Wednesday, November 30, 2011

I Fear I May Break Down Into Tears at Any Moment

A fellow student and I had the privilege of 15 minutes of closed-door, private mentoring by a successful "Hospitalist" who graduated from our school.  He is a preceptor for some of us in our class which requires that we spend a few hours twice a month in a medical setting to learn how it is in the real world and gain hands on experience interacting with patients and medical staff.  Rumor has it our school produces students who score outstanding on the USMLE Step 2 because of the effort which goes into developing our personal and clinical skills.  It makes perfect sense to me.

In any case, this doctor said something like this:
"I know you are in the 'anger' phase.  I've been there.  It sucks.  It's a lot more difficult that you expected it to be.  You don't have time to be here when you are taking a course load that consists of 27.5 credit hours including a whole bunch of really hard sciences.  I get it.  It sucks.  Look, you didn't fool anyone to get here.  You are obviously intelligent enough to be here, or you wouldn't be here.  The same goes for your work ethic.  It's gonna get easier, and I will let you in on a little secret.  The reason they push you so hard and test you so much is so one day when you are a doctor and a nurse calls you at 3:00 A.M. to wake you up it will be no problem.  You will be able to bark orders into the phone then go right back to sleep without giving it a second thought.  You are being conditioned to deal with stress."
Honestly, I hadn't looked at it from that perspective.  It makes perfect sense to me.  I actually thought it was because they want to push and push and push and barely pass us in order to force us to work three times as hard so we will study and work harder so we become better at being students, on rotations, residencies, and professionals so we make the school look better.

Either way it is DEMORALIZING at times.  Our second year students gave us an updated "Survival Guide" which they had passed along to them when they were M1's.  This guide states that 25% of the students in the class before us had to remediate AT LEAST one course during their M1 year.  Holy cow.  This tiny piece of information sometimes helps me retain my sanity.  If my nightmare of failing a course comes true, it is not the end of the world.

A friend asked me how I was doing earlier, and I jokingly responded, "I fear I may break down into tears at any moment.  For now, I've got my big-boy britches on."  --Or, maybe it's big-girl britches?  It's back to the anatomy lab for 4 more hours of review before Monday's final.  Essentially, we have a final Friday and then one every other day for two weeks starting Monday.

We spent 3 hours in the lab having a review last night.  I don't know how it is at most schools, but I was blown away to learn that the M2's doing the tutoring had stayed up all night studying for their two last finals which they took before tutoring us for 3 hours.  The students in the class before them did the same thing last year, and so on.

It's another one of those awesome "culture" things I did not expect.  I hope I am fortunate enough to have the opportunity to "Pay it Forward" next year...

For now, the following image is burned in my mind.  I think about it often, and it makes me laugh!!!!!!  Because that doctor was correct, I am in the "anger" phase.  This little boy looks like he knows exactly how I feel sometimes -even though I don't have someone who deserves to have my frustration directed towards them.  It's just part of the process, and I am aware that I better be able to laugh about the process sometimes!!

Wednesday, November 16, 2011

Future Doctors Will Inherit Short-Fused Patients

We medical students will be spending a lot of time in doctor offices throughout the span of our education and career.  What follows is an interesting perspective I am sure we have all heard.  I post it as a reminder that we should always be cognizant of how our actions affect and even enrage patients.
A friend updated her Facebook status with a complaint about waiting for an hour at the doctor's office.  She stated that she should submit a bill for her time to the doctor because she had to wait so long.  I just happened to see her post in time to be the first to post a response:

