sanguinemare

March 17, 2015

Match Week

Filed under: Med School and the MSTP — sanguinemare @ 3:44 pm
Tags: , , , ,

My classmates with whom I entered medical school with are graduating this year.  Match Day is coming up at the end of the week, and it’s a highly charged atmosphere.  Yesterday was apparently when people found out whether they matched or not period, and my Facebook newsfeed was blown up with a ton of posts, both from med school friends here and around the country, about how happy and excited people were to have matched (though they won’t find out where they will end up until the Match Day Ceremony on Friday).  Lots of congratulatory statements and likes were passed around on Facebook – so much that a couple people posted in our private class page with memes to the effect haha.  It’s kind of a surreal feeling – that we’ve all been here for four years already, and that people who I still think of as classmates have gone through so much training already and are going to be official doctors soon.  To them, as well as to those who are unfortunate enough to be in SOAP (where one ends up in the week-long, stressful process of desperately trying to find a place to do residency at on of the remaining spots after finding out they did not match on Monday), I wish the best of luck.

In case you’d like to know a bit more about The Match, which is arguably the most important day of a medical student (even more-so than graduation day), here is one article that explains the gist of the process and how it’s become so much more competitive over the years, and if you’re interested, here’s another rather angry article about how The Match is not the best way to get into residency, from a graduating medical student last year, presumably after her own match.  It is true that the cost burden of the current system is quite high for seniors – at a recent talk, people mentioned how the average one spends on applications and the residency trail may be somewhere around $11,000, if I remember the number correctly, which is kind of on the ridiculous side.

In a way, it’s interesting that the concept of the Match is made such a big deal of over here, because that is standard practice in Asian countries (or at least for sure in Taiwan and I think China as well) all throughout every major school transition (elementary to middