Things Get Real

I am in the Spring of my second year now, and in preparation for for 3rd year we are starting to work on interviewing and performing a physical exam on real patients.  From the beginning of our first year we had been taking baby steps towards this moment, and this involved working with standardized (i.e. fake) patients.  These are volunteer actors and they come in at different stages of our education so we can practice on them.  This was usually done in a group setting, so we could take turns embarrassing ourselves and giggling at others in the group.  The neurological exam “patients” were particularly fun!

I always felt comfortable with the fake patients, in large part because they always knew what was coming.  Taking a sexual history or asking about drug was no problem.  I knew they knew it was coming and everything was nice and safe.  I consider myself a “people person” and generally am comfortable talking to almost anyone, but I have to admit when I first walked in to talk to my first real patient, it was harder than I thought.  All of a sudden, things got real, and I had to talk to a person who didn’t necessarily want to be talked to and ask questions that they might reasonably think is none of my business.

For the most part, the patients have been great, but I know the tough ones are coming.  This is just a preview.  Next year, which is really only a few month away because it starts July 1st, all I will be doing is talking to real patients who want a real doctor.  Now I will be the one faking.  This is how it has to be.  We need to learn somehow, but who wants to be a guinea pig?  In the real hospital, people are vulnerable and not at their best.  They are in need of help, and they want the best.  But what they are going to get is me.

The saying, “Fake it ’til you make it” comes to mind.  This journey started off with pretend patients, and has transformed into me playing a pretend doctor.  In truth, it’s all still baby steps, and I am going to only be a small part of a team of real doctors.  But, there is definitely a change brewing from the confines of the classroom (or in my case more like my  computer desk) to the wards.  It’s exciting, but definitely a little daunting.  I like to think of myself as a “mature med student”, but I am still a baby in my training.  I am looking forward to growing up a bit over the next few years.

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Good Resources for Pre-Clinical Years

Video

Hi, everyone. I thought making videos might mean I post more often. So here is the first one (be gentle). I hope it is helpful. I didn’t cover every class in the first two years in this video, so if you have any specific questions, you can let me know in the comments. I tried to cover the biggies and get you pointed in the right direction. Disclaimer: this is what worked for me and you might be different.

Lastly, I meant to mention in the video how helpful YouTube has been. There are tons of good lectures on there. I might make a post on some I have had helpful. Also, (lastly, again) most texts are available in the Amazon Kindle format, and I have found that really convenient. There are desktop and iPad apps that work great for having everything in one place.

Time Flies

Wow, my last blog post was very prophetic!  Time has flown by.  I have found that time for myself is the first thing to go.  So, now I am all flabby from not going to the gym and haven’t made much time for this blog.  I hope to change both going forward.

After a year and a half of school definitely have a handle on things.  I think two things happen that makes med school easier as you go.  First, you find out you can actually survive the thing.  First year is intense for everyone on some level, because none of us are completely sure we can hack it.  On the plus side, that fear is a heck of a motivator.  Secondly, most people learn to relax a bit.  First year, I think most of us (myself included) tended to freak out a little too much over almost everything, but grades in particular.  At my school we are on the A, B, C grading system, but it is my understanding that a lot of school are on some sort of pass/fail system.  So, maybe we tend to freak out more about grades.  There is such a huge difference between an 88 and a 90 sometimes.  I think for most people, they learn to relax a bit during second year, but it is hard given the competitive nature of most people in med school.

For me, I still care about grades and try to do my best, but I try not to obsess too much.  In general, I have always tried to “run my own race” and not get caught up in comparing myself with others, but that is a challenge as well because for some reason they always post the average of each exam.  So, it becomes a matter of making sure you are on the right side of that average.  

Overall, I think the biggest change that has occurred in all of us is that we are no longer just glad to have made it into med school.  The favorite past time of any med student is complaining about being a med student.  it’s darn near impossible to get a group of us together without breaking into a whine session.  This is part stress relief and bonding through a shared hardship, and part frustration with the less than perfect reality of med school (and medicine as a field).  Turns out not all the professors take our classes as seriously as we do and they make really cruddy notes and power points, which is the most evil thing any professor can ever do.  Now my wife is a PhD, some of my best friends are PhD’s, heck I was almost one so I say this with love: some PhD’s are the biggest slackers in the world.  And in med school, they can get away with it because we all study so hard it covers up really bad lectures.  

MD’s aren’t perfect either.  Generally they are so busy, and some one is making them lecture (sometimes from slides I am sure they didn’t prepare).  Generally, they lecture like we already know everything, and include way more details then needed and it becomes a guessing game on what you need to know.  Sometimes med school is a game of hide and seek; they hide the real info in a pile of junk and we do our best to find it, hopefully before the test.  

So, am I a little jaded?  I think it’s more like the old parent’s line, “I am not so much mad as I am disappointed.”  I actually used that one in an evaluation once.  Crazy, but it’s true.  Sometimes I feel out tuition is really just a very large cover charge.  It’s what we pay to get in the game, so to speak.  The truth is in med school you learn on your own.  We all come to accept that, but it is kind of a shame sometimes that there isn’t always a great return on investment.  