Don't you be hating on doctors! If the doctor has to see 10 patients an hour to make a profit that's only 6 minutes per patient, but if a patient requires 15 minutes of the doctors time you can bet the doctor will stay late to make accommodations. If he does this for 7 patients the doctor's whole day is backed up by an hour... You have an unstated but agreed upon contract with that doctor whereby you won't be that 15 minute patient most the time, but when you are he/she won't complain about it, and you won't complain about it when other people are that 15 minute patient.
Very quickly 15 of her friends chimed in with similar complaints about doctors and long wait times.  Only one of her friends defended my comment as being sensible while ultimately agreeing that the doctor should be billed.  I was appalled to read a comment from a guy who was at a doctor's office at 8:15 in the morning for an 8:30 appointment.  He stated there were five other people waiting, and somehow they caught the doctor coming in to work at 9:00.  While they were sitting around for 30 minutes waiting all six of them realized they each had an 8:30 appointment to see the same doctor.
Patients are genuinely perturbed, and many are intolerant of what they perceive as unjust treatment by doctors.  We future physicians will inherit from those physicians who came before us, a frustrated customer base of patients who feel they have been taken advantage of by doctors.  It seems this new generation does not respect the profession as their parents did.  They really don't care that we spend 12-15 years of our lives acquiring the education necessary to qualify us to medically treat them and their loved ones.  They have no appreciation for the fact that we will spend 8-11 years of our lives working 80 hour weeks.  They don't care about the debt we will accumulate to experience this privilege.  They perceive that all of us are very well off -even if we are not.  They do not realize the frequency with which many of us have been advised by countless practicing physicians to avoid their profession because it is not what it used to be.  Yet, we have ignored that advice because we are so compelled by a burning in our guts to follow our hearts and pursue a career where we can spend our lives helping others.  We future physicians recognize that it is a privilege and an honor to have the opportunity before us, regardless of how bumpy we know the road will be.

Most patients of today are aware of and can relate to the "99%" movement, and while the public at large may not lump us in with the despised 1%, they also don't include us in their 99%.  In their minds we lie somewhere in the middle, and it is our responsibility to serve them.  It is in their nature to treat us as a commodity.

It is up to us, the future physicians of the world to collectively rebuild the doctor/patient relationship in a positive manner one patient encounter at a time.  It will not be easy, but by the time we are treating patients very little of what we have experienced on our journey will have been easy.

Tuesday, November 15, 2011

Medical Student: Memorize or Learn?

I realize it's not actually that simple, but for the sake of a simple exercise in comparing different strengths let's consider the learning styles of medical students in these simplistic terms.  Certainly both exist, and each should appreciate the other.  I hesitate to publish this post because I know it's going to anger a memorizer and leave them with the impression that I feel somehow superior.  Nothing could be further from the truth.  Sometimes I wish I was a memorizer.  I know each type of student is capable of the other with effort, but only one comes easily.

I found the picture above and the following quote from a dead blog-site, meta-mentoring: "between a bright child and a gifted learner, the former is a good memorizer, the latter a good guesser.  Now as to creative learners, perhaps they may not even be on the same page."

My "out of a hat" guess is that 90% of medical students were considered "gifted" by an academic authority at some point in their lives, but it sure doesn't seem that way when you talk to some of them.

I have a horrible memory.  I thought this malady would be rare in medical school.  I didn't expect a medical student to admit such a thing, but I have actually heard many confess this ailment.  During undergrad I felt like I was pounding stuff into my head, and it just wouldn't stick.  It required brute force at times.  I literally forced myself to write things down on a notebook or whiteboard 50 times or more to make it stick.  If information was not presented to my brain within some context of usefulness then my brain just refused to acknowledge that information and store it for future regurgitation.  Of course this condition persists and is even more inconvenient in medical school.  I am good at seeing patterns and thinking my way through a problem, but I am actually confounded by both memorizing and learning because with regards to learning I often get hung up on details and irrelevant possibilities and even sitting still.

Conversely, the following is not uncommon:  I can have a conversation with a student who I am certain has higher grades than I do in every class, but it is apparent they don't really get what's going on in some class we have a discussion about.  Sure, they may be able to recite many more facts than I can, and they may even be able to tie some memorized facts to others based on a perceived connection they would not have noticed had they not memorized both sides of the connection.

Sometimes it's like talking to a robot.

To be sure, I have no doubt that such students have outstanding work ethics or they would not have had such successful academic careers culminating in acceptance to medical school.  I know some who are just lucky that they have great memories, but that's really not going to cut it in medical school without a strong work ethic.

I actually overheard one such student complaining about a physiology professor.  She stated, "I may have to remediate physiology over the summer, and I just don't get it.  I'm at the top of the class in every other subject so it MUST be something to do with the professor."

That was weeks ago, and I immediately recognized her as a memorizer with a top-notch work ethic, but I hadn't taken the time to parse my jumbled thoughts until I wrote this blog post which will finish with the following advice.

If you are a "memorizer" as opposed to a learner:

You can memorize biochem and histology, and you can memorize enough anatomy to succeed but not excel.  It is unlikely you will be able to memorize your way through physiology because physiology is a whole different animal which requires learning.  You can do it as long as you acknowledge the time and effort it will require.

If you are a "learner" as opposed to a memorizer:

It will take a learner with a strong work ethic AND enough free time to use brute force to memorize enough anatomy to excel.  Brute force memorization will be required for biochem and histology, but physiology will come naturally to you.

If you are a "creative learner" as opposed to a learner or memorizer:

Good freakin' luck.  Work hard.  Be patient.  If I actually had this figured out I would have better grades.  I will happily take any advice I can get.

Source of picture and quote:

Meta-Mentoring: Bright Child Gifted Learner Creative Learner

Monday, November 14, 2011

Day 1,772: Sitting Alone in a Room

You can get help from teachers, but you are going to have to learn a lot of stuff by yourself, sitting alone in a room -Dr. Seuss.

One of my classmates took a picture of this painting which was hanging in one of the private study rooms in our medical library.  They spelled Dr. Seuss wrong, but otherwise it is a brilliant quote, painting, and location to hang the painting.

With finals looming just three short weeks from now, this is weighing heavily on many of us.  Once finals begin there will be a test every other day for a couple of weeks.  It is not possible to wait until the last minute to study.  For the most part the next three weeks will be spent "alone in a room".

That's just the way it is.  It can and will be lonely.  It is most difficult on those who are extroverted and unable to sit still.  Whether or not you are a medical student, it is interesting to have conversations with medical students of all levels, particularly during the first couple of years when they don't get much human contact.  I remember reading a post years ago on some medical student's blog about how difficult it is to start new relationships during medical school.  The author's recommendation was to "stick with your own" based on the premise that only other medical students truly understand how difficult the path we are travelling can be.

Regardless of the the difficulties, or perhaps in part because of the difficulties, ours is an awesome path.  If it was easy everyone would do it!

Sunday, November 13, 2011

Medical School Rumors & Schools Paying for Board Prep Material

A reader asked me a question about a rumor regarding our school discontinuing the policy of paying for board preparation materials, and I thought it was funny because it was the THIRD different rumor on the subject I have heard TODAY.

I'm guessing most medical schools have similar rumor mills.  I can tell you very early in the day on the VERY FIRST DAY of class our Dean or Assistant Dean warned the whole class about rumors from the podium -I honestly can't remember which one made the speech, but I remember the take-home message very well.  Basically, we were told not to believe anything we hear.  They told us they have been around long enough to have witnessed some funny and some not-so-funny effects of the medical school rumor mill.

Here is an example:  Just today, one of my classmates posted on our Facebook page that she heard our school is going to switch to providing "Doctors in Training" board preparation material.  Another student posted that he heard yesterday at a two hour "Board Preparation" seminar hosted by a couple of M3's that the school will start allowing students to select what board preparation material they want, and the school will pay for it.  Then a person posted on this blog the rumor they heard is that the school is not going to pay for board preparation materials at all any more.

Our school administration is on top of things.  I would be willing to bet that either one of two things happens by tomorrow -only ONE day after a couple of students expressed confusion on our class Facebook page.  1)  A person from the administration office will stand up in front of our whole class and tell us exactly what is going on with the board preparation material, or 2) Someone from our Student Government will meet with administration to get the status and let us know either in class or via email/Facebook.

My guess is that the administration has not made a decision, yet.  I would bet my laptop they will NOT stop paying for board preparation materials for students.  Think about it.  They want us to succeed.  It reflects poorly on the school when students do not pass board exams.  It's the same logic I used to explain why classes are SOOO DIFFICULT.  They want us to succeed, but they want it to require a whole lot of hard work and study on our parts.  The harder we work, the more we study, the more we know, the better we perform on boards/rotations/residency/careers -and that reflects positively on the school.

Saturday, November 12, 2011

Got Free Time Before Medical School Starts?

Here is my advice in order of preference:

1.  Get an MBS (Master of Biomedical Science)
2.  Take one or more classes -anatomy, physiology, histology, SOMETHING
3.  Do some self-study

This is something I regret not doing.  I followed the school of thought that medical school is going to be difficult, and you are going to be cramming your brain full of information for  around eight years and periodically suffer from burn-out, so don't do anything but relax prior to matriculation.  Just relax and enjoy the last months of freedom because when the first day of class arrives it is going to get real, very real.

