am keenly aware of knowing so very, very little.
Here's how the next two weeks are shaping up:
- Friday. Exam over block content
- Tuesday. "Customized" shelf exam (somewhat of an oxymoron...the Block Director selects the content area and the National Board of Medical Examiners supplies the questions)
- Thursday. State-wide physicians' conference. I serve on a committee and am expected to attend.
- Monday. Pathology NBME shelf exam
- Tuesday. Pharmacology NBME shelf exam
- Friday. CBSE-2. A repeat of that "are you really ready" assessment required by my school
- Entering into the study cave
Sunday, April 5, 2015
It seems as though I've disappeared
When did it become April? It was just moments ago that snow was falling outside my window, and I was enjoying a warm cup of cocoa while crafting my plan-of-attack for USMLE Step 1.
Some how I have managed to find myself in the middle of the last block of medical school "basic sciences." This last block covers endocrine and reproductive pathology, and our first exam is just 48 hours away. It seems as though more than half of my classmates have abandoned the drive to "honor" the block by shifting their study time away from the highly-detailed material presented in lectures in favor of focusing on Step 1 prep materials. Though I have long-ago abandoned my desire to honor a block (the equivalent of getting an A+), I am not comfortable with tossing aside lecture material. After all, each and every block must be passed in order to sit for Step 1. The practice exam I took last month let me know that I'm on a path to pass Step. Of course, I want more than the minimal passing score. I even have twinges of guilt that I am not spending more time on Step studying. But given all the other bonus, grown-up, single-mom of teens and 'tweens stuff I've got going on, I keep reminding myself that I'm doing what I can and it seems to be working.
As I emerged from my study-zone at lunch time, I told my daughter that Step is just two months away. She smiled at me and add, "And you aren't allowed to freak out. Remember?" Clearly, I am smarter than I realized; preparing my kids for the inevitable melt-down is beginning to show its benefits.
I feel like I should write about my detailed Step prep strategy, as though that will provide some structure or guidance to another person who finds herself in my shoes. The problem is, I haven't got one. I mean, I have a general plan. But "detailed"? "Structure"? Those aren't really words that describe me. I can make a plan (I have made a plan), but I don't have much confidence in my ability to stick with it. My biggest challenge is that I learn in a rather circuitous manner. Tangential strolls down "what the hell is that?" lane mean that getting through material (whether it is course lectures or prep materials like First Aid or Doctors in Training) always takes me longer than I expect.
Today's studying so far has gone something like this...
Last Night's Plan:
- Pathoma chapters 13, 15, and 16;
- Do 500 flashcards on Anki;
- Review lecture #16 through #28
Today's Reality:
- Anki review (I decided to set my timer for 30 minutes)
- Oh, no! Not the steroid synthesis pathway. Ugh. I don't think this is on Tuesday's exam, but DIT said it was a 5-star topic. To learn or not to learn? Might as well learn. 5-stars! How on earth can I remember 3-beta hydroxysteroid dehydrogenase?
- 4th web-search since starting Anki. This one is the longest. (Timer beeping!) Wikipedia image to the rescue. I see...it just pops off that little proton.
- Back to the Anki deck I made for class. (P.S. I love Anki and wish I started using it earlier.) Ah, yes, questions on 21-hydroxylase insufficiency. Wait a second...I attended lecture 6 live, but I don't think I made all of my questions.
- Open PowerPoint for lecture #6 and look for notes on which slides I skipped. Create questions for them in Anki. I have no idea how long this took, but my coffee is frigid.
- Lunch
- My son asks me to search for an email notification I was supposed to recieve. I check multiple accounts. It's not there (though he doesn't seem to believe me), but --oh yeah-- I should probably approve that last comment made on my blog. What? I haven't posted in nearly 3 months! Whatever happened to the time?
- Here I am. Clearly, I am spending too much time on my blog. Perhaps leaving out pronouns and sentence subjects will save me some time.
- Small talk with my 10-year-old. Flip through a few more emails and RSVP for an endless number of meetings.
- Really? I have to answer a survey about how much Step 1 preparation I am currently engaged in for the Office of Curriculum? I select "less than 10 hours per week" and "less than 250 UWorld quesions completed." Now I feel embarrassed that the ether-god that is collecting this data and shaking his head at my apparent lack of commitment. After all, this is my very first licensing exam. (And the ether-god is obviously a male, because, why? I don't know. He just is.)
- Ask my 15-year-old if we can chat about something tomorrow morning on the way to school instead of right now. Remind my 16-year-old for the 3rd time that her uniform is sitting in the dryer and will get more wrinkled the longer she leaves it there.
- Speaking of reminders, remind myself of the seemingly-forgotten "to do"-- Pathoma (three entire chapters!), 400 flashcards on Anki (woo-hoo! 100 done!), lectures 16-28.
- End my blog post abruptly since coming up with something tidy and clever just seems to require more mental energy than I can currently spare.
- Besides, my daughter just gave me four lovely miniature cupcakes topped with spring colors and I can't type and eat them at the same time.
Friday, January 16, 2015
Step Prep
I have finally managed to score two standard deviations above the class mean on a shelf exam! Of course, it would be on a test that was "formative" and did not contribute towards any block grade. The best thing about this little victory was realizing how much I don't care about doing better than my classmates. Doing well on the Behavioral Sciences NBME simply reflects my familiarity with the subject area prior to medical school. It included a smattering of human development (my bachelor's degree), public health (my master's degree), and ethics (let's just call that my mothering degree). I was delighted by my score because of the sense of relief I felt. I chose not to waste away my precious winter break studying for this exam, so I can confidently assert that experience trumps studying any day. The more I see and do, the better I learn.
That is precisely why I am so grateful for being enrolled in the accelerated family medicine program at my school. The clinical experiences I have had during the past semester have been invaluable in putting what I am learning in the classroom into context. Last week, my teammate (another second-year medical student working with the same preceptor) ran up to me with his eyes wide open. "Vieve, you've got to see this! Ms. Smith has a nystagmus!" Two months ago, I would have had no clue what he was talking about, but now that I've seen it, I'll never forget.
