August 3, 2017

Ear irrigation and Dix-Hallpike Maneuver and Updates

Today was an interesting day!  Surprisingly mostly because of clinic rather than what’s been going on in the in-patient setting.   So much a bit of background – I’ve switched over to the VA for the month on a different team, and we go to clinic once a week as well to experience what things are like at the outpatient setting.  The first time last week was a little hectic – my preceptor had just come back from a week of vacation and had a lot of catching up to do, so it was a bit of a whirlwind.

Today at clinic though, I actually felt like I was able to participate in the healthcare a bit, which was nice – I am starting to realize I would like to be able to do procedures/work with my hands at least a little with the patients.  Currently in the in-patient setting, I feel like my role has mostly just been talking to people (either patients, other team members, or making phone calls) and looking things up on the internet, but it’s mostly theoretical/medical management, and not as much hands-on.  But today during a routine check-up at the clinic, I got to help out with an ear irrigation due to earwax plugging up of ears leading to decreased hearing (and the patient was actually more comfortable when I did it I think), which was something I’d always heard about but never saw in real life.  Basically, she added drops into one ear (5-10) to soften the wax, then plugged it up with cotton and turned the head over to repeat on the other side.  Then they prepared a spray bottle with lukewarm water, attaching a small, flexible tubing to the end, and then removed the cotton, put the tubing into the ear, and gently spray into the ear until the earwax/dissolved debris runs out (don’t forget to put towels below and use a container to catch the water!).  Also don’t spray too hard, or it’ll 1) be painful for the patient and 2) it’ll spray all over you when it comes back out!

I also finally got to see how to do the Dix-Hallpike maneuver in person!  The latter was pretty exciting to me (even though the move actually turned out to be quite simple) because I’d had a patient with unexplained vertigo last month at the hospital that I thought might have BPPV, but since I didn’t know how to do it and no one on my team had done it before either, I wasn’t sure if I should try it, especially since she was so dizzy at baseline.  But now I know!  Essentially the person sits on the bed, turns their torso to a 45 degree angle, and they are supported down to the bed straight down in that manner (without turning their torso back to a supine position), to see whether they get dizzy.  As an aside, I did end up trying the Epley maneuver on that previous patient to try to improve her symptoms, but it was hard to tell which side was worse for her, and I don’t think it did anything much but make her more dizzy… :\  The one thing that did seem to help though, was talking to her and listening to her – she’d had a lot of really sad things happen to her children/family over the last few months, including deaths, stroke, diagnoses of cancer etc, and so talking with her and praying with her on the last day of her stay I think did much better than anything else we’d done for her during her stay.  I’m grateful I had that opportunity.  May God watch over and comfort that family.


April 27, 2017

Got the green light to write! (And a little about the graduation process)

Filed under: "Me" updates,Grad school,Research — sanguinemare @ 1:08 am
Tags: , , ,

Today, I had my (hopefully) last committee meeting before my thesis defense.  Basically, I presented the data I had thus far and asked whether they thought I had done enough work to graduate in the summer.  They said yes, praise God!  So I will be defending my thesis in early June, in time for starting medical school on schedule at the end of June (well, actually I found out that the rest of the class actually starts next week, oddly enough, on block “6A”, whereas the end of June one is called “1A”, but anyway…). The timing only gives me a week or two at home before starting back again, but at least there’s a little break, and it gives me an extra two weeks or so to write than I would have had if we’d done it at the end of May (my PI is out of town until early June, so that was the earliest that was feasible).

I’m not sure if it’s the same at all schools, just to walk you through the graduation process a bit, here’s our rough graduation process.  After the committee agrees you can graduate soon, we have to turn in an “application for degree form”, after which the graduate school will give us an approval form that we need to fill out and return to them 2 weeks before our defense at the latest.  This form will be the official confirmation to the school that we are defending, and they apparently put it on a school-wide calendar.  We also have to turn in our entire written dissertation (usually ~100 pages long) to our committee 2 weeks before the defense date so they can read over all the materials in preparation for the defense.  Then, we have our public, oral defense, where we present our work over the last few years to the public, and then we have a private defense after, where the committee decides whether the student has enough proficiency in their area to be awarded a PhD.  If this thesis defense is passed, we then make the final edits to the dissertation and need to submit the written thesis to the graduate school, where I think it gets bound and also put online.

In my program, the thesis itself can be either in the traditional format (an introduction, a body which has multiple chapters describing work done, and a conclusion), or a “3-paper model”, where essentially 3 individual papers are written up, which become chapters in the dissertation, and they are sandwiched between an introduction and conclusion.  That’s the route I’m going, because it seems the simplest way, especially since I’ve gotten one paper published already.

Ok, time to head to bed – tomorrow’s the all-day orientation for MS-3 year (pretty crazy to think that it’s finally happening!) so better get some rest before that.

Until next time!

April 14, 2017


Filed under: "Me" updates,Grad school,Research — sanguinemare @ 1:16 am
Tags: , , , ,

Ok, a very unprofessional title, and about 10 days or so late (now that it’s officially the 14th, at least here), but just wanted to post a quick update that… after staying up until 4am a couple nights re-creating the figures from scratch because for some reason they were apparently not in good enough resolution the first time and the (semi-)quick fix didn’t work… MY FIRST, FIRST-AUTHOR PAPER GOT ACCEPTED (for publication)!!! WHOO HOO, PRAISE THE LORD!  That means I’m all set for non-thesis related graduation requirements!

Oh how easy it is to bring a grad student joy, haha.

Now all I have to do is… revise paper 2, do all the assays and writing for paper 3, and write an introduction and conclusion… all within a little less than a month now, plus a committee meeting in the middle of that.  Whew.  I’ve actually been pulling 13-14 hour days in the lab every day from last Tuesday until Sunday (minus Wednesday for weather concerns), and then averaging around 9 hours every day since. Apparently this is pretty typical during the end-stage – I ran into a fellow MSTP a year below me in the elevator the other day and after relaying my current schedule, and he was like “what are you doing, trying to graduate?” I blinked a couple times at the irony, then replied with a “why yes, actually!” with a bit of a cheeky grin, and he nodded understandingly, saying “ah, the extremely productive final year huh?”  On a bit of reflection, I suppose that is actually sort of true.  Everyone always talked about the last year being the most productive in terms of both experimental data gathering, and paper-writing, and I suppose technically that has somewhat been the case for me as well.  So there you go – “n of 1” as they say, haha!

Just finished organizing all the miscellaneous parts/templates for my thesis tonight.  It’s starting to feel a lot more real now.  Yikes.

Wish me luck!

March 29, 2017

Struggles of a grad student – Part 1

Filed under: "Me" updates,Grad school,Research — sanguinemare @ 1:49 pm

Today was the epitome of Murphy’s law for a grad student – the classic case of needing to order supplies for a key experiment, and the lab not having it… and then not being able to order it due to a series of unfortunate events: the supply center which I’d sent the order in to yesterday is apparently closing and not accepting any more orders –> the other person we place orders from has an auto-reply e-mail saying they are out having surgery and not to place orders until they’re back tomorrow unless it’s an emergency, then contact person b –> person b also has an automated e-mail reply saying they are out of the office today and won’t be responding e-mails until tomorrow –> another supply center that I found out about from the one that’s closing ALSO has an auto-reply e-mail saying they are out of town right now and will only intermittently check e-mail.  *Sigh*  At least that means I should be able to place an order first thing tomorrow, but it also means that’s another day’s delay before I can start the assays.  At least there’s a few other steps (aka days’ worth of work) that I have the resources for beforehand.

Generally this sort of thing can be avoided if 1) there is good communication in the lab (and/or a good lab manager and/or a good system in place so you can easily check the lab inventory), and 2) you plan ahead.  Both are good practices to have so you don’t need to delay your work just to wait on things to arrive.

Sometimes, however, it is not really avoidable, such as in this case, where the study only recently finished, I only just figured out how many samples I had total, and then found out that there’s a 384-well plate machine on the 2nd floor that we are allowed to use that would make my life a LOT simpler (less reagents used per sample and a lot less plates to run: 12 vs. 46)… but the catch is that we’d have to buy the plates ourselves.  So I decided to try to go for that, and that’s how this happened.  Also decided to order some different primers to try based on the literature, and those need to be custom-made and take time, so yeah.  Timing is so tight right now because I have a committee meeting set for the end of April, and the extractions and processing itself will likely take 2-3 weeks of full day schedules, plus analysis time and putting together a presentation (while writing 2 papers and my thesis).  Additionally, I just found out from the lab I was supposed to get my samples from today that because they aren’t getting in the new freezer until tomorrow, I won’t be able to access my samples until Friday afternoon after they’ve re-put everything back where it needs to be.  These are the little day-to-day things that people don’t really think of being part of research, but are snags that will affect how quickly things can be done.

Anyway!  At least the couple days’ reprieve from retrieving and processing samples means I have time to look over the short students’ Letter to the Editor I wrote with a couple students on a side project that just got accepted with minor revisions, as well as to re-draft my 2nd paper, which my PI and I just decided we should expand to a full manuscript yesterday (as vs. the Brief Report we were originally thinking of submitting it as – there are different lengths and purposes of publications, which I might get into in a future post if anyone’s interested).  So yeah, that’s life at the moment!  No rest for the grad student – at least not one who’s trying to graduate in a couple months.

Catch you guys later!

March 24, 2017

Just sent in my revision for my first paper! (And why that is a big deal)

Filed under: "Me" updates,Grad school,Research — sanguinemare @ 4:12 pm

HELLO all you lovely people (aka the 1 person who may actually see that I have finally posted after months of hiatus)!  I’m so sorry for dropping off the face of the planet, but well, PhD life is somewhat of a struggle and between that and battling long bouts of depression, it’s been difficult to drag myself up to write something substantial like this.  (I have also come to realize that I think almost all graduate students go through a mini existential crisis/period of depression before it’s over, unless they are extremely lucky and really love their work, mentor, and are extremely fortunate in their ability to generate and analyze data, but that is a story for a different day… if I ever get around to it, haha).

… and now that I actually revisited my last post, I realize I have somewhat reiterated myself, so I guess not much has changed over the last… 7 months?  Haha whoops.  Oh well.  Also apologies in advance for the somewhat incoherence of thought on this post as my brain is currently rather fried.


So I literally just clicked “submit” on my revision for my first paper.  This is a big deal for multiple reasons:

  1. It’s a graduation requirement. Of course, this is my first priority right now, so it gets to be first on this list 😛  As a graduate student, at least in the biomedical sciences, we are usually required to have at least one paper published under our name before we are allowed to graduate.  This is because, as I’ve mentioned in my last post, publications are essentially the “currency” of academia, and programs want to help their students show that they are competent and competitive in the scientific world, which will help with their upcoming job search.  The slightly less altruistic reason is that it also reflects well on the department/program/school/institution if they can show that a significant portion of their graduate student population are publishing good papers in peer-reviewed journals (important statistics for funding purposes).

    The publication requirements will vary based on said department/program, school (i.e. school of health professions vs. school of bioengineering) and institution, but my particular one requires at least 2 papers published before graduation, with at least one being a first author paper (*note: review papers – which are essentially summaries of a particular topic based on research that has already been published – do not count towards this second stipulation).  The paper that I have just turned in is my first, first-author paper, and thus is super important to get accepted since I am trying to graduate in May/June, and it has so far seemed to take an average of 2 months for responses from journals, which means timing is really tight right now. Speaking of which…

  2. Revision = higher chance of acceptance (?). Considering this is my first experience with submitting a manuscript, I’m not entirely sure how accurate this statement is, but from what I gather, a revision decision is usually a positive sign for a manuscript to get accepted into a journal for publication, especially if the revisions are minor.

    To give a little walk-through of this whole process thus far, I first started the analysis for writing up this paper a little over a year ago, ~Feb 2016.  The first complete draft was written by June, and after many (many) revisions, we finally submitted this article to a journal in August.  We waited for a long two months, during which one of my co-authors casually mentioned that perhaps it was actually a good sign we hadn’t heard in so long because she had also submitted to the same journal a couple weeks later and had already gotten a rejection letter.  She was right in a way, because in October, we got our paper back with reviewer notes, which is better than an outright rejection since it means that the editors thought it was at least interesting enough to send out to reviewers.  However, the journal ultimately rejected it after the review, though they did give us an option to do an internal transfer to another of the journals in their group.  We took that option and I did revisions based off of the reviewers’ comments.  We then resubmitted it to the new journal this January (there was a brief hiatus on this work as I was out of the town/the country for a little over a month between Nov-Dec).  After waiting another 2 harrowing months, we finally got the decision letter last week, which basically said they thought it was interesting, but reviewers had concerns which made it unacceptable at the present moment. Hopefully that means it will be acceptable after the changes…?  So I made the changes, and sent it in today. (Though a slightly concerning note at the bottom of the letter said that any decision after the revision was final, which induced a minor paranoia as I went to click the submit button earlier today. Heh).  Here’s to hoping it gets accepted!  Which brings us to the last point…

  3. (If accepted =) it’s a milestone as a scientist/researcher.  I kind of alluded to this above, but basically, having a first-author paper in a peer-reviewed journal helps to establish your worth to the scientific community.  The first author is the one who has generally been involved in all the aspects of the study, including conception/design of the study, conduction of the experiments, analysis, reading of the background literature, and writing the manuscript. Thus, in a way, a first first-author paper establishes the level of work others can expect from the author in the future, and is thus like a debut of sorts into the scientific world.

So yeah. In a nutshell, that’s why I’m actually quite happy with myself/life for once, and will likely take this weekend to celebrate (some of us in MSTP are going to Six Flags for a day!) before the massive freak-out session starting next week about how I only

Thanks for reading and see you on the other side (after my defense)!

April 7, 2014

Life/MSTP journey update

Hellloooooo!  I am alive!

So sorry it’s been so long since I last posted… a lot has been going on this year, so it has been difficult to find time to actually sit down and write something cohesive/coherent.

Part of the reason it’s taken a while is because I started up a blog for our MSTP earlier this year, as an additional part of our Communications Committee (which previously only consisted of making a bi-annual newsletter).  As you can imagine, that took a decent amount of time getting off the ground and trying to find people to write for it, and/or writing for it myself, which made me less inclined to write here, due to brain fatigue and the desire not to duplicate posts.  I have recently passed on the responsibilities of the blog to another member of my team though, so I am finally able to take some time and come back here to post.  Yay!

So since I’m on the topic, I’ve done a decent amount as the head of the Communications Committee this year – put together 2 newsletters so far, which I decided to have come out in time for the first applicant interview day, and another one for 2nd look day which was early last month.  Our next one will come out in time for our summer retreat.  By the way, newsletters take a surprisingly long time to put together… or at least ours does, which may be more a reflection about how our “newsletter” is more like a “newspaper” in glossy pages and in color, at this point.  I’ve realized why it’s important to set a word limit now – trying to put together a newsletter when some stories run 3-4 pages and others run 3/4 of a page is rather difficult.  Plus, I had to completely revamp the newsletter the first go around, since my team was unanimous in saying the layout, design, fonts, and everything pretty much were pretty displeasing to the eye at the time.  So I took about 2 full weeks’ worth of time learning how to use InDesign (and really also how to use a Mac… ugh, I hate Macs).  There was a lot of time spent fighting both the machine and program… many many hours.  And a couple of my team also tried tackling one page for at least 5-8 hours each, and also barely got anywhere.  Frustration abounded, but we eventually got something decent-looking, I thought.   I thought it would go easier the next time, but this was where I ran into the page limit problem, and had layout issues, so it again took at least 15-20 hours to put together. *Sigh*.  Here’s to hoping the next one will go smoother.  I’m definitely thinking about stepping down from that next year, as I’ll presumably have more research going on than I did this year.

So now research/grad school.  Both have been rather trying, in different ways.  Hm. Looking through my blog, it looks like I started an update draft back in October (10/8/13 says the date on WordPress) before my last post on conferences but didn’t end up getting time to write anything.  So!  To recap the whole school year then – last semester was ridiculous, school-wise.  Due to obligations in both my PhD program and the MSTP, I ended up with 16 units (normal load is 9-10 units), so it was effectively almost a double load, and unsurprisingly, not a lot of research got done that semester, though I did do enough to write an abstract over winter break for the American Diabetes Association (ADA), which got accepted as a “guided audio tour” poster (which I gather is better than a poster, but less than an oral presentation).  Whoo.  Also, I am going to insert what I wrote back in October here – since I wrote it at some point, might as well not let that go to waste right?

I finally picked a lab!!!  

This is probably the biggest hurdle that I had to get over this summer, and a pretty decent source of chronic, underlying stress because picking a lab is one of the bigger decisions I think we as MSTP’s have to make (prior to residency decisions), since that’s where we’re basically going to be living for the next 4 years or so.  Given that I had chosen a field that is not normally part of the MSTP-affiliated PhD programs here, and rather late at that, I had not had any rotations with professors in the program yet, so had to cram 2 6-week rotations in this summer.   One was a pathology lab, and my project focused on inflammatory markers and monocyte rolling, while the 2nd was an obesity/diabetes lab where I worked on glucose transport in cells.   In total, over the last 3 summers starting the summer before med school, I had rotated in 4 labs: a LC-MS lab that was more chemistry-based, a stem cell lab, and these last two.  Ultimately, I decided to make this last lab rotation my thesis lab for a few reasons: the funding is relatively stable (or so I think/hope), the projects were decently interesting, the PI knows a lot and is willing to introduce me to a lot of people involved in the field (actually I was lucky enough that all 4 PI’s seemed like they would be great mentors), and there is potential to do translational research – that is, some bench-work, but also some clinical work.  The last reason was probably one of the more important deciding factors for me, and it seemed like that was something the PI really wanted to push for in my training with him.”

Well, looks like I was rather excited at the beginning of the school year in relation to lab, which subsequently has waned some due to the complications listed above and below.  This semester, I had somewhat of a lighter load, but still above the normal (13 units), which has been fine for the most part… although I recently had a review paper that I literally spent the entire spring break working on, as well as pulling my first all-nighter ever for school, working straight from 9am the previous morning until 5pm on the due date… which eventually came out with a poor grade last week, and I now have to re-write it.  That was quite a bit of a disappointment, as I’ve never spent so much time on something for school before.  Plus, due to some miscommunication, the professor who graded it (who happens also to be the director of the program) now probably thinks I’m one of the worst students ever… blah.  I really hope that doesn’t prejudice them against MSTP’s because I am not reflective of the typical MSTP, and also I think there was just bad miscommunication. :\  Research was also basically stalled for 3 months, due to my mentor not being that available and thus me not being able to do much since no one else in the lab is doing anything related to my project.  At least now I have a direction and can actually start gathering data again this month, whoo hoo!

Anyway, with all that going on, as well as helping out with being an SP (standardized patient) and various other things, I think I may have over-stressed myself because I have been having strange joint pains for the last 3 weeks or so, and a couple days ago, after being outside for a few hours, I noticed I had redness on my face and in patches around my legs.  Given the distribution of the rash, the arthralgias (joint pains), photo-sensitivity, and various other problems I’ve had in the past, I’m fairly certain I have either exacerbated or just triggered a systemic autoimmune disease, which is rather unfortunate.  (I’m sure if you look up those symptoms, you’ll be able to figure out what it is).  So that has been something that’s been weighing on my mind a bit the last couple of days.  I am hopeful this won’t impact me too much, but I think it’s also a sign that I need to stop piling up so much on my plate and to start taking better care of my health.  I just sent an e-mail last night to the people in charge of SP’s to let them know I might need to quit, especially if I can’t become a trainer anytime soon (which is the whole reason I became one in the first place, since it was a prerequisite to the position).  I may slowly need to start phasing other things out of my life as well.

In other news, I have also become much more involved in the church that  I decided to officially join/become a member of here.  I see that in October I was probably going to write a decent amount about it because I started out with “This is generally not something I would normally share on here, but I feel it has been such a significant part of my life in the past couple of months especially that I felt I should”… and it ends there.  Not going to go into too much detail right now as this is already getting long, but becoming involved in the church (which I’d been attending fairly regularly for a year prior) this summer and subsequently has played a huge role in helping me get over a depressive spell over the summer due to a bad break-up situation, as well as helping me feel a lot more grounded here.  I feel like I actually have community and friends now.  Not to mention being able to play violin on worship team has been a HUGE blessing… I knew I missed it, but did not quite realize how much until I was able to play again.  It helps center me a lot, and is good for stress relief sometimes, or just as an expression of joy.

Along that route, I have also started teaching violin this semester – one student has now been with me for 2 months and has made pretty good progress (to even my surprise haha, since it’s my first time teaching violin really).  I may also be getting a second student soon, which I am pretty excited about.

Ok! I think that about sums up things going on in my life right now.  I had a bunch of links I was going to put at the end here, but as this is so long, I think I’m going to save it for the next post.  Stay tuned!

May 25, 2013

Hypochondriasis? Or heart/lung problem…

Hah – one thing that studying for med school/Step 1 really does is turn us all into hypochondriacs (people who worry about/think they have a disease despite medical assurance that they don’t).  Well, I was feeling my heart yesterday and noticed that I definitely felt some heartbeats/flutters in the left sternal border (slightly left of midline in between the ribs).  Normally, you’re only supposed to feel a heartbeat at the point of maximal impulse on the left side of your chest, not near the midline.  In addition, I had been having some chest pains (for years mind you), and a semi-recent bout of a weird feeling of coldness in my lungs for a while, and recently also noticed that I either have an S3 heart sound or a very clear splitting of the second heart sound that is not affected by inspiration.

So of course I talked with my med school friend about it, and after looking up a bunch of stuff, we determined the heartbeat I felt was probably a right ventricular heave, which can have all kinds of bad stuff be the cause, or (hopefully) just subconscious high anxiety that manifests physiologically.  The other thing it could be however, given my other symptoms, and also the fact that I’ve always had some sort of exercise intolerance, is idiopathic pulmonary arterial hypertension (iPAH), which is not very good.  :\  Also most other things that cause a RV heave are also not very great… so I may end up getting that chest X-ray after all… bah.

It was also kind of funny because yesterday, my friend was saying, well, this iPAH this is pretty rare in real life – like 1/1 million.  But if you see this on a test with those symptoms, you should probably pick that.  So today, as I’m going over old test blocks (since my UWorld subscription for the test I took 2 Sundays ago expires tomorrow morning), what happens to be the first question (that I got wrong at the time)?  A question about iPAH.  Haha, oh life.  You’re funny.

May 21, 2013

The decision (and advice for future Step-1 takers)

Filed under: "Me" updates,Med School and the MSTP,Step 1 — sanguinemare @ 2:42 pm
Tags: , , , , , ,

The Decision

Well, it has finally happened.  I have decided to delay Step 1.  $100 in schedule change fees and plane ticket changes later, as well as giving up on my family medicine rotation and multiple long e-mails and conversations with faculty and a few med school friends, the decision is now final. (Skip to the Advice section if you just want to know my advice on Step 1 studying, and how I would do it again if I could redo it after going through all this)

The decision was not an easy one to make.  There were a lot of things I was concerned about. One major thing was my family medicine rotation, which I either had to do in June or would not be able to do it until I returned to medical school in my 7th-8th year, because of the way the MSTP pays for our tuition.  What that means is that 1) I would not be able to get the experience of medical practice before starting my grad school years.  From what I’ve heard from upperclassmen and staff, this opportunity (which our school only instituted a few years ago) is very helpful in both understanding how to put our basic science knowledge to practice, especially coming off of Step 1, as well as helps ease the transition later 4 years from now.

It also means that 2) I will have one less elective/Acting Internship (AI) to explore in my clinical years, since we are required to do family medicine (in order to apply to states like CA for residency, a family medicine rotation is required).  Why is that a bad thing?  Well, I tend to be one of those people who can’t make up their minds about what they really want to do in life, so having more options to explore is always a good thing.  I worry that I will end up being one of those people who finish 3rd year clerkships but was not able to rule enough things out, and still has no idea what they want to do, thus making the electives all the more important.  What I should also add to this is that apparently as MSTP’s, at least at our school, we don’t get the full 2 years that other MD students do to do clerkships and AI’s.  We only get 1.5 years.  Hence even more why “losing” one elective slot is kind of a bummer.

So what ultimately decided me?  Well, yesterday I took a full-length Kaplan practice test (all 7 hours of it) and my brain was fried.  And while I was going through it, almost every single question was a guess.  For those who don’t know, Step 1 is 7 sections long, 46 questions for 1 hour each.  Each question is usually a small paragraph in length that gives you a clinical scenario, and you have to figure out not just what the problem is, but some additional fact about it.  They call it a “2-step” question – basically after you figure the first thing out (like what the problem is), the actual question asks something associated with the disease, like what other problems that disease could present (show up) with, or what genetic markers puts people at risk for the disease, or what you treat the disease with, or what would not be used to treat it.  Stuff like that.  So it’s  pretty much a long day of your brain trying to run a marathon.

Anyway, so I took that test and… got pretty much the same score as I did last week.  Slightly disheartening of course, but I didn’t work nearly as hard as I should have so it was only to be expected.  Plus, last week I only took the 4 hour long one… this 7 hour long one was pretty brutal.  And I hear Kaplan’s harder than UWorld, so it makes me feel at little better.  The question styles are certainly much different, and have a much different focus.  After talking with some of my CA med school friends, I think I’ve decided not to extend my Kaplan date (it expires next week) as it sounds like UWorld is pretty representative of the actual test.

So I talked with my two friends about the test and their advice (they are 3rd and 4th years now), and after discussing it with them, I feel much better about my decision to delay the test.  Step 1 IS important after all, and it sounds like especially so in CA (which is where I would eventually like to end up), so ultimately, I have come to the conclusion that my test score is more important than having the experience of being able to do family medicine prior to my graduate school studies.


All that being said, I do not necessarily suggest medical students to go this route (and in fact it does throw off a lot of scheduling and such, so should be avoided if possible).  If I were to do this again, this is what I would suggest.  Plan ahead and work hard.  Get a head start if you feel like it.  I don’t know if I would recommend starting over winter break because most people seem to feel that it’s too far out to help much, but if you’re someone who needs multiple passes through material to get it, then go ahead and start then.  In general though, I would say start looking through material maybe 2 months ahead of time (for outside resources besides First Aid.  For example, Pathoma is excellent to go through early in your studies, and BRS phys was great as well.  And you may as well listen to Goljan if your spare time if you want to just solidify stuff.  Micro made ridic simple was also good).  During this time, if you want, you can buy Kaplan’s Qbank or Robbin’s Path Review to drill questions on what you’re learning to make sure you’re getting the right stuff out of your studies. Then, 1 month prior, read through First Aid, which will maybe take a week or so, and start drilling question blocks.  Take a UWorld practice test maybe after reading through First Aid the first time, then again maybe 2 weeks out. I have been told conflicting things about the NBME practice tests, and I personally have/am not planning to try them, so not sure about their usefulness.  But most seem to feel UWorld is pretty solid.

That’s just what I would do.  I’ll try to post at the end of my Step 1 journey about different ways I’ve heard of people studying (and roughly how well they did using that strategy).

In terms of whether or not to delay a test if you’re at a point in your studies where you feel completely lost and disheartened, I would say this.  How far away from the test are you?  How confident do you feel about your performance?  Of course, as far as I know, no one ever feels completely prepared going into this test, or even close.  But how familiar are you with the style of questions and being able to at least somewhat figure out what’s going on?  If you are hitting 60-70% on UWorld and have done at least 75% or more of it, I would say don’t delay and just go for it.  If however, you’re like me and barely hitting 50%’s and most of those are luck, and you’re also only 1 week away, I would say it’s probably a good idea to at least consider delaying (unless you are either one of those people who know for sure for sure what they want to do in your career and the field doesn’t require a high Step 1 score, or you don’t care at all what location and/or specialty you go into).

If you do decide to delay, (and every individual med school has their own policies on this), I would just like to say not to feel really bad about it, like you are somehow a failure by doing so.  I know quite a few people who have delayed their test this year, so don’t be afraid to do so if it’s necessary.  I spent a long time wrestling with the embarrassment and feeling like if I delayed my test, it would mean I was somehow cheating because hey, most of the other students can take it on time and plan their days out so it works, why can’t I?  And to a large extent I still do feel that way.  But after talking with my friends, I have recognized that well, this is perhaps one of the most important tests that we will be taking in our career, and like my friend said yesterday, confidence can significantly affect test day performance.  So if you don’t have the confidence, whatever the reason, it might be something to consider. (Caveat: if you’re one of those people who’ve already done UWorld 2-3 times and/or Kaplan Q-bank and many practice tests and still don’t feel ready though… just take the darn thing already!  😛  You’re already as prepared as you’re ever going to be.)

For me personally, with so much of the Qbank not yet done and my abysmal practice test grades, even if I had known more of the material, I probably still would have done poorly simply due to lack of confidence, if this practice test was any indication.  As I kept marking almost every single question as a guess, I could feel myself almost giving up halfway.  Probably, if I had done all the Qbank questions at least once and was just hitting say even 15 points lower than my target score, I would have gone ahead and taken it.  But at this point, I think this is the right decision for me. 🙂

March 20, 2013

Last day of preclinicals… and the general overview of medical school

It’s kind of surreal, but it’s here.  Today was the last day of our pre-clinical years – the last day we will be sitting together in the same classroom, listening to lecturers and seeing the same faces every day.  Technically yesterday was our last day of real lecture – today was just a couple of review sessions before our very last test in this building.  It’s hard to believe that this is it… the culmination of 2 years in medical school.

For those who don’t know, medical school is divided into 2 “sections”, if you will.  The first two years are called “preclinical” years because, as the name implies, it is what you learn before entering the 2nd half, which are your “clinical” years.  Preclinical years are where you spend every day in lectures or small group discussions on medical cases, and you do all your basic science and medical learning.  It includes courses on things like anatomy, physiology, biochemistry, microbiology, etc, as well as organ systems like our school uses, so going through cardio (the heart), respiratory (lungs), GI (bowel stuff and all organs in the abdominal area), renal (kidneys), musculoskeletal (muscles and bones), neurology (brain), hematology/oncology (blood and blood-related cancers/diseases), endocrine (hormones), and the last one we are just finishing up, reproduction (gonads and related diseases).

After this and before entering the clinics, we all have to pass what is called the Step 1 of the USMLE Board Exams (or Step 1 for short).  This is what is going to take up my life for the next two months or so.  The Step 1 is like the MCAT, but probably 100x harder.  It’s made up mainly of clinical vignettes, or short clinical scenarios, that you have to decipher to get at the right answer.  It’s also usually formatted in a “2-step” manner – meaning, they could give you a long story about a patient, but instead of just asking you what the patient has (which would be a 1-step thought process), they would ask something like “what is the genetic mutation most likely associated with this?” or “What other conditions are commonly associated with this?”  So you not only need to be able to recognize what the problem is, but you also need to know all the other random facts associated with it.  On top of just the difficulty of the exam is the fact that for many specialties, especially competitive ones, this is a key determinant to whether or not you will get interviewed, or even if the rest of your application will be looked at.  So in a sense, your Step 1 score will determine what specialties you can feasibly apply for.  Just passing isn’t nearly good enough, especially with the fact that the numbers of medical students are currently increasing, but the residency cap is still in place and thus residency spots are getting relatively more and more limited.  Pretty intimidating huh?

Assuming you pass Step 1, you then move into the clinics for 3rd and 4th year.  The clinical years are basically when medical students really get their feet wet on working in the hospital and being part of the medical team.   3rd and 4th year medical students are the ones who get spend the most time with patients and writing up reports and presenting them to the residents (post-med school trainees) and attendings (who I think of as the “real” doctors).  I think there are core clerkships you need to take, like medicine, surgery, OB/GYN, etc, after which you now need to take national standardized exams called  and then there are electives that you can choose from if you’re interested in them, which include more of the specialized topics, such as anesthesiology, dermatology, orthopaedics, etc.  There’s a lot more specialties than there are rotations for electives, so you need to be thinking about which to choose early.  At the end of 4th year, you take Step 2 of the Boards (which has 2 parts – a knowledge portion (CK) which is like a regular test, and a skills portion (CS) which tests your clinical skills with simulated patients.  You also apply for residencies that year.  After getting into residency, in the first year, you are called an intern, and the following years, you become a resident.  That’s as far as I understand it anyway 😛

As MSTP, it’s a little different for us.  Most schools follow the same schedule we do, which is first two years as preclinical years, then take Step 1, then enter our labs/PhD programs, defend our thesis and earn a PhD, and then go back to medical school to finish our last 2 years in the clinics.  We’ve recently changed it so that 2nd years have the option to do a family medicine elective rotation first before entering the labs, which I think is a good idea because we’ll be coming fresh off of Step 1 and will be able to apply some of our clinical knowledge before going off to a different world for 4 years or so.  The last two years of MSTP’s here have said they it was a good experience as well, so I’m looking forward to it.  Part of the reason for this change was apparently because some residencies, like those in California, require a family medicine rotation before applying, so that’s something to note.  We also only have 1.5 years to finish our 3rd/4th years for some reason, which is another reason why it’s good to get that rotation in early.

Anyway, hopefully that was informative, or at least wasn’t too boring or redundant (I vaguely remember posting something briefly about how the MSTP schedule works out sometime last year or so…)  Sorry if I did end up repeating myself, although I think I understand clinical stuff a bit better now.

Ah, I’m going to miss the people in my class.  As an MSTP, we’re already going to be pretty disconnected with our classmates to begin with, but now also around 1/3 of our class are going off to branch campuses, so it’ll be even harder for me to see them around.  :\  I have heard that the hardest for MSTP’s  is when Match Day comes in 4th year for our respective classes, where everyone finds out where they’re going to go, and everyone we knew in med school will really be gone and scattered around the nation.  I’m slightly depressed already thinking about it, haha.  Ah well, it’s been a good two years.  Best of luck on Step 1 everyone!

February 24, 2013

Genetically Modified (GM) foods and regulation

So I have relatively recently decided to pursue my PhD studies in Nutritional Science.  It is off the beaten path for most MD/PhD’s, and even more so at this school where I’ll be the first to go through with it (more on that later perhaps), but because of it, I am taking some Nutri-sci classes while finishing up my 2nd semester of my last pre-clinical years (aka 2nd year of med school).

2 weeks ago, our topic was Integrative medicine – a topic near and dear to my heart since I started the Integrative and Alternative Medicine Interest Group at my school this year (again, more of that in another post perhaps).

Last week (and my current homework assignment) is on genetically modified foods, aka GM foods or GMO’s (genetically modified organisms).  Since we have to do some write-ups about it, and I thought there were interesting discussions about them in these links, I thought I’d share them here in case anyone is interested.  It seems to be a pretty controversial and polarizing topic, although it also seems most people in the US wouldn’t mind them as much as long as the foods were labeled and people could have a choice in the matter.  Other countries abroad seem to be much more concerned about it however, going so far as to ban goods from the US that contain it.

Here’s the NOVA/Frontline video of it on youtube that gives a background of the issue.  Here’s also a supplemental interactive PBS website where you choose whether you agree or disagree with GM crops based on what you know and they’ll present the opposite argument.  You do that 6 times, and then you can look at all the arguments and see what you think after. Here’s also a WebMD article about GM foods and the issues associated with it.

If you’re a glutton for punishment, or just really like reading Bills, here is the official Bill for Initiative 522 on genetically engineered foods (from the Washington State Legislature website).  Otherwise, here’s the more people-friendly version.  They had the hearing for the Bill on Feb 14 this year (Happy Valentine’s Day hah), so I guess we’ll see what happens with that.

I personally am more on the fence for this issue I suppose.  As I am someone who is more for natural products, I tend to stay on the side of preferring non-GMO foods for myself.  However, in countries that are ravaged by a blight on their most important crops, or who are having trouble feeding all their people, such as the case of the Hawaiian papaya or the African sweet potato shown in the video, I think it’s fine to use GMO’s against that specific disease or problem to help feed people, as long as it is safe and is the best alternative.   I do, however, think it is a good idea to label GMO foods, because I support the idea of the right of people to know what they are consuming and to make the decision for themselves.  Not because I necessarily think GMO’s are unsafe, but because we ought to allow people to make informed choices for themselves.  After all, isn’t that what nutritional labeling is all about in the first place?

Other factors to consider that the links bring up include things like the potential introduction of toxins and allergens people, or antibiotic resistance (which are used as markers for genetic recombination) developing in natural gut bacteria or in the environment.  On the other side, they say that the foods have all been tested for safety and “substantial equivalence” in what their products contain compared to the original, and they have been approved by the USDA (which regulates what you can grow), FDA (which regulates if things are safe to eat) and the EPA (which regulates whether things are ok for the environment).  It can also be said that GMO’s are better for the environment than the current widespread use of pesticides, which target a much larger variety of animal/plant life in neighboring areas.

So, yay or nay on GMO foods?  Just some food for thought for ya ;P


Edit:  Hey look at that!  Whole foods recently announced that it would require all GMO-containing foods to be labeled in all stores in Canada and the US by 2018!  It’s apparently the first national store to set a deadline for labeling of GMO foods.  Pretty neat 🙂

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