That seems logical, right?  Many medical students will offer you this advice, and I suspect it is because they are suffering from some degree of burnout.  I wish someone had offered me the opposite advice, the advice I am offering you.  Here's the deal.  You should do anything you can do now to make your life easier in medical school because once you get here it is going to consume your life -unless you are a slacker.  They do exist.  I'll write a post about that another time.

If you can make one or two classes easier to digest because you came prepared then you will have more time and energy to devote to the other classes and be more successful over all.

Do you think you know physiology or anatomy?  I highly doubt you do to the level which is required to be a physician and excel at medical school, but maybe you do. Buy the physiology/anatomy books I mention on the right side of this blog and prove it to yourself.  The same goes for other subjects.  The average on our recent written anatomy exam was a 64, and the highest score was an 88.  You should probably start studying.

At the VERY LEAST learn some anatomy.  The bones are easy.  For the muscles you need to know all of them plus the action, blood supply, innervation, site of origin, and site of insertion.  Learn the nerves and arteries and veins.  Know how each name changes as it moves into a different part of the body.  Learn the plexuses such as the brachial plexus.  Learn about what each nerve innervates including the spinal nerves, and understand the sympathetic and parasympathetic branches from what to where and how they function.

I wish you the best of luck.

Thursday, November 10, 2011

Day 1,768: What? A Culture of Teamwork at Medical School??

My MS1 class is AWESOME!!

There is a culture here I don't think very many people would expect.  It is my experience that premed students are ridiculously competitive, and I expected that to carry over into medical school.  I was constantly telling my undergraduate classmates I dragged to study sessions to be team players because one of us doesn't have to do better than the rest in order to be successful because a rising tide lifts all ships, and there is plenty of room in the world for us all to be successful.  That speech is not necessary here at my medical school.

I'm not sure exactly what I expected, but holy smokes, I certainly did not expect the level of teamwork I am witnessing.  I mean, WOW!  When I was working on my undergraduate degree in biomedical science I watched things go down that can be described as nothing less than cut-throat.  Students would not share notes with classmates who couldn't make it to class.  Students would not share study sources such as old exams.  They would laugh out loud at "dumb" questions.  These kids thought it was an all-out war so they were hyper-competitive with each other.  Certainly, not everyone was this way, but indeed many were, and they were MEAN about it.  "Screw you" seemed to be the attitude because it was one against all to get the highest scores they could in order to increase their chances of getting accepted to medical school.

Here at medical school where we use GoogleDocs to collaborate, one of my diligent classmates posted a document with her rendition of answers to the study questions posed by one of our biochemistry professors.  This document quickly had more than 50 students simultaneously building it until it had all the study questions and answers from all three of the professors for the next exam.  For the 48 hours leading up to the exam at any given moment there were more than 50 people in GoogleDocs concurrently editing the document and using the chat feature to have intelligent discourse regarding answers and different interpretations of subject matter.  The class average on exam 2 was something like 15 points higher than it was on exam 1 before this started happening, and I believe a big part of that was due to teamwork.  That's good stuff!

This has been going on since the semester began but not to that degree.  Students will post old exams when they get their hands on them.  Students will post lecture notes professors hand out in class so those couldn't make it are able to print them out and study effectively.  It is not uncommon for someone to actually post their own notes from a class that had a very low attendance rate because everyone skipped it to study for an exam.  Reminders of deadlines for all manner of assignments are posted on our Facebook page where regular discussion happens regarding everything from physiology topics to restaurants.  Students often create their own study guides for specific tests and post them for everyone to use.  I have done the same because I am on board.  I like the collaborative team environment, and I feel damn lucky to be a part of it!  A rising tide lifts all ships!!

I am genuinely surprised, and I look forward to talking about my experiences with students from other schools because I am curious about whether this is a phenomenon unique to my school or if it is common among students who recognize the fact that everyone is more successful being part of a team than going it alone.

I may be idealistic, but I don't believe I am naive.  I expect students will be more competitive in small groups while doing rotations during the 3rd and 4th years of school and during residency, but for now things are nice –very nice.