Of course, I'll never clinically see most things that are tested on board exams. It's the obscure and uncommon conditions that make for more challenging questions; and challenge is what these exams are all about. Now that January has arrived, I have joined the thousands of other second-year students around the country who are obsessing over just how challenging those questions will be. USMLE Step 1 is a mere season away. It is the first of four tests that I will take to become a licensed physician.
Unlike many second-years, I am a little ambivalent about Step 1. Don't get me wrong! Of course I want to do well on the exam. But I have classmates who are already having anxious dreams about the test they will take in June. They seem to interpret those dreams as signs to begin their in-depth review now. I refuse to let myself go there. Pouring my heart and soul into studying for an exam that is five months away--especially while continuing to have regularly scheduled classes--will only make me to freak out and burn out.
Hopefully, my study strategy will get me the results I want in terms of Step score (shooting for a tad above national average) and sanity (staying connected with my kids and taking care of my physical health). My plan is pretty basic...
My school is offering (technically, requiring) a practice Step exam eight weeks from now. In the next eight weeks I will annotate First Aid 2015 and Pathoma while studying the material my professors are presenting this block (pathology of cardiovascular, respiratory, renal, and gastrointestinal systems) and working through the UWorld question bank. I've got plenty of resources to draw upon in order to refresh what I learned last year such as Costanzo's Physiology and SketchyMicro. There are a ton of resources available to medical students prepping for Step 1. It's possible for me to spend thousands of dollars on resources that I will never, ever actually have time to go through. (I've shaken the belief that the more resources at my disposal, the better I will do. Funny--it's kind of like the myth that if you join a gym, you'll work out. The truth is, joining a gym may help, but you'll only work out if you prioritize fitness as part of your day.)
Oh, yes. The first step of this Step prep? It's time for me to kick-start my studying by watching Step Up with my daughters. :-)
That is precisely why I am so grateful for being enrolled in the accelerated family medicine program at my school. The clinical experiences I have had during the past semester have been invaluable in putting what I am learning in the classroom into context. Last week, my teammate (another second-year medical student working with the same preceptor) ran up to me with his eyes wide open. "Vieve, you've got to see this! Ms. Smith has a nystagmus!" Two months ago, I would have had no clue what he was talking about, but now that I've seen it, I'll never forget.
Of course, I'll never clinically see most things that are tested on board exams. It's the obscure and uncommon conditions that make for more challenging questions; and challenge is what these exams are all about. Now that January has arrived, I have joined the thousands of other second-year students around the country who are obsessing over just how challenging those questions will be. USMLE Step 1 is a mere season away. It is the first of four tests that I will take to become a licensed physician.
Unlike many second-years, I am a little ambivalent about Step 1. Don't get me wrong! Of course I want to do well on the exam. But I have classmates who are already having anxious dreams about the test they will take in June. They seem to interpret those dreams as signs to begin their in-depth review now. I refuse to let myself go there. Pouring my heart and soul into studying for an exam that is five months away--especially while continuing to have regularly scheduled classes--will only make me to freak out and burn out.
Hopefully, my study strategy will get me the results I want in terms of Step score (shooting for a tad above national average) and sanity (staying connected with my kids and taking care of my physical health). My plan is pretty basic...
My school is offering (technically, requiring) a practice Step exam eight weeks from now. In the next eight weeks I will annotate First Aid 2015 and Pathoma while studying the material my professors are presenting this block (pathology of cardiovascular, respiratory, renal, and gastrointestinal systems) and working through the UWorld question bank. I've got plenty of resources to draw upon in order to refresh what I learned last year such as Costanzo's Physiology and SketchyMicro. There are a ton of resources available to medical students prepping for Step 1. It's possible for me to spend thousands of dollars on resources that I will never, ever actually have time to go through. (I've shaken the belief that the more resources at my disposal, the better I will do. Funny--it's kind of like the myth that if you join a gym, you'll work out. The truth is, joining a gym may help, but you'll only work out if you prioritize fitness as part of your day.)
Oh, yes. The first step of this Step prep? It's time for me to kick-start my studying by watching Step Up with my daughters. :-)
Thursday, October 30, 2014
A Day in the Life
People often ask me about balancing school with family. Let me begin by saying that each person's perception of balance is very personal. My equilibrium would make many of my friends and classmates uncomfortable. I'm a mom first, and a medical student second. I was a mom long before I became a medical student, and I will be a mom long after residency is over. I value my relationships with each of my children more than anything else on this earth. My ex-husband felt like I had to choose between medicine and my family. The truth is, you can have both, but it might not be how you imagined it.
In a few days, I will have my second integrated neurosciences exam. The week before the first exam, I opted to attend two professional conferences. My ex doesn't spend much time with the kids unless I'm out of town. I needed the break and they needed dad-time. The conferences were both fantastic, despite catching a bug and spending a day in bed. Need less to say, I didn't study as much as I would have liked and I definitely did not do so well on that test. Chances are, I won't do so hot on this next exam either. But that is where my equilibrium lies--I need to stay connected with my kids, and I'm simply not willing to give up any more sleep.
Since there really is no "typical" day in my life, I'll just recap my day thus far:
6:45 AM Hit snooze on the alarm.
6:55 AM Embrace the inevitable and roll out of bed.
6:58 AM Step onto the scale. How did that happen? Up three pounds this week. Yeah, yeah, yeah. Normal variations and all that, but I've "normal variated" a total of 14 pounds now since early May.
7:05 AM Enter the family room. Kids munching on cereal; books getting tossed into bags. The back-to-school frenzy of August usually takes two months to subside. I think we've finally hit our stride.
7:25 AM High-schoolers are out the door and coffee is in my cup.
7:30 AM Into the garage with youngest two, stopping at two schools before I head to clinic. I have had morning clinic once or twice a week since mid-August. It is part of my family medicine clerkship that most students do during the third year of med school.
7:55 AM Feeling awfully proud of myself for making it to clinic before 8:00 "team meeting" for the third time (which means that it has taken this long to get into the morning school routine with the kids).
8:10 AM Download Lose It! to my iPhone. The only way to fix the scale is to focus on fixing me. :-)
8:35 AM First patient of the day. Ah, clinic! This is why I am in medical school. Today I saw three patients: two women close to my age and a newborn. My clinic notes are improving each week and I feel like I'm starting to gain some familiarity with common medications. Next year will be nothing but clinical clerkships for me. I'm simply thrilled about that.
12:10 PM Apologize to a club president (I'm an officer) that I won't be attending today's guest lecture since I have a mandatory meeting for the Emergency Medicine class I signed up for. Snag a taco on my way out the door.
12:15 PM Emergency Medicine Elective lecture. This class includes 8 lectures and 5 skills workshops. I know that I'd like to work in small emergency departments in the future, and I thought this class might give me an idea of what I might be getting into. I doubt it will make much of a difference helping me find moonlighting opportunities during my 3rd year of residency, but who knows. This week was focused on immobilizing spinal injuries for transport. Last month I was certified in CPR for the umpteenth time. It's odd to realize that this skill I've been trained in since I was a teenager will actually be put into use as a clerk and a resident.
1:00 PM Lectures for second year students are scheduled until 4 PM. I'm so grateful that my school makes a video recording of all lectures. I feel like I only grasp about half of what is said on my first go-through. Fifteen minutes into my second lecture (while on slide 5 out of 60) I gave up on walking away with much this afternoon and pulled out my laptop to answer emails and to start this blog post. Yes, lecture is just that engaging today.
2:50 PM I'm packing up. I get my middle-schooler around 3:15 each day. We usually have about an hour together before everyone else gets home. Last year he was in a new town, at a new school, with his dad no longer in the home. Needless to say, it was a challenging year for all of us, but particularly for him. This year has been so much better for him. I'm glad that we get to have a little time with just to two of us. Today, however, was not one of those days. I had to drop him off (he'd rather not go along for the ride) as I headed to the high school to give my oldest son a ride to work. Since I have to pick him up, my other kids opt to go along for the ride and by-pass the bus. After all the driving is done, I get home around 4:30.
Tonight's agenda will include helping my budding author with her English paper, reminding my son that Khan Academy is much better at teaching physics than I am (though he doesn't seem to believe me), taking the youngest to the Fall Festival at his school, and maybe (fingers crossed) getting through the lectures that I missed when I left early yesterday and the day before. Just 90 hours until test #2!
In a few days, I will have my second integrated neurosciences exam. The week before the first exam, I opted to attend two professional conferences. My ex doesn't spend much time with the kids unless I'm out of town. I needed the break and they needed dad-time. The conferences were both fantastic, despite catching a bug and spending a day in bed. Need less to say, I didn't study as much as I would have liked and I definitely did not do so well on that test. Chances are, I won't do so hot on this next exam either. But that is where my equilibrium lies--I need to stay connected with my kids, and I'm simply not willing to give up any more sleep.
Since there really is no "typical" day in my life, I'll just recap my day thus far:
6:45 AM Hit snooze on the alarm.
6:55 AM Embrace the inevitable and roll out of bed.
6:58 AM Step onto the scale. How did that happen? Up three pounds this week. Yeah, yeah, yeah. Normal variations and all that, but I've "normal variated" a total of 14 pounds now since early May.
7:05 AM Enter the family room. Kids munching on cereal; books getting tossed into bags. The back-to-school frenzy of August usually takes two months to subside. I think we've finally hit our stride.
7:25 AM High-schoolers are out the door and coffee is in my cup.
7:30 AM Into the garage with youngest two, stopping at two schools before I head to clinic. I have had morning clinic once or twice a week since mid-August. It is part of my family medicine clerkship that most students do during the third year of med school.
7:55 AM Feeling awfully proud of myself for making it to clinic before 8:00 "team meeting" for the third time (which means that it has taken this long to get into the morning school routine with the kids).
8:10 AM Download Lose It! to my iPhone. The only way to fix the scale is to focus on fixing me. :-)
8:35 AM First patient of the day. Ah, clinic! This is why I am in medical school. Today I saw three patients: two women close to my age and a newborn. My clinic notes are improving each week and I feel like I'm starting to gain some familiarity with common medications. Next year will be nothing but clinical clerkships for me. I'm simply thrilled about that.
12:10 PM Apologize to a club president (I'm an officer) that I won't be attending today's guest lecture since I have a mandatory meeting for the Emergency Medicine class I signed up for. Snag a taco on my way out the door.
12:15 PM Emergency Medicine Elective lecture. This class includes 8 lectures and 5 skills workshops. I know that I'd like to work in small emergency departments in the future, and I thought this class might give me an idea of what I might be getting into. I doubt it will make much of a difference helping me find moonlighting opportunities during my 3rd year of residency, but who knows. This week was focused on immobilizing spinal injuries for transport. Last month I was certified in CPR for the umpteenth time. It's odd to realize that this skill I've been trained in since I was a teenager will actually be put into use as a clerk and a resident.
1:00 PM Lectures for second year students are scheduled until 4 PM. I'm so grateful that my school makes a video recording of all lectures. I feel like I only grasp about half of what is said on my first go-through. Fifteen minutes into my second lecture (while on slide 5 out of 60) I gave up on walking away with much this afternoon and pulled out my laptop to answer emails and to start this blog post. Yes, lecture is just that engaging today.
2:50 PM I'm packing up. I get my middle-schooler around 3:15 each day. We usually have about an hour together before everyone else gets home. Last year he was in a new town, at a new school, with his dad no longer in the home. Needless to say, it was a challenging year for all of us, but particularly for him. This year has been so much better for him. I'm glad that we get to have a little time with just to two of us. Today, however, was not one of those days. I had to drop him off (he'd rather not go along for the ride) as I headed to the high school to give my oldest son a ride to work. Since I have to pick him up, my other kids opt to go along for the ride and by-pass the bus. After all the driving is done, I get home around 4:30.
Tonight's agenda will include helping my budding author with her English paper, reminding my son that Khan Academy is much better at teaching physics than I am (though he doesn't seem to believe me), taking the youngest to the Fall Festival at his school, and maybe (fingers crossed) getting through the lectures that I missed when I left early yesterday and the day before. Just 90 hours until test #2!
Monday, August 4, 2014
The Big Four-Oh
Forty snuck up on me this summer. Well, "snuck up" meaning that it came banging on pots and pans and whooping and hollering. Yes, the month before my 40th birthday I cried. "I'm turning 40," I lamented to my daughters, "...and I'm getting divorced," sob, gasping for breath, "...and I know I wanted it, but it's hard and I'm old and feeling alone," deep inhalation with tears, "...and I'm so glad I'm in med school," quiver and shake, "...but it is just so tiring," gasp, "...and now my head hu-ur-urts!" This was met with awkward stares from my 18 and 16 year old girls. Did I mention I was driving at the time? We had taken a little girls' weekend. It was fun. It was girlie. But my last huzzah at being 39 was slipping away.
Now that I'm on the other side of 40, I can breathe a little easier. It happened. And I didn't die. And my ex-husband and I get along amicably. And school, well...school is restarting today, so who knows? My plan is not to let it get quite so tiring this year.
Now that I'm on the other side of 40, I can breathe a little easier. It happened. And I didn't die. And my ex-husband and I get along amicably. And school, well...school is restarting today, so who knows? My plan is not to let it get quite so tiring this year.
Tuesday, June 10, 2014
It's over...sort of
I took my final exam as a first-year medical student last Friday. It was an NBME shelf exam on micro and immunology, so that means that my score won't be released for another week or so. That's fine by me, as I'm certain I passed the course.
This past year has been a little like manageable insanity. Yeah. I have no idea what that is supposed to mean either. It wasn't easy. It wasn't unbearable. It kind of sucked. It was kind of cool, too. As I think about one more year of the "basic sciences" before I take USMLE Step 1, I get this sinking sensation in my gut. Really? More of this? Dang. I thought I signed up for a marathon, and somehow I ended up on a freaky 100-mile "ultra."
But, wait....there's more!
While 135 of my classmates are enjoying 8 weeks of summer break, I'm sitting in a meeting room with 14 other individuals who have opted to participate in a family medicine prep course. The downside is obvious: 4-hours of daily lecture plus additional clinical commitments, just like the regular school year. The upside is the opportunity to begin clerkships this fall instead of at the start of third year. Getting a head start on clerkships means that fourth year doesn't have to happen for us. All we have to do is give up our summers and add extra classes and clinical time to second year. Oh, yes, and commit to going into primary care. Some how, all of this struck me as much more reasonable 12 months ago. Twelve, long, pre-medical school, pre-burn-out months ago.
As tired as I am today, I'm not despairing. Mark my words. I will find time to hang out at the pool at least once a week. And I will consume my fair share of ice cream. Summer school might not be fun, but I'll do my best to make sure that summer is.
This past year has been a little like manageable insanity. Yeah. I have no idea what that is supposed to mean either. It wasn't easy. It wasn't unbearable. It kind of sucked. It was kind of cool, too. As I think about one more year of the "basic sciences" before I take USMLE Step 1, I get this sinking sensation in my gut. Really? More of this? Dang. I thought I signed up for a marathon, and somehow I ended up on a freaky 100-mile "ultra."
But, wait....there's more!
While 135 of my classmates are enjoying 8 weeks of summer break, I'm sitting in a meeting room with 14 other individuals who have opted to participate in a family medicine prep course. The downside is obvious: 4-hours of daily lecture plus additional clinical commitments, just like the regular school year. The upside is the opportunity to begin clerkships this fall instead of at the start of third year. Getting a head start on clerkships means that fourth year doesn't have to happen for us. All we have to do is give up our summers and add extra classes and clinical time to second year. Oh, yes, and commit to going into primary care. Some how, all of this struck me as much more reasonable 12 months ago. Twelve, long, pre-medical school, pre-burn-out months ago.
As tired as I am today, I'm not despairing. Mark my words. I will find time to hang out at the pool at least once a week. And I will consume my fair share of ice cream. Summer school might not be fun, but I'll do my best to make sure that summer is.
Wednesday, May 14, 2014
Overabundance
After a long and philosophical monologue about turning us into "independent learners," I asked a faculty mentor if "brought to you by YouTube and Wikipedia" would be printed on the bottom of my diploma. He just laughed. I did, too, in order to hide my frustration. Physicians are required to have an absurd number of continuing education hours each year. Believe me, I appreciate that independent learning is a part of my future. What I'm not such a fan of is paying tuition, attending lecture, and then feeling clueless over what to expect from the exams. (Yeah, yeah, yeah: there is more to life than the exams, but when you fail an exam, you kind of don't care about all that other stuff.)
Medical school is radically different from anything else I've ever done. As an undergraduate, I attended lectures regularly and took meticulous notes. I was accustomed to looking at the chapter headings, skimming through the material, and reading the summary at the end. Sometimes I'd even read the chapter and do the practice problems. It wasn't easy, but it also wasn't that hard to master the material. That's not where I am any more. It's almost as though some maniacal mastermind saw me speed-walking on a treadmill and thought that I should pick it up a notch to (oh, I don't know) a sprint. It isn't an issue of what I need to learn that is hanging me up, as much as it is the sheer volume of it all. It's a lot. Fast.
So when you are overloaded with gobs of information to process in a short amount of time, you know what you really don't need more of? Resources. Really. You might think that you need more resources, or that if you found the right resource, you'd manage your time like a champ. The problem is, in medical school, they will be flying at you from so many directions. No doubt--having excellent study materials is vital; having a virtually endless number of sources to draw from is overwhelming. Oh, but wait. Isn't an "independent learner" someone who relishes spending hours hunched over her laptop Googling "galactose-1-phosphate uridyltransferase" and reviewing as many resources as it takes until she has a complete understanding of how this autosomal recessive enzyme deficiency is manifest as failure to thrive in newborns?
Seeing as I don't have an innate knowledge of galactose-1-phosphate uridyltransferase deficiency, and considering that it is only one of the hundreds of enzymes I will need to know by the time I take my step exam in 12 months (oh, wow! I hadn't even realized I was counting), I'd like a little more direction than "you should Google it."
In med school, there is simply no way to cover in lecture everything that you need to know for the board exams. I don't think it is even humanly possible to know all of the material I will be tested on by the time I become a fully licensed physician. My take on it: if I do my best to swim in this sea of knowledge, I ought to get at least a little bit wet. There isn't time for me to sit on a rock and study a solitary starfish.
And this is when I appreciate (and curse) the overabundance of resources with which I have been blessed. It's actually a nauseating number of resources, really. Wading through all of it to figure out what works for me is a real time-suck. Maybe you are starting your first year, and you just happened to chance upon my blog, at a time when you were just wondering if you'd ever run out of study material, and that got you feeling a little anxious. Well, you are in luck, my friend! I'm here to let you now that you won't run out of study aids and your anxiety is legit. Maybe, just maybe, my experience might be instructive. Or maybe it will simply distract you from that 40 minute YouTube video you were about to watch on galactose-1-phosphate uridyltransferase deficiency.
First, a Confession and Disclaimer. I know that the capstone of the first two years of medical school is the USMLE Step 1 exam. I've heard about it. (Duh.) I knew that that was the biggy. Schools use their Step 1 scores as a way of saying, "We are the best!" I've heard the advice to study for Step with each class you are in. Now, you've heard it too. Hearing and doing aren't necessarily the same thing.
Anatomy. No getting around this, I really did learn more from YouTube than attending lecture or reading the textbook. Sad, but true. Of course, spending 20-40 hours each week in the cadaver lab certainly helped. I bought an old edition of Moore's Clinical Anatomy. I earnestly attempted to do all of the reading...for the first week and a half of class. The textbook might be essential for understanding the clinical correlates, but YouTube videos tie them together more concisely. And there are so many clinical correlations that this class bears little resemblance to the undergraduate anatomy I took five years ago. Naming all those parts? That's "first-order," my friend, and it's time to be thinking "second-order." It's not adequate to know the blood supply to the head. Instead, you should appreciate how a pimple in the "danger zone" can lead to a brain infection. Thanks, YouTube!
Of course, you can't do second-order problem solving without having a good grasp of what you are looking at. Acland's Video Atlas of Anatomy is a fabulous resource! It is like being in anatomy lab, without the smell, and with everything labeled. Acland's can be a little creepy to watch. A friend told me that he was sitting in a coffeeshop reviewing the videos and heard a lady behind him gasp. He wasn't trying to be shocking; he was just wrapped up in the insanity of being an oblivious med student. He appreciated the situation and switched over to YouTube. Again, there are always way more resources than there are hours in the day, so you can change from one to another without wondering if you are leaving something out. (Which, of course, you are.) There really isn't one or two key sources for great videos on YouTube. Dr. Preddy's anatomy mnemonics were fantastic for the upper limb and the neck. Peter J Ward/Clinical Anatomy Explained has excellent material on embryology. I also like material posted by TheAnatomyRoom.
Studying for Step 1? No. Simply trying to keep afloat. Good thing that Step is only 5% anatomy questions.
Biochemisty. Memorize the enzyme deficiencies that result in disease! Wish someone had told me that. I was caught up in memorizing as many pathways as possible and really missed the boat on this one. I thought the class would be similar to what I had as an undergraduate, and it really wasn't. It followed the same topics, but the focus was on clinical derangements. It seems like a real "duh" for me to say that, but it wasn't what I was expecting based on the lecture material.
I purchased Rapid Review Biochemistry and used it a little. I (foolishly) thought it was too disease-focused for the test. It was exactly the level of focus I should have had. It will be a dear friend as I prepare for Step 1.
Cell Biology. Biochem was a rude awakening in how I prioritized the material to master. Clinical correlates! Yes, there was plenty of good, old fashioned memorizing of what goes from where when. Only now it seemed slightly more obvious that I should remember the synaptonemal complex that occurs during the diplotene stage of prophase I during meiosis I since that is when oocyte development is arrested in the five-month old fetus until ovulation. Duh! That is clinically relevant. There is a ton of pure memorization in medical school. It's way more than I will ever be capable of processing. I'm breathing a little easier now that I have a better idea of where to focus. I also switched from taking notes on my computer (annotating the PDF electronically) to printing up six slides per sheet and actually writing out notes the old fashioned way. Marked up papers were surprisingly faster for me to flip through and review.
Histology. Our professors really rocked this one! The lectures and handouts were surprisingly comprehensive. When I came across a concept that was unfamiliar, Wikipedia and the class text generally sufficed to fill in the gaps. Connecting clinical correlates to what I saw on the slides was easier for me to memorize than simply seeing words on a page. Shotgun Histology on YouTube is very good, and pretty quick. Attending histology lab and discussing slides with my classmates was probably the best way for me to learn the material. This was the first time I began really reviewing lectures asking myself what three questions would a professor ask. Of course, sometimes the answer would be "something from this table of 20 items." You'd be amazed at how memorizing that table meant that I was really narrowing things down.
Even with excellent material from the professors, there is so much to learn that it is easy to fall behind. At the end of histology, I made a pact with a friend. Daily review of lectures together or the one who backs out has to buy lunch.
Physiology. Costanzo's Physiology is written with greater clarity than most and is only 500 pages. This is slightly more manageable to conquer in the 8-week block than the other recommended texts (which I kind of abandoned anyway). The daily review with classmates made a difference in getting the knowledge to sink in. I started using Picmonic to aid in the absurd amount of memorization. Review questions on Firecracker was frankly overwhelming...too many to get through on a daily basis, though worthwhile if you can fit it in. (Friendly reminder, single mom with six school-aged kids. It's a bit hard to fit things in.) PreTest review questions are an excellent way to identify weaknesses.
My end of block self exam (aka, NBME) subscores reflected my performance on the five systems exams I took during the block. We are given one day of study time between our last system (endocrinology) and the comprehensive exam. It simply wasn't enough time to review. I had intended to relearn the subjects I had done poorly in throughout the block by reviewing on the weekend, but with exams every 10 to 14 days, "free" time was hard to find. Gastroenterology was my strongest area followed by pulmonology. YouTube videos of Dr. West teaching the concepts in his book is the way to learn pulmonology. Abandon Constanzo and focus on West.
I finally started annotating my copy of First Aid, though I anticipate using my annotated Costanzo a year from now when I prep for Step. Step 1 became real in January. I think the sooner if feels real to you, the better you will be studying for it.
Microbiology. This is when I finally got smart. My focus went from preparing for the class exams and focusing on Step 1. Professors inevitably give detailed questions that are unique to their lecture material, but Step 1 study means that I'm spending my time learning the most high-yield, testable concepts. Picmonic is very helpful for drilling in the unique properties of microbes. Of course, the volume I needed to learn for in-class exams exceeded the content they offer. That's OK; at least I know that I am focusing on the ones that I am most likely to encounter on the board exams.
MicroCards! These "flashcards"--which really aren't flashcards--cover just about anything you need to know about microbiology for Step 1. I just purchased First Aid for the Basic Sciences. Um, yeah, I should have gotten that earlier, though, honestly, when I was told to get a dozen books for each class that lasts 6-10 weeks, I just knew there was no way on earth that I could get though all of that. I've returned to Firecracker, but still hate it when it tells me to do 112 questions today. Hate it might not be the right term. It's more like I resent it. Bossy, know-it-all, over-achiever telling me that I need to spend 2 hours cuddled up with it. The board exam for this material will be given with the immunology exam at the beginning of June.
Immunology. Think I finally figured this out. We just started this content a few days ago. I need multiple and varied exposure to get this stuff in my head and so I watched a series of videos at double speed as a preview. Tonight I will do the same thing with a different series to give myself more familiarity so that the concepts in class don't sound so foreign. I have been doing PreTest questions as my final review before the exam. I plan on doing them earlier this time in an effort to identify key words as I delve into the material.
Less than a month until I am officially done with my first year. Can't believe I've made it this far.
Medical school is radically different from anything else I've ever done. As an undergraduate, I attended lectures regularly and took meticulous notes. I was accustomed to looking at the chapter headings, skimming through the material, and reading the summary at the end. Sometimes I'd even read the chapter and do the practice problems. It wasn't easy, but it also wasn't that hard to master the material. That's not where I am any more. It's almost as though some maniacal mastermind saw me speed-walking on a treadmill and thought that I should pick it up a notch to (oh, I don't know) a sprint. It isn't an issue of what I need to learn that is hanging me up, as much as it is the sheer volume of it all. It's a lot. Fast.
So when you are overloaded with gobs of information to process in a short amount of time, you know what you really don't need more of? Resources. Really. You might think that you need more resources, or that if you found the right resource, you'd manage your time like a champ. The problem is, in medical school, they will be flying at you from so many directions. No doubt--having excellent study materials is vital; having a virtually endless number of sources to draw from is overwhelming. Oh, but wait. Isn't an "independent learner" someone who relishes spending hours hunched over her laptop Googling "galactose-1-phosphate uridyltransferase" and reviewing as many resources as it takes until she has a complete understanding of how this autosomal recessive enzyme deficiency is manifest as failure to thrive in newborns?
Seeing as I don't have an innate knowledge of galactose-1-phosphate uridyltransferase deficiency, and considering that it is only one of the hundreds of enzymes I will need to know by the time I take my step exam in 12 months (oh, wow! I hadn't even realized I was counting), I'd like a little more direction than "you should Google it."
In med school, there is simply no way to cover in lecture everything that you need to know for the board exams. I don't think it is even humanly possible to know all of the material I will be tested on by the time I become a fully licensed physician. My take on it: if I do my best to swim in this sea of knowledge, I ought to get at least a little bit wet. There isn't time for me to sit on a rock and study a solitary starfish.
And this is when I appreciate (and curse) the overabundance of resources with which I have been blessed. It's actually a nauseating number of resources, really. Wading through all of it to figure out what works for me is a real time-suck. Maybe you are starting your first year, and you just happened to chance upon my blog, at a time when you were just wondering if you'd ever run out of study material, and that got you feeling a little anxious. Well, you are in luck, my friend! I'm here to let you now that you won't run out of study aids and your anxiety is legit. Maybe, just maybe, my experience might be instructive. Or maybe it will simply distract you from that 40 minute YouTube video you were about to watch on galactose-1-phosphate uridyltransferase deficiency.
First, a Confession and Disclaimer. I know that the capstone of the first two years of medical school is the USMLE Step 1 exam. I've heard about it. (Duh.) I knew that that was the biggy. Schools use their Step 1 scores as a way of saying, "We are the best!" I've heard the advice to study for Step with each class you are in. Now, you've heard it too. Hearing and doing aren't necessarily the same thing.
Anatomy. No getting around this, I really did learn more from YouTube than attending lecture or reading the textbook. Sad, but true. Of course, spending 20-40 hours each week in the cadaver lab certainly helped. I bought an old edition of Moore's Clinical Anatomy. I earnestly attempted to do all of the reading...for the first week and a half of class. The textbook might be essential for understanding the clinical correlates, but YouTube videos tie them together more concisely. And there are so many clinical correlations that this class bears little resemblance to the undergraduate anatomy I took five years ago. Naming all those parts? That's "first-order," my friend, and it's time to be thinking "second-order." It's not adequate to know the blood supply to the head. Instead, you should appreciate how a pimple in the "danger zone" can lead to a brain infection. Thanks, YouTube!
Of course, you can't do second-order problem solving without having a good grasp of what you are looking at. Acland's Video Atlas of Anatomy is a fabulous resource! It is like being in anatomy lab, without the smell, and with everything labeled. Acland's can be a little creepy to watch. A friend told me that he was sitting in a coffeeshop reviewing the videos and heard a lady behind him gasp. He wasn't trying to be shocking; he was just wrapped up in the insanity of being an oblivious med student. He appreciated the situation and switched over to YouTube. Again, there are always way more resources than there are hours in the day, so you can change from one to another without wondering if you are leaving something out. (Which, of course, you are.) There really isn't one or two key sources for great videos on YouTube. Dr. Preddy's anatomy mnemonics were fantastic for the upper limb and the neck. Peter J Ward/Clinical Anatomy Explained has excellent material on embryology. I also like material posted by TheAnatomyRoom.
Studying for Step 1? No. Simply trying to keep afloat. Good thing that Step is only 5% anatomy questions.
Biochemisty. Memorize the enzyme deficiencies that result in disease! Wish someone had told me that. I was caught up in memorizing as many pathways as possible and really missed the boat on this one. I thought the class would be similar to what I had as an undergraduate, and it really wasn't. It followed the same topics, but the focus was on clinical derangements. It seems like a real "duh" for me to say that, but it wasn't what I was expecting based on the lecture material.
I purchased Rapid Review Biochemistry and used it a little. I (foolishly) thought it was too disease-focused for the test. It was exactly the level of focus I should have had. It will be a dear friend as I prepare for Step 1.
Cell Biology. Biochem was a rude awakening in how I prioritized the material to master. Clinical correlates! Yes, there was plenty of good, old fashioned memorizing of what goes from where when. Only now it seemed slightly more obvious that I should remember the synaptonemal complex that occurs during the diplotene stage of prophase I during meiosis I since that is when oocyte development is arrested in the five-month old fetus until ovulation. Duh! That is clinically relevant. There is a ton of pure memorization in medical school. It's way more than I will ever be capable of processing. I'm breathing a little easier now that I have a better idea of where to focus. I also switched from taking notes on my computer (annotating the PDF electronically) to printing up six slides per sheet and actually writing out notes the old fashioned way. Marked up papers were surprisingly faster for me to flip through and review.
Histology. Our professors really rocked this one! The lectures and handouts were surprisingly comprehensive. When I came across a concept that was unfamiliar, Wikipedia and the class text generally sufficed to fill in the gaps. Connecting clinical correlates to what I saw on the slides was easier for me to memorize than simply seeing words on a page. Shotgun Histology on YouTube is very good, and pretty quick. Attending histology lab and discussing slides with my classmates was probably the best way for me to learn the material. This was the first time I began really reviewing lectures asking myself what three questions would a professor ask. Of course, sometimes the answer would be "something from this table of 20 items." You'd be amazed at how memorizing that table meant that I was really narrowing things down.
Even with excellent material from the professors, there is so much to learn that it is easy to fall behind. At the end of histology, I made a pact with a friend. Daily review of lectures together or the one who backs out has to buy lunch.
Physiology. Costanzo's Physiology is written with greater clarity than most and is only 500 pages. This is slightly more manageable to conquer in the 8-week block than the other recommended texts (which I kind of abandoned anyway). The daily review with classmates made a difference in getting the knowledge to sink in. I started using Picmonic to aid in the absurd amount of memorization. Review questions on Firecracker was frankly overwhelming...too many to get through on a daily basis, though worthwhile if you can fit it in. (Friendly reminder, single mom with six school-aged kids. It's a bit hard to fit things in.) PreTest review questions are an excellent way to identify weaknesses.
My end of block self exam (aka, NBME) subscores reflected my performance on the five systems exams I took during the block. We are given one day of study time between our last system (endocrinology) and the comprehensive exam. It simply wasn't enough time to review. I had intended to relearn the subjects I had done poorly in throughout the block by reviewing on the weekend, but with exams every 10 to 14 days, "free" time was hard to find. Gastroenterology was my strongest area followed by pulmonology. YouTube videos of Dr. West teaching the concepts in his book is the way to learn pulmonology. Abandon Constanzo and focus on West.
I finally started annotating my copy of First Aid, though I anticipate using my annotated Costanzo a year from now when I prep for Step. Step 1 became real in January. I think the sooner if feels real to you, the better you will be studying for it.
Microbiology. This is when I finally got smart. My focus went from preparing for the class exams and focusing on Step 1. Professors inevitably give detailed questions that are unique to their lecture material, but Step 1 study means that I'm spending my time learning the most high-yield, testable concepts. Picmonic is very helpful for drilling in the unique properties of microbes. Of course, the volume I needed to learn for in-class exams exceeded the content they offer. That's OK; at least I know that I am focusing on the ones that I am most likely to encounter on the board exams.
MicroCards! These "flashcards"--which really aren't flashcards--cover just about anything you need to know about microbiology for Step 1. I just purchased First Aid for the Basic Sciences. Um, yeah, I should have gotten that earlier, though, honestly, when I was told to get a dozen books for each class that lasts 6-10 weeks, I just knew there was no way on earth that I could get though all of that. I've returned to Firecracker, but still hate it when it tells me to do 112 questions today. Hate it might not be the right term. It's more like I resent it. Bossy, know-it-all, over-achiever telling me that I need to spend 2 hours cuddled up with it. The board exam for this material will be given with the immunology exam at the beginning of June.
Immunology. Think I finally figured this out. We just started this content a few days ago. I need multiple and varied exposure to get this stuff in my head and so I watched a series of videos at double speed as a preview. Tonight I will do the same thing with a different series to give myself more familiarity so that the concepts in class don't sound so foreign. I have been doing PreTest questions as my final review before the exam. I plan on doing them earlier this time in an effort to identify key words as I delve into the material.
Less than a month until I am officially done with my first year. Can't believe I've made it this far.
Monday, May 5, 2014
Random Confessions of an Optimist
There is so much that is ugly in this world, which is exactly why I believe in finding the beauty. Sometimes that takes no work at all. I look up and find myself lost in the colors of the sunset. Sometimes finding the beauty requires a little discovery. "Discover," in my book, means "hey, that wasn't exactly obvious, was it, but look what you got now!"