Having said all that, I still feel like I am on the right path, even though no one is really sure what practicing medicine will look like in the future.  I am still surrounded by a bunch of great people, though most of us don’t go to class anymore.  I still feel like the upside of being able to help others will trump the crud that one has to go through to get there.  More to come…I hope. 

I only study on days that end in Y

Wow.  Time is flying by.  There are only a few weeks left in the semester, and I am finding free time to be a little scarce.  That being said, there have been a ton of great experiences that I would love to share, but it’s hard to pull myself from the books.  I am hoping that I can catch up on blogging during winter break.  In the meantime, I thought I would share some insight to how and how much I am actually studying.

In a previous post, I shared how I planned to approach studying.  It has changed a good bit.  Briefly,   in the beginning, I used to take notes from the PP’s and study the notes, and I attended every class.  I don’t really take notes any more.  I simply edit the PP’s, condensing things and study them over and over.  I have also found the Quizlet iOS app and website to be really helpful.  It allows you to create flash card decks and use them to quiz yourself on the web or on any iOS device.  I like it a lot, and next year I will have a ton of decks all set to study for the boards.

Since the first round of exams, I have strategically missed quite a few classes, and my grades have only gone up.  I kind of hate to say it, but class time can actually be a waste.  It’s basically 50 minutes of jam packed material.  In the end, still would need to go through it all again on my own to digest it.  Med school is all about learning on your own.  Lectures, particularly in anatomy, are not so much to teach you but to tell you what you need to learn.  I still think there is value to lectures, but not a lot.  So, I strategically miss my 8AM classes if I need more sleep, or I might skip biochem and head into the anatomy lab before a quiz.  I might miss a few class in one subject to study for the exam in another.  At my school, some of the classes are recorded, which really makes it convenient, but not all.  And I have the suspicion, that is because the school realizes no one would go to class if they were all taped.

Paradoxically, I have actually found that I keep up better in classes I miss.  When I attend a class, it is easier to think I am caught up, but really I haven’t internalized the material.  When I miss, it’s in the back of my head that I really need to put in time studying, and I usually show up in class later with a better grasp of the material than others because I had to go through it on my own.  I am not saying everyone should skip classes.  But I will say, some classes are more important to be at than others, and time is at a premium in med school.  You have to make wise time management choice.

Now, a book plug.  I have found the BRS Anatomy series to be great.  It’s a really nice condensed form of everything you need.  I can’t recommend it enough.  It also has a lot of board-like questions at the end.  Really good stuff.  I also like Grey’a Anatomy for students.  My school required a different text (Moore’s Clinical Anatomy), but someone gave my Grey’s and I like it a lot.

So far, I am finding med school very manageable, but very time consuming.  It is an immersive experience.  I had planned to take off Sundays.  That hasn’t worked out.  I keep telling myself that once I don’t have to spend hours in the anatomy lab, I will be able to free up some time next semester.  We will see.  Soon, I hope to post on managing time with a family.  Needless to say, it takes some effort.

Nice Doctors Finish Last?

As part of my first semester of medical school, I have to take a class called Intro to Clinical Medicine (ICM).  It is basically a class on how to be a doctor.  It covers topics relating to the doctor patient relationship, ethics and cultural diversity.  During our second year, this class will be where we learn how to take patient histories and perform exams.

Of all the things we have to learn in med school, I was surprised when the first ICM was largely dedicated to teaching us how to be nice.  We even had to read a paper on the topic.  I couldn’t help wonder while reading it how such paper would have gone over in other graduate programs – law school for example.  I think it would seem kind of silly.

The gist of the class was that while we are all idealistic do-gooders now, after med school and residency we will be mostly likely jaded and mean to patients.  There was talk of studies showing this, lots of stats and figures.  Apparently, 4th years are the most jaded, which I found odd because that is supposed to be a pretty sweet year (check this out).

It seems being nice is really important.  We were told it is even more important than getting diagnosis right. This seemed a little odd to me, until the slide that basically showed people don’t sue doctors they like. Apparently, Dr House is not en vogue.

If you can’t tell, I was kind of annoyed that someone was giving me lessons on how to be nice.  There is even a whole program some hospitals implement to help doctors appear nice.  It’s called AIDET and is a five step plan to niceness.

Don’t get me wrong, I am all for nice.  I think I am usually very nice.  I even say please and thank you.  I think most of my classmates are nice.  Maybe even nicer than average.  But something about this idea of trying to train future physicians how to be nice from day 1.  It all seemed like makeup on a pig – a huge response that ignores the real ugly problem.

The real, and unaddressed, question in all this is what takes nice, empathetic and committed individuals and turns them into miserable physicians?  It’s as if we are ignoring the problem because it’s too big and nasty, and are saying to our future physicians, “Look, we know healthcare stinks.  We know it’s going to be incredibly frustrating and soul sucking at times.  But, please, remember to smile.”

