medical school
October Updates – MS2 + Research (Again!)
Cardiovascular Exam on Wednesday Yesterday
We’re well into half of the first semester. This block of courses was Pulmonary (finished) and Cardiovascular. Mixed into our ‘classroom’ time we’re also scheduled for didactics training, and interspersed among everything we have workshops on medical imaging (X-rays, CT scans, etc). It’s our last year of ‘classroom’ time, from next year we take the boards and hit the wards and pretend to be doctors — I keep using the parenthesis with “classroom” because I don’t actually go to class unless it’s a discussion, skills training, or seminar. I spend most of my time studying like I did for the MCAT, at a cafe with headphones — I find studying in public really helps to break up the monotony, and it’s nice to strike up a random conversation with a stranger (I’m Californian).
Started Project
In the summer between MS1 and MS2 I had a project in the cardiology department. In the project I made new friends, and I even gained a role model. With that project completed, and classes ongoing, I received an email asking to help with another project. I like having projects, it keeps me busy and out of trouble — idol hands. Monday, I traveled to pick up the proprietary software/laptop I’ll be using for the project. A week ago I received a batch of portal ECG device I’ll use with patients, and from today I started on recruitment. It’s going to be a tough schedule for the next few weeks, this pilot project should be done in two weeks. The neurology part of this block also has its exam in two weeks. There is free time in medical school, I’ll just have to use it judiciously in the next few weeks. Anyways, I’m really excited I get to help with this project because I believe the results will be generalizable. Selflessly, a large bonus is that I believe this project’s scope will help my own parents health. I want to talk more about it, but half of the project is still proprietary and the hard work didn’t come from me.
I believe it was around this time, two years ago, that I interviewed at my program. Because cardiovascular disease has literally plucked those I care about away, I ended up dropping all interests of PhD programs to become a MD. I have no idea if I’ll be a cardiologist, if I’m qualified to be one, or if I’ll still be interested when it comes time to apply for that fellowship. But, what do do know is that I’m grateful that I even have that as an open possibility.
Research, I Missed It — Also Known as Funding Summer
Hello,
So, I get to approach patients from a different perspective, this summer I will work with patients for research purposes. I imagine this is coming for most medical students. During the summer, we aren’t funded — as far as financial aid is considered, we just disappear off the face of the earth, then we reappear out of the blue in the fall (to their credit, this is totally feasible at a quantum level). Thus, we do things during the summer to make ends meet. Some just have pared expenses, and have enough to scrape by for the summer. Others, they return to their home state or stay with nearby relatives because it works out budget wise. Many do research projects, paid (CNA) nursing exposure program, others traveled to foreign countries on stipends, and some give an extra hand as a student doctor at satellite community clinics.
The very fortunate, they do a well deserved nothing. If you’re one of those people, please, party a little harder in my honor as I live vicariously through you.
For myself, I think I’ve mentioned it before that I’ll start working on a cardiology project. I wanted to avoid the stress of trying to find a summer project, so I contacted the doctor I’m working with now early in the fall quarter. This may sound sort of ridiculous, but I did it early because I knew that most of the deadlines for scholarships come in February. And, it’s a lot easier to accomplish research related stuff like funding, required medical human research training (a lot of online modules and quizzes), writing a proposal etc. I’m a lazy person, so I knew I had to space these tasks out or I’d feel overwhelmed. Most projects involving people or animals will involve those steps, with the only big modification being the level or type of online ethics training they’ll need to do. There are different ethics training you can do, NIH, CITI, depending on the place you’re at. However, that CITI one is usually considered gold currency between institutions. The reason why I’m saying all of this is because I was fortunate to have a lot of my old ones roll over, because I had to do a lot of them for work before (you always use the same account for ethics training, it’s ethical!).
To back things up a bit, and to make a point, I think you should make it a point to do research only if:
1) You found/know where to find money.
Finding money is a big deal in research, no matter the purity of intent, plenty of great ideas go unfunded. Also, unless you’re helping the unfortunate, you shouldn’t be afraid to not want to eat Cup Noodles ever again when trying to raise money for the summer. In undergrad, I did a lot of free research work/labor, sometimes paid usually not. Admittedly, it was a lot of the unpaid portions that probably help catapult me into medical school. Therefore, I can entertain the argument that there’s more to research than your stipend. Indeed. And, if you can find a landlord that accepts “good spirit” as a form of payment and I’m with you. But, life is unpredictable and you can’t determine when you’ll have a random expense you didn’t see coming (in my situation, just found out my landlord is selling the house so it’s time to hit the market, again 😞.
2) The subject/purpose really matters to you.
A seminal event for me, was the death of my grandmother. She was a second mother to me. Her death was untimely. But, who’s death is timely? She died of a pulmonary embolism during surgery to remove a stent, secondary to the stent that had built up plaque on it — in fact, these stents come with huge contraindications. Understanding that my grandmother, who grew up physically cripple and illiterate but full of spirit and love, essentially drowned in her own fluids until her heart finally failed never sat right with me. It was also the lynch pin event that sealed me to sign my soul away into medicine. For myself, I wondered what life would have been if I were a physician in training instead of chasing my curiosity. I suppose, now I feel the answer lies somewhere in between. So, I’m doing research in cardiology.
Started training and sat in several meetings to prepare for the project.
For the project, last week I had a required session for electronic health records training, the system we use is called EPIC. This is just a computer system for patient charts/hospital records, physician notes, prescriptions, surgical histories, labs etc. — part of my project involves going through a lot of charts. Boston has the most physicians per capita in the US, number two I believe is New York, and so we have a lot of hospitals and clinics. Beyond that, a lot of large hospitals have interconnected health records. So, when I’m at the community clinic I see primary care physicians using EPIC; they use it to chart and look up patient medical histories after (while) interviewing. Even while shadowing at the main hospital, EPIC is also used at the hospitals where I shadow. In other words, I will have to learn how to use it, might as well do it now.
Part of my project, or rather part of my grant, involves co-mentoring and running journal clubs for 10 undergraduates who were invited to Boston University (with free housing and a research stipend). I just saw the schedule, apparently we have a journal club meeting every week, and we’ll take them out on the town several times to seduce them into science. The rest of my days will be spent doing my project.
I won’t bore you too much with the details of my research, other than saying it’s a project in atrial fibrillation (AF). I’ll be recruiting patients, and possibly analyzing (preliminary results) extensive ECG records. So, to prepare for that the principal investigator (cardiologist) and with my research partner (fellow classmate/friend) and I, spent most of the early morning discussing AF: epidemiology, socioeconomic factors, statistics, etiology, genomics, physiology, and finally the impact on patients as people. He gave us a tour of the parts of the hospital we’ll be working. Our hospital is a medical complex, so there’s several buildings, and many floors and buildings built later than others. As such, it’s like maneuvering through a catacomb, underground dungeon included. We met several physicians, nurses, spoke to several coordinators, and many other friendly faces.
Tomorrow, I’ll help the undergraduates move into their dorms. I so rarely go to the undergraduate campus, so it’ll be an adventure. But, before that I’ll meet with my research partner and we’ll practice running the research consents past each other. We figured if we stammered through it with each other we’d better feign competence when working with patients. This weekend we’ll be spent reading the eight research papers our PI just sent us, and of course making sure to take time out for a beer.
To summarize, or distill something useful from this post:
1. If you know what you want to do have things lined up so that you may apply for grants and scholarships (scholar programs) early, it’ll remove a lot of the last minute scramble. Keep in mind that a lot of deadlines come in February of the year you start medical school, so it’s easy to miss these if you’re not aware of them.
2. Don’t be afraid of the occasional double booking of plans, as long as you don’t commit it’s okay, because some plans fall through (PI ran out of funding, or something like that). Don’t try to double dip, but do make a plan A and B. My plan A was this opportunity, my plan B was an amyloid cardiology project. I was honest with my plan B, I told them that I had plan A, and they told me to come to them if plan A fell through.
3. Don’t be afraid to apply for outside funding as well, especially since institutional money (usually as spread out as possible) won’t be given to everyone who applies. Also, I enjoyed feeling removed from the competitive pool when people were wondering who got funding and who didn’t. I applied for several scholarships and didn’t hear anything back from any (including a Tylenol grant). But, applying to medical school means being rejected by a lot of places and hopefully gaining acceptance somewhere. So, it didn’t feel that bad to hold out for help since I wasn’t facing any real deadlines yet about earning money. In the end, I received a NIH partnered with American Heart Association grant/scholar program. It’s important to say that I didn’t just solo mission, I also used the resources given to us by our school and followed tips about who to talk to when I got the chance.
So, even though I have a lot of work ahead of me, some coursework, meetings on meetings, patient screenings, and data splurges, I’m just happy I have money for both rent (including enough to search for a new place) and security that I can fly to see my parents and friends this year.
Thanks for reading!
So first year is over…
Hey Everyone!
Sorry I’ve been away for a while, things have picked up more than I expected.
First year is over, technically, all of my lecture material is over. But, I still need to take an exam next month to finish the entire year. I’ve had the last two weeks off, and I’ve used it wisely. I said goodbye to a friend who matched in California, he was actually the person who housed me during interviews (he didn’t know me at the time). We spoke on the phone several times before that, and his personality, and thoughts about our school had a big impact on my decision to come here. Anyways, so when he invited me to Cambridge for some beers with his friends I jumped at the chance to wish him off. There, I met two of his friends, one of them a rising 4th year who I’ve seen around a lot at the hospital/campus but never interacted with; all of them very nice people. I was expecting him to talk about his residency, instead we talked about books they suggested I read: Les Miserables, A Tale of Two Cities, and also Pride & Prejudice. Then we talked about Bram Strokers Dracula, you know, before vampires were sex symbols.
Then they asked me a question I hate to be asked now, “What are your hobbies”. For once, I replied honestly to this question, “I..actually don’t remember anymore”, I responded. Then they asked me something I haven’t been asked in a long time,
“How are you doing?”
It’s funny, the difference between prefacing your conversation with the phrase, “How are you doing?”, and interjecting it later into the conversation. At the beginning of the conversation, it’s the “ice breaker” we all learned how say to be polite. Used later, it’s a genuine question.
As medical students, we soon learn not to expect to be lent an empathic ear. Many of our problems seem to pale in comparison to others. In good taste, we don’t try to garner it from our patients. We can’t explain how we feel exactly to our parents, they’d seen as not being appreciative of the opportunity given to us. When we try to vent with non medical friends, we’re reassured we’re going to be doctors anyways so it’s okay. Many of our peers within our class are too afraid to vent, some will pounce on your ‘weakness’, and castrate you for not being as dedicated as them. Well intentioned [and fundamentally correct] folks will tell you, “Just stay balanced”, then you realize you’re even failing the concept of balance. If I whine to a premed, they’ll rightly counter, “Well, at least your in medical school”. Interestingly, the only people who give a shoulder of support end up being more advanced doctors in training or physicians; they’ve been through it: no matter how you feel you need to perform well.
So, after many months of holding back how I felt about things I was able to share my feelings over some beers with upper classmates. It was a re-affirming, if not purely a cathartic experience. I told them how I felt, and what I’ve seen, and overheard. The distasteful (albeit, inadvertent) things said by classmates that haunted me, my random feelings of inadequacy (see first clause) and ‘war’ stories, and pent up stress mostly due to not being able to explain myself in earnest — things I’ve had to keep off of here because my blog is now followed by a couple of classmates, some don’t know who I am (the intrigue!)
If you’re in medical school this time of year, and you’re reading this as a first year, I’ll give you advice that those advanced students gave me:
1. Make time for yourself, or else you’ll crack.
2. Hang out with upper classmates when you can, they’re usually more chill about things as they have things in prospective.
3. The first two years of medical school are formative, but grades aren’t that big of a deal (Step 1 however…)
4. Exercise.
5. Find your hobby. (writing ✔️)
6. Know when to stay away from neurotic people.
7. Read something unrelated to medicine everyday, i.e. no more JAMA over milk and cookies.
8. Know when to stop studying, sometimes it’s just not worth it.
I’m sorry if you were hoping for a big moment of awe and reflection, or perhaps an entry on how easy I thought medical school is. My big reflection, if anything, is that I need to do a better job at taking care of myself. While I’m getting by in medical school, I’m not utterly destroying my courses so it’d be arrogant for me to toss out advice. But, what I can say is be sure to find a place where you can speak, where you can admit your flaws and not be judged.
It can be hard and tiring, pretending like you have it all together =)
Stay tuned, the next post will be less about me and more about what I’m doing as a medical student with my summer.
Understandably, you may not be able to reach out to others, so if you’ve got some pent up emotions over medical school and no where to share them then just message me, or email me doctororbust@gmail.com. Your stories will never be used in my writings, if you want to share then fine and we can work that out, we can do so anonymously to the public (obviously, confidential to me).
Forgive the wine-ladened typos/errors!
I LIVE!!! — And Plans for The Future
Hello Everyone,
Sorry for the absence, medical school had me a little occupied. There are a lot of tests and competency evaluations in medical school, especially within the first couple of years — though, let’s face it medicine means a career of learning and evaluation. This post will include some details about my class load, a general synopsis of what’s going on. Another point of this post will be to talk about the summer, a critical time for students transition from first to second year in medical school.
I don’t want to freak any premeds out, but there’s a rumor that circulates quickly during the first year of medical school that you have to do certain things to even have a fighting chance at obtaining a residency later. Besides the obvious Step 1 score, there’s a lot of talk if being busy during summer “secret requirement” of residency programs later. Those with concerns aren’t just being neurotic, graduate medical education is capped and not everyone finds a residency across the country (for brevity I’m excluding this conversation to MD match system). This means that about 5% of US senior MD candidates don’t initially match, though there is another match system ironically called SOAP — this 5% could also merit another debate for another day. With that all said, the word of advice that I’ve heard from upper classmates and faculty is that you don’t need to worry about using your first summer for residency. Actually, I’m of the opinion that your number one goal during medical school, especially in the first year, is maintaining your sanity (in public at the very least). You taking off time might mean a fresher you and better you. In short, for you summer do what’s good for you.
Currently, my class load are medical courses (fun fact: we are the last class year to have this curriculum, the future classes will have a more guided lesson through medicine):
1. Physiology – we just finished circulatory and gastrointestinal. Now we’re moving onto pulmonary and renal. We will end the semester with endocrinology with a unit to itself. For neurology, we had a separate and dedicated neuroanatomy/neuroscience block earlier this winter.
2. Genetics – just finished this course. If I learned anything from this course is that when I’m a physician I will both 1) appreciate that I learned more about genetics and 2) understand that genetic counselors have a large role to play in both short term diagnosis and long term patient education. My program really explored some interesting topics such as sexuality, rare diseases, and ethical dilemmas I will later face from genetic test results.
3. Immunology – we will start this next week. I expect alphabet soup.
4. Clinical Medicine – we have clinic or hospital (or both) hours assigned to us. The first year it’s four hours per week, the second year it’s up to eight, and well the 3rd year you’re just abducted by the hospital. Right now, what you do during your hours depends on who you’re attending is. One reason why I chose this program was because of the early exposure to “doctoring” and the fact that it’s a safety net hospital system. For various reasons we’ll leave unaddressed in this post, a lot of the patients “unwanted” at other institutions are our primary patient population. We do a variety of things, from standing around to randomly helping during a procedure — they don’t call it a teaching hospital for nothing. Most of our time is spent talking with patients, taking their histories and learning more about their story. You learn a lot from patients : you learn that the cute little old grandma-eusqe patient that you like also just quit heroin for years prior, how some people writhing in pain from cancer worry more about their families than their diagnosis, or see even those embroidered with intimidating prison tattoos can still weep in the face of chronic depression and disease. I’m learning a lot about humans, it gets me through the week.
Summer Research Plans
The summer of the first year is a wonderful time. Some feel pressured to keep busy, but I don’t think that’s necessary. They’ll be plenty of time for research later and clinical experience, in fact by that time you’ll probably be more useful of a team member. So, if you’re into traveling (or vice versa, want to curl up for the summer with a book, go for it!). Some students do a lot of things during the school year and nothing during the summer. For myself, the load of medical school was enough so I’m using my summer for my ‘side goals’:
1) Find something to motivate me (I’m goal orientated)
2) Raise money for summer rent and food
3) Become better (useful)
The first two are constant pursuits, the latter is the latest goal I’ve stapled onto my agenda. I think the biggest motivator right now for improvement, besides the obvious clinical applications, are my classmates. It’s really hard to overstate how awesome they are, in how they think, the questions they pose that I did not. It’s not a competition you see, I just really bask in awe at times at their individual geniuses and focuses. As such, it makes me want to work harder so I too can add something.
For myself, I’m planning to get involved in cardiology research for the summer: atrial fibrillation. The great news is that I solved my summer bill problems (and then some) with a stipend I’ll receive for it. So, this month I’m working reading up on atrial fibrillation so that I can submit my proposal. I interviewed a few weeks ago for the research grant, it had a number of steps to undertake because it’s funded through the NIH and the American Heart Association. Fortunately, I passed that phase, and all that’s left is for me to submit the proposal start working with patients that have already been screened from the hard work of another arm of the project done by others. Coincidentally, the turning point for me going into medicine was a cardiology related death of my grandmother, so I’m happy to turn my attention towards heart disease. About the timeline of the research, it’ll be conducted mostly during the summer. However, project and grant requires a longer commitment, so I’ll continue the work in my second year as well — by the way, although it’s unlikely for myself, some students with field changing results choose to take their second year off to publish etc. Though, I think the end point of this research is to add to some patient literature, so it should be an interesting trip.
In case you’re curious how to find a research position in medical school, it’s actually a lot easier than in college. Of course, the opportunities available to you will depend on what medical school you attend. Though, even if your program doesn’t have the clinical or bench research that you want to work with you can always do an externship program — though a lot of the institutions prefer to internally fund their students than others. For myself, I used the time honored tradition of just pestered a cardiologist I found with emails until we could meet. I was awarded for my persistence with an invitation to join in the summer. When I chose my school, one of the reasons was because I already looked up some labs I thought were interesting or cool to me. My main source of healthcare has been clinical trials, I had been enrolled in them for over a decade (in fact, I’ve donated quite a few chromosomes towards the cause of pharmagenetics). So as a former patient, I have a big belief in the importance of medical research and I’m happy to be on this side of the court yard where I can hopefully have more influence.
Community Service
I need to figure out how to serve my community here in Boston. I’ve lived here for less than a year, and I’m still learning which way is north and where the food is. But, as time goes on I can’t forget that service is one of my main driving forces. I think I just have this fear of being useless, though we can probe into my sanity and self esteem in another post. Luckily for me, part of my research grant includes the requirement that I mentor and “show the ropes” to a trope of premeds who’ll receive a scholarship (from universities across the country, including Puerto Rico) to live in Boston for the summer and learn about research. I believe they’re selecting 10-12 (I’ve seen some of the list so far) people from several thousand applications, interestingly their selection criteria isn’t that different from picking medical school invites. The big goal of the program is to give a chance to those with the mental abilities but lacking opportunity — robust plants that just needed some water and sunlight. We’ll lead them through journal club discussions, and other exercises, and answer random premed questions — aka mentorship arm of the program.
At some point in the summer I’ll figure out how to take a vacation. I have very easy vacations: I go watch jazz or go to drink coffee, I’m easily satisfied. But, I think it’s important to emphasize that you can easily take the summer off during medical school and it likely wouldn’t have much impact on your residency application. But, if there’s something you just want to try or dabble in, the summer is a good time to go for it. Though, if you need to raise money for the summer, then accomplishing your goals and getting rent money is a good way to go about it. If you want more access to scholarship money then be sure to enter your medical school email into interest groups, the research or activity you’re doing might coincide with the requirements for a grant if you’re lucky.
Last Hospital Shift of the Year
Hello Everyone!
Happy holidays, I’ll be ringing in my last shift (possibly, unless I get the itchy urge and find another slot) of the year in the ER/Trauma tonight. Tonight’s ‘uniform’ will be white coat and scrubs (also known as medical pajamas).
Doctor: can you guys call the other pharmacy to verify their prescriptions, dosage, and amount? If you don’t understand what they say ask them to repeat it.
Other medical student and I in unison:….sure…
Medical school is interesting because you cross the line of your comfort level a lot, for me it was a simple phone call. Everyone has seen the gibberish on prescription bottles, it’s a niche language, unless you mother tongue is latin I suppose. At my level of, without any pharmacology coursework, you might as well be speaking dolphin if you rattle off drugs to me. Anyways, it was a mission accomplished after googling the pharmacy and boasting my best competent person impersonation to the pharmacist over the phone.
The line between being a fly on the wall and becoming part of the process is ever blurring, even if it’s in the most modest of ways. For the surgical residents we stayed with making phone calls was probably the most trivial part of their day.
In class updates my neuro exams were yesterday, so academically I’m done for 2014! The verdict? Neuro is going a-okay according to my exams. Last semester’s medical biochemistry gave many of us quite a pummeling (even biochemistry majors), so I’m trying to learn from that experience and make improvements in how I approach studying for medical school — if neuro is any indication I’m headed in the right direction.
In physician training news we start giving physical next year (January 2015), upon admittance some generous alumni paid for all of our medical equipment:
After further work with real patients, for the first time, we’ll be exposed to a standardized patient to evaluate/grade our proficiency. In the meantime I’d rather not torture patients, so this month I’ve been volunteering my friends to eye and ear exams — incidentally, I never noticed how intimately close you need to be for eye exams:
I won’t be traveling home for holidays, I’ll just hang out in Boston instead this year. In Boston a large chunk of the population are students, college students at that, so plenty of people leave this city this time of year. As a consequence, a lot of my classmates have flown home, while some like me are sticking it out here. But, I’ve already made my agenda for how to spend the vacation:
1. Blog a little more (not to be substituted for sleep), hopefully it’ll be helpful for premeds
2. Go to favorite jazz bar several times, possibly with other people (haha)
3. Sleep
4. Experience Boston Christmas experience
5. Skype with family
6. Oh yeah! Wash white coat, this thing attracts stains
*7. Take time to appreciate the volume of information I just absorbed, won’t be studying, but I will bask and reflect
I wish everyone a happy holiday!
Neurology Midterm Over!
Hello,
Finished part of neurology, the midterm was worth 30% the final will be worth 70% of the grade. The course is split up between lecture, lab, and discussion (electrophysiology). The lecture portion of the course only started a few weeks ago, but we’ve already covered several hundred pages, between 1500-2000 slides (120-180 new slides per day), and several hundred more pages out of the text if you found time to do that as well — I should note that of the 120-180 slides you’ll probably only receive 1-3 questions, so you study everything in the hopes that you might understand it and hopefully see that concept on the test. In lab we dissect the brain we dissected out from gross anatomy, it’s a good break from lecture and requires less brain power than participating in electrophysiology discussion. So, you might be curious what learning neuroscience/anatomy is like. Well, the easiest way to understand it is the example below:
In the ball above, imagine your were given the task to find out where each rubber band was going. This also means knowing where each rubber band was crossing another band. Now, imagine each rubber band has a function, so you’ll need to know that too. And now, imagine you weren’t allowed to take the rubber bands apart, you’re forced to make a 3D map in your head instead. That’s medical neuroanatomy.
So, medical neurology/anatomy comes in several flavors. Some questions give you an amorphous blob and you’re expected to make sense of it:
A typical medical school question in neuroanatomy is a second or perhaps third order question, they’re doing you a favor if they ever ask you a first order question. For example, it’s rare that you’ll be asked ,”What is structure L?”, instead it’s more normal to ask “Where do the axons that originate in location L?”, or, “What symptoms would manifest in a lesion of structure labeled L?”
From the lecture material we receive many vignette style questions, also known as mock board exam style. If you’re not familiar with a vignette, it’s just a short story that leads into a question. Some of the story will be useless some of it will be useful, it’s your job to figure out which is which — it’s not far off from how real cases tend to be. A typical style question for neurology is:
“A 53 year old right handed bartender comes in after insistence from his wife because he’s been tripping more than usual lately. His pupil reflexes are intact, and he’s orientated in time and place. The neurological exam was unremarkable, except that his reflexes were exaggerated in his left leg. You also notice that he stumbles to his left when you ask him to walk with his eyes closed, this only happens when his eyes are closed. In general, what lesion would explain his symptoms?”
A. upper motor neuron lesion, right posterior spinocerebullar
B. upper motor neuron lesion, left posterior spinocerebullar
C. lower motor neuron lesion, right posterior spinocerebullar
D. upper motor neuron lesion, left rostral spinocerebullar
E. upper motor neuron lesion, left ventral spinocerebullar
On the upside, the questions are interesting and you start to feel all doctorey! Now, I feel a lot more prepared to attempt to understand when a patient comes into their appointment with a constellation of symptoms not easily explained away. Presumably, now that I just learned a bit of neurology I’ll think every patient that comes in has a neurological problem — I also assume I’ll think the same way for each system that I learn about. I suppose it may even sound a little silly, but it’s funny how the symptoms you learned just but a day or two before become relevant when that patient walks in the room. Sure, you won’t see that 1/100,000 diagnosis, but you will see stroke survivors and those with lifestyles that all but summon an impending cerebral accident. So, neurology is tough, but it’ll be the first time in medical school medical students will start to think like physicians.
Agenda & Updates — P.S. Do Your PS!
Hi,
Here are some updates:
– I invited a recently accepted medical student who starts next year to a Q&A to answer some premed questions. If you have any questions you’d like to see answered then write me at doctororbust@gmail.com. I read and critiqued her personal statement, and I’ve been rooting for her the whole time, so I’m happy to see her get in!
– I will be editing/critiquing a limited number of essays this year, during winter break. I’ll talk more about this later.
– I’ve just finished my first semester of medical school, in the autumn I took:
- Medical Gross Anatomy
- Essentials of Public Health
- Biochemistry & Cell Biology
- Medical Histology *will return in the spring.
- Integrated Problems 1
- Introduction to Clinical Medicine
- Human Behavior in Medicine
The classes sort of dribbled off with time, that is as time went on within a semester we’d have less classes. What I learned very quickly was that this also meant you just simply squeeze in a years worth of normal material into an even shorter interval. I couldn’t say what everyone found to be the hardest courses, but overall people found Biochemistry and Anatomy to be both incredibly interesting and yet incredibly difficult. However, others felt Human Behavior in Medicine to be difficult — not because of the content of the course, but instead because our school gives us exams that are meant to imitate the board exams, i.e. read a vignette then pick the best answer (being right just isn’t good enough anymore). I survived for the most part, but not without a bruised ego and an arm off.
“I’ve paid my dues,
Time after time,
I’ve done my sentence,
But committed no crime,
And bad mistakes,
I’ve made a few,
I’ve had my share of sand,
Kicked in my face,
But I’ve come through” — Queen*
So, now my winter Turkey Day holiday vacation is over, and I have the following courses:
- Introduction to Clinical Medicine II
- Neuroscience
In Introduction to Clinical Medicine I we focused on obtaining a history. To practice obtaining histories we either rounded at hospitals with outpatients or at clinics with inpatients. If you were doing inpatient then it was typically just a didactic exercise, if you were with inpatients then your history obtained likely became part of the medical record (if you obtained a good history). This course was the highlight of the week for us, it was a stiff reminder of why we’re doing all of this, why we lose sleep and eventually cry (internally or externally) ourselves to sleep at night: the patients. Overall, it’s a good course, and it’s a good time to measure how much you feel like seeing patients. My program focuses on being a safety net for those who are denied by other hospitals, so we field quite a variety of the sick and the poor — this was one of the big reasons I chose this school. In the second part of the course, now, we’ll also focus on doing physicals and auscultation and then practice them with patients during our shifts starting in January.
I’ve learned a few things about how to better study, and about efficiency, I’ll write it up at some point so and you can judge what you feel is useful for you (if useful at all).
About Critiquing Personal Statements
A lesson that I learned after applying to medical school was a basic one: do everything you care about early and do it right when it’s time to do it right. So, if you’re a premed reading my blog right now (first, thanks for reading!) please be sure to make every effort to put in your application early. Turning in your application early takes a lot of work, one of the most onerous parts is writing your personal statement. Sure, you may know person who astonishingly did everything late and still got into medical school but as its commonly said, “Even a broken clock is wrong twice a day”. So, as a friendly reminder I’m trying to tell you it’s probably time to get working on your personal statement even though it’s just December. Having a rough draft this early in the game gives you a lot of time to polish your apple before application opens.
Anyways, to facilitate this process of getting you to write I’ll be reading a limited number of personal statements over my Christmas break. Last time I read over 40 people’s statements, it was entertaining but rather labor intensive, so I won’t be doing that volume again. Instead, I’ll take personal statements in batches, at a first come first serve balanced by your need (and while it’s unfortunate, you being late isn’t a need). It’ll be the same rules as last year, you submit a final draft and you’ll get three re-writes critiques with me. When editing I’ll focus on your narrative, style, and structure but I will not re-write your personal statement as that’s fradulent. The grammar is your beast to conquer, I won’t fix anything unless it’s a mistake I don’t expect to be caught by your other editors — I’m not trying to be curmudgeon, rather it’s to encourage you to use your three re-writes with me wisely. This year, I will be accepting donations via Venmo, you can pay as much or as little as you’d like. However, if you can’t afford it (once, I was in your boat) just let me know and I’ll do it pro bono (you don’t need to write me a financial assistance essay, just give me a heads up).
This winter break over, I will be limiting the number of people I accept to five (potentially minus one, to make four spots; I’ll keep you updated as the spots run down). For now, if you submit to me or not, here is some links of previous work I wrote up about personal statements:
https://doctororbust.wordpress.com/category/medical-school-applicant-life/ps-personal-statement/
Good luck!
Editorial note: originally, I wrote a line about my experience. And then I realized it sort of sounded like a Queen song, so the result was the quote before above — I love Queen.
3 Myths About Medical School
1. You’ll never have time for anything else but studying.
Don’t get me wrong, there will be periods in your medical school career where it’s not reasonable to do more (studying for exams, boards, 3rd year), but so far everyone I’ve talked to at my program still has a life and are getting things done with their education. People in my class run half marathons and other random events, go to theatre, coach soccer, married and some have children. For myself, I still have time to schedule in events (saw Atul Gawande speak last week) and crank out a post or two, go out for walks around the park etc.
Though, medical school was giving me a good stomping at the beginning with the course load (had 4.5 courses at the beginning plus out patient clinic hours) you eventually learn how “you” can get on with it, and well you just get on with it. This isn’t to say medical school is easy either, it’s the most challenging thing I’ve ever attempted, but it’s certainly doable without ruining your personal life. Some parts of medical school are difficult because of the conceptual parts, but some most of it is just knowing when you have to brute force learn concepts in order to make the conceptual part intelligible — and you have to learn to find the balance between it all and your time.
2. Medical school is full of gunners, waiting to slash your brake lines so you don’t make it to the final on time…or at all and will ruin your life.
Whereas, some people adopt a definition of the person who wants to be “the best”, I believe a gunner is someone who while trying to be “the best” while hoping everyone else is beneath them is rubbish. If there is anyone in our class like that, they’re doing a stellar job at hiding it. Usually, people post/share their own study guides and charts, or useful links for the whole class to see. There are study group cliches, but it’s pretty easy to get invited, make, or to crash any study group you see. Maybe different programs will have different experiences, but most of my friends at other medical schools feel the same way about their class in general. The gunner talk is a sticky subject, by definition being the best means you’re better, but in a team (medicine) being the best individual is less important than the team being at it’s best. Wanting to be at your best, that is being better than you were before, is what I think most medical students strive to.
If anything, I feel people were a lot more Lord of the Flies tribal in undergrad than now in medical school.
3. You’ll never use that premed stuff in medical school.
You’ll never sit down and calculated a long winded titration problem again, that much is true. Nor will you try to figure out the coefficient of friction between the IV lines and the hospital bed pulling the line tout. No, you won’t sit down and calculate how many ATP and FAD molecules will result from burning 90 grams of sucrose, nor will you ever be asked again to show the conjugation on retinol. But, it’s tacitly expected that you could understand the concepts (or main ideas) in all of your first year of medical school and into the future. I don’t need to write out each molecule’s Lewis structure in metabolism, but understanding Lewis structures and organic chemistry make the information easier to digest conceptually while I brute force memorize steps. You’ll definitely never be as detailed orientated with the steps, but you need to have a broad understanding — it’s all about the basics. Le Chateau still comes back as the Bohr Effect in blood as does ferromagnetism when talking about oxygen carrying ability of heme. You’ll never really strip away the science from life, because life is science in action.
So, to pay homage to all of those hard working premeds: all of your hard work is for not. But, don’t worry if you’re admitted into medical school you likely have the skills and dedication to finish it even if you have an eternal hate for the prerequisites. In fact, most of the things you’ll need to be a good doctor will likely be much later in medical school and into residency. So, on one hand in the scale won’t play out day to day in our futures — no one calculates the amount of joules imparted into the cyclist who was struck by a trunk in trauma, but understanding the concepts makes it easier to explain to the cyclist he’s lucky to be alive because doubling his speed quadrupled the punishment on his tattered body as raced down the hill. If anything, your understanding of science will always carry you on the concepts and being able to explain things to others effectively (assuming you also have communication skills).
With that said, back to studying for me (see the first myth).
What Weekends Mean as M1 – A Study Break Entry
No new material to stuff into my brain, that is what weekends mean to me now. Yes, this still means I study on the weekend; but instead of studying while being swamped with new information, on the weekends I can finally come up for air because there is no new material being added to my “study list”. But, medical school isn’t all work and no play, today I went to an 3D printing fair at MIT. I saw a couple of cool things while I was there, I found a few objects crafted from the 3D printers and decided to make a display for your viewing pleasure:
But, the weekend doesn’t mean it’s time to slack off either, most because I can’t afford to. I spend less time studying on the weekends than during the weekday, except a week or two before the exams. On average though, I spend about 6 hours a day studying during the weekday and 4-6 hours on the weekends. Typically, Friday is making a game plan for the weekend, the weekday is surviving getting hosed by new material. Getting into medical school is analogous of thinking you’ve just climbed Mount Everest, but you find out quickly once you start medical school you’ve only reached the first base camp; and not only that but the mountain is growing each day. Those hours of studying also don’t account for the time spent watching and attending lectures. All in all though, I say things are working out for most of our class — we’ve only had one person drop out of the program thus far (they decided they would follow other goals). For myself, I’m doing what I can do to not only learn the material but to also get better at getting the material to “stick”. After all, studying endlessly sounds noble but it’s not that efficient, and time management is the name of the game now.
The trouble with the first year is really figuring out how to retain information efficiently, this will be easier or more difficult depending on your classes. We are the last year to not have systems based learning, and we are doing the traditional format, so we have seemingly disparate courses that somehow weave together as you slowly gain epiphanies by endlessly working on your general base of knowledge. I’m not sure if the more archaic way is for everyone, but it’s pumped out exceptional doctors those far so I’m okay with it (power to you systems based people!). With that said, each course here takes a different approach to how I should study. For anatomy, it’s mostly change into those dingy scrubs and spend more time with my donor — it’s faster then trying to imagine what it should look like. Sometimes, I prefer a library or coffee shop over than dissection lab, go figure, and at those times I use a combination of Netters (illustrated gross anatomy), Color Atlas of Anatomy, and now like everyone else in my class 1 mm axial cross sections of cadavers. Netters is very good for seeing the ideal form of how things should be because everything is rendered. The Color Atlas of Anatomy is a book full of prepared cadavers, so you’ll see the more visceral things you should see in real life. But, when I don’t have those at my disposal, or want a break from that type of studying I try to draw or make diagrams:
When I need to understand minute differences, I’ve always find that drawing made me spend more time conceptualizing the object that I’m sketching. So, this is how I studied the heart, and made a lot more sense after one drawing without looking at the real image. Another thing I used drawing for was the lungs, to capture the differences in relationship between the pulmonary arteries and the bronchi. Though, I still need to study a lot of things more to become more confident in my answers:
Sometimes, watching videos on Youtube and using Anki cards are the way to go for learning things I need to both memorize quickly and understand — tonight it’s cardiac embryology. About Anki cards, I’ve found that just taking notes almost straight onto Anki cards is more efficient then having to make them later. I’ve also try to make a variation of primary to secondary type questions for some of the content I understand less, for me, it’s important to spend more time with material that I don’t like and keep up with stuff I’m okay on to keep on schedule.
For some classes, you just need to discuss it aloud and you’ll understand things more. For example, if you’re having problems conceptualizing an ethical question or law, some times a conversation is a lot more effective than flash cards. The only important thing, for myself at least, is to have a decent foundation. That’s a fancy euphemism for memorizing a plethora of nouns and simple ideas. After I have those things, I can hopefully both understand the language of my classes and build a higher performance level of understanding from my foundation of memorized knowledge. I’m not saying this is the most ideal way to study, in fact, I’m sure others study differentially in my class and probably get scores and maybe with less effort. But, for me it’s how I pick up things besides reading it.
Medical school is very interesting in that there’s a lot of ways to get it done, even though everyone takes essentially the same courses — and you’ll be astonished at how each person in your class who makes it will work hard to make things work. And now, my study break is over, and I must go back to my studying. Good luck if you’re interviewing for medical school, I’ll see a fresh batch of applicants on Monday as usual, I’ll be sure to try to calm any nervous one I see — for me it’s back to work!
What’s Expected of a Medical Student
Hi All,
Fall here is in Boston and it’s interview season for premeds, I know because I see a calvary of anxious students awaiting their interview in the lobby of my school; coincidentally I camp out in that same lobby because I (and other medical students) know you guys never finish the food ordered by the school because you don’t want to look like glutens during the interview day — we empathize with you, but thanks for the free grub. It’s been a somewhat busy time for most medical students as well: most M1s across the countries just had their first exams, M2s across the nation are very happy they are no longer M1s and the boards are still far away, M3s have disappeared off the face of the planet into an alternate universe, and M4s are stressing out for both positive and negatives reasons, their match applications and their match applications respectively.
Here’s how I’ve filled my last few weeks:
- First Testing Block Complete: Gross Anatomy, Biochemistry & Molecular Biology, Public Health/Heath Law (hybrid), Human Behavior in Medicine
I’m on a traditional schedule, so our tests were jam-packed together, so from a Monday, we had a test every other day (3 tests) and the final test after “test week” weekend on the following Monday. Before that, we had a experimental Histology quiz, this will come back as a full class in the spring. Somehow, I’ve survived thus far, though I’ll definitely made some adjustments now that I know how the tests work. I don’t have any general advice, because I’m just trying to survive the zombie apocalypse here, but in general when you’re in my boat make sure to find what works for you as quickly as possible and be open to change and never fall behind more than a lecture or two in material.
Gross Anatomy is pretty cool, but impressively difficult as you try to remember the name and embryology relationship, vasculature and innervation of muscles, organs, and bones (and the imaginary spaces and lines concocted by anatomist). There’s a laboratory portion of the course and lecture, each weighted 45% of your grade (both making 90%) and the rest comes from a 10% dissection grade. Today we took out the visceral organs while leaving the kidneys in place, we’ve already taken out the contents of the thoracic cavity (heart and lungs) — we take great care to keep the organs with the body, as well as the tissue we must strip off, because at the end the donors will be cremated and their ashes will be given to their family. There’s a practicum and written test for Anatomy: for the practicum you just go about a room identifying pinned structures or their functions for a minuter per question, and for the written you take some medical anatomy tests with questions like :
“Steve was drunk at 3 AM, with his friends on his birthday. He had too much to drink and fell asleep standing up all while suspending himself on a railing at his right armpit. Steve wakes up at 5 AM, after taking a cab home he’s now sober he rushes to change clothes. While changing his short, he realized that he has a difficult time extending his right elbow and feels slight weakness when opening his right hand. Worried, he rushes to the hospital, after examination he’s discharged and told not to worry and an appointment for his PCP was made. What nerve roots would innervate this nerve that he likely impinged?”
On a high note, we also learned the age/occupation/cause of death of our donor, it was nice to get to know them — I think I would have loved my donor when they were alive. For their privacy, I’m afraid I can’t say much more about this. However, I’m happy they waited to reveal this information to us, they’ve been really systemic about allowing the experience sink in as we try to retain the innocence we had before we started this process ourselves. It’s easy to forget about how important the dissection is, both to you and your donor. But, it’s important to remember that, for our donors at least, they requested to be at our university and their families also agreed after their death. So, we are literally fulfilling one of their dying wishes — and that’s really quite a honor.
Biochemistry and Molecular Biology is sort of like a combination of college Biochemistry and Molecular Biology on steroids (a nerdy joke, I know), and how much information you’re responsible for is nothing short of amazing. They’ll almost never ask a first order question (e.g. Histidine has what charge?), it’s usually in some type of context and clinically related. I’ve been told even some Biochemistry majors have failed the exam, so don’t rest on your chemistry laurels in this course. Occasionally, there’s a patient study where a patient comes and we learn about how this person experiences their life with their disease. There’s a lot to remember so you can have a base level understanding so that you can understand the clues in the short vignette.
Health Policy and Health Law were too different classes, some classes were taught by economists, some by public health professors, and Health Law by lawyers. It’s sort of telling of how much you’re expected to have an understanding of as a physician. The tests were about laws (such as DNR, when pulling the plug is both ethical and legal as physicians, and patient rights), malpractice, health policy effects and trends, how billing works and insurance policies (including the Affordable Care Act). One thing I took away from this course was that insurance is very confusing.
Human Behavior and Medicine, that’s like psychiatry 101 mixed in with a lot of other things like professionalism, depression and drug abuse with physicians. This course is also called the “silent killer”, because many students put it off, choosing to put their time into other courses to only be dominated come exam time. This course is tricky, because you must pick the best answer in a field of relative decent answers, often two answers are good but one is just better. If you spend a lot of time with the required texts and talk out the points with others it’ll stick, and it won’t seem that bad. Every Friday, I meet up with my beer study group and we discuss the learning objectives and what we took away from X lecture — in other words we learn by talking it out. Incidentally, I can’t wait till Friday.
- Trying to find research opportunities Atrial Fibrillation versus Heart Amyloidosis versus Neurology research
I’ve reached out to a few people, and I’m looking to pull off some research next summer. We were told to try to find something early, and I want to find a good fit so I started looking early. My previous work was with reading squiggly lines and making interpretations (electrophysiology), so I wanted to get into something somewhat related.
- Signed up for more Trauma/ER shadowing for after Thanksgiving, may sign up for Neurology as well after some spots open in the winter
I really enjoyed my first Trauma shadowing experience as a medical students (I was also pleasantly surprised how much was expected of me), I signed up to be with the same doctor as last time (hopefully the schedule works out). I joined an interest group for Neurology, I’ll be signing up to shadow there too.
- Attended annual semi BUSM student event with date in tow
See cover photo. Can’t say what happened because “What happens in Vagus, stays in Vagus”, I’ll just say medical students know how to unwind after exams!
doctororbust 