I've been told that people who are optimists have their heads stuck in the sand. I've also heard guys (why does this seem more male than female?) proclaim, "I'm a realist," as though being connected to reality makes their dour outlook on the world more legitimate.
I'm a realist, too, and I really believe in being optimistic. I believe in dreaming because I know people who have given up on their dreams. I hope for the best because there is nothing more desperate than an individual who is hopeless. I trust in the goodness of others because I know how imprisoning it feels to living with mistrust.
My first year of medical school will come to a close in one month. Focusing on the good of this experience is what has gotten me through.
I've been told that people who are optimists have their heads stuck in the sand. I've also heard guys (why does this seem more male than female?) proclaim, "I'm a realist," as though being connected to reality makes their dour outlook on the world more legitimate.
I'm a realist, too, and I really believe in being optimistic. I believe in dreaming because I know people who have given up on their dreams. I hope for the best because there is nothing more desperate than an individual who is hopeless. I trust in the goodness of others because I know how imprisoning it feels to living with mistrust.
My first year of medical school will come to a close in one month. Focusing on the good of this experience is what has gotten me through.
Saturday, April 26, 2014
My Med School Personal Statement
One of the most nerve-wracking parts of applying to medical school is crafting your personal statement. Schools use MCAT scores and GPAs as a quick and easy way to eliminate applicants. The personal statement is your chance to say, "Please don't toss me in the recycling bin yet."
I really can't remember how many times I revised this essay. By the time I was done with it, I felt a combination of satisfied with it and sick of it. I'm posting this here as there are very few examples of personal statements for medical school applicants to read. My take on it was to emphasize the "personal" and to explain why medical school at this juncture in my life as opposed to when I was younger. All in less than 4500 characters.
Personal
Statement
January
days aren't supposed to be bright and beautiful, but this one was. The azure
sky was a crisp backdrop to the dormant trees. The tall oaks reached
heavenward, surrounding the lawn like a fortress wall. Their bare branches
reminded me that despite the warm sunlight on my skin, it was the dead of
winter.
The
metallic blue coffin in front of me held my father's body. His diagnosis of
cancer had come less than three months earlier, on Halloween. As a 14-year-old,
I thought it was impossible for a disease to take my dad.
Just
the month prior, I sat at the foot of his hospital bed. "You know," I
told him, "I've heard about people who got rid of their cancer. They
visualized their bodies destroying all of their cancer cells, and it
worked." Dad just smiled. His once thick, black hair was now thinning. His
eyes were tired, his face swollen.
It
was odd for me to be there, at the foot of his bed. I wanted to cuddle close to
him, rest against his shoulder, talk to him, just as I normally did, but
everything about the hospital room told me to stay away. The leads and lines
connected him to massive machines. The wires and tubing looked too delicate to
touch. Long before cancer took my father's life, the hospital had taken him out
of my reach.
As
I headed off to college, I knew that a career in medicine was not for me. Three
years after Dad's death, doctors and hospitals still meant shattered dreams. I
chose a degree in the social sciences. I learned how the most primitive and
intimate relationships we form early in life profoundly shape who we become. I
sought to understand the human connections which influence how individuals
respond to the human condition. Nothing was more fascinating.
The
mother-child dyad had been a particularly intriguing area of study for me. I
got married while I was a college student, and started a family. Once I became
a mother, theory was tossed aside. Motherhood transformed me through the new
roles that I took on. Even after my daughter was born, I found myself endlessly
reading about the physical and emotional processes of childbearing.
Assisting
a woman through her journey into motherhood was a way for me to integrate my
personal experiences and my education. I became a childbirth educator and a
doula (birth assistant). Preparing couples for birth and parenting, and
attending births, reframed my view of hospitals. It became a place where I
belonged, a place where my skills helped others navigate challenging and
transformative events. Most significantly, I was able to serve as a bridge that
helped patients stay connected to their loved ones despite the wires and
tubing.
Working
as a doula was the first time in my life that I felt the call to become a
physician, and I felt torn. I had two small children at that time and a desire
to have more. The lifestyle of a medical student seemed at odds with the
lifestyle of a baby-wearing, breastfeeding-on-demand, young mother. The thought
of working my way through the science courses was daunting. Medicine simply
wasn't a priority.
Though
I enjoyed my work as a childbirth educator and a doula, I wanted to do more.
Becoming a midwife felt like the logical next step. The training was
challenging both didactically and physically, yet it still allowed me to enjoy
a balance between family and career. Working as a midwife has been immensely
enjoyable. I still feel privileged to be at each birth I attend--rendering
meaningful service to the families that I care for. That desire to become a
physician, however, hasn't left me. I still have that drive to do more and
become more, and that drive has grown.
In
October 2010, I sat down next to a 68-year-old woman at a professional
conference. Some might call it fate, others might consider it a coincidence,
but our conversation is something that my mind has returned to over and over
again. The stranger who I sat by was at the tail-end of an FNP program. She
asked me about my clinical background, and I shared that I was a midwife.
"You're
a midwife?" It was more of an exclamation than a question. "I've
always wanted to be a midwife! I want to start a midwifery program once I'm
finished with my family practice classes."
"Do
you mean to tell me that the dreams don't just fizzle out and disappear with
time?" I laughed. "I've
dreamed of becoming a doctor for the last ten years. If I don't do it now, does
that mean I'll find myself applying to med school in my 60s?"
"Of
course you will, and you already know that," she said in all seriousness.
"If there is something you truly want, it will never go away."
Less
than two weeks after that conversation, my big sister died unexpectedly. Sara
was the one who stood next to me at Dad's funeral. She was the one who held my
hand during the service. And she was the one who told me that we (especially
me) were going to be all right.
At
her funeral, I thought of Sara, Dad, and Mother (who passed away 10 years ago).
I felt that two paths were set before me--one of feeling lost and another that
told me to seize the day. Every day, Sara's passing reminds me that life is
simply too short to stop moving forward.
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