Coming Up For Air After First Anatomy Exam

So much for making time to blog during me school.  Turns out, time is never on my side.  In a previous post, I compared med school to a never ending buffet, but lately I have been calling it a marathon on a treadmill.  You can never get off.  Today was the first anatomy exam, but no time to rest.  Next week brings another exam, and then another.  No rest until December, when I will collapse in a heap.

I have now been is school for a little over a month and have had an exam in each class.  I feel like my studying habits have been good, and I have been prepared.  The reality is there is a ton of material, and no amount of preparation before you start school can really make you appreciate that.  That being said, if I was just trying to pass it would not be so bad.  I don’t like the term “gunner” because it seems to be applied too easily.  I am simply trying to do my best, and that brings some pressure, but ultimately I want to be able to say I gave my best effort and be proud of that.  There are definitely those who want to do their best, but also want you do do worse to lower the average.  I think those are the real “gunners”.  Truth is almost everyone is studying harder and longer than they ever had to in med school, but everyone acts like they aren’t.

This brings me to something I have been meaning to post on, but haven’t had time.  I have decided med school is more like high school than college.  It’s smaller, everyone is taking the same classes, there are little clicks and everyone is riding the fine line between looking dumb and looking too smart.  Perhaps because I am older, more settled and comfortable with myself (or at least like to think so), I find it all amusing.  Our class average GPA was a 3.7, we were all nerds.  Yet, you can still run the risk of being a nerd amongst nerds.  Some things never change.

I would like to comment on is stress in med school.  It’s important to remember everyone is stressed and for the same reasons.  We all show it differently and have different coping mechanisms.  I tend to joke a lot to loosen things up and my lab table is always having a good time, so people think I am not stressed out as much as them.  I think I might be more.  I just do my best not to let it get me down and use it as motivation.  We all want to do well, but the reality is some of us might have to redefine well.  Most of my classmates never saw a C in undergad, and if they did it was a rare event.  Accepting that you might now be a C/B student in med school can be a huge jolt.  I have seen people in tears, I have seen a lot of frowns.  The reality is we will all most likely make it through, and get some extra letters after our names, but that can be little consolation at this early stage.  I suspect that next semester things will settle down when everyone realizes they might not need to finish first in class to follow their dream.

Finally, how was the first gross exam?  I have heard all kinds of horror stories.  During a recent visit to my son’s pediatrician he confided in me that he failed is first anatomy exam.  I don’t know what I made yet, but I am sure I passed.  Not to brag, because I am sure I missed my share, but I was one of the few smiling at the end.  It was long (2 hour written exam followed by  2 hour practical), but it went fast.  And it was fair.  Not to say that I didn’t get tricked (probably did) or that I didn’t out think myself at times (I know I did at least once and it kills me), but it was a good representation of what we had to learn, which was a lot. I wanted an A, and might have got one if I got a little lucky.  I feel like I prepared myself well. So, how did I walk out of the exam without tears in my eyes?

For me, I learned best in the lab, and I think that is true for most people.  The difference is I spent a lot of time in the lab because I realized this early on.  We have two groups for each body, so I don’t have to be in the lab on my non-disecting weeks, but I found that I didn’t learn as well.  So when I am not dissecting, I give the others about an hour head start, and then I am in the lab going around form table to table, which is actually better than dissecting.  This way I can follow the various instructors and hear all their input, and, equally important, I get familiar with all the bodies.  It’s easy to focus only on your body or your dissections.  I found going in my non-dissecting days was huge.  I could study the book in the library for that first hour, and really learn it in the lab.  I think I was the only one who did that.  There may have been a few, but I didn’t seem.  Some would argue you could use your non-dissecting time to study other material.  For me, anatomy is by far and away the hardest class first semester.  You can never spend too much time in the lab.  There were many times when I was teaching stuff to people during their dissections.  When it came time to prepare for the exam, I had my ID’s solid and could focus on secondary questions.  But I also did that in the lab and spent 4-5 nights in the lab for about 5 hours leading up to the exam.  Sometimes there were only a few others in lab with me.  There are a 100 in my class.  More came in as the exam got closer.  The most I saw was the day before the lab closed to prep the exam.  Study in the lab early and often.

Never-ending Buffet

Week two has come and gone, and I have to say I feel much better now. First week, was a lot of information and a lot of stress. But now, I have a nice rhythm to the week, know what I need to do and a plan to do it. I find the key to minimizing stress is to stay on top of the material – easier said than done.

I have heard people describe med school as trying to drink from a firehose. The idea is there is so much information flying your way and you try and suck up as much as you can without it blowing your head off. I kind of feel it is more like a never-ending buffet.

Each day, you get served a big pile of information that you need to digest. By the end of the day, you are feeling pretty full, but you get it done. Then the next day, you sit down and are served a brand new serving of stuff you don’t know and need to find some room for.

You just got to keep taking it in and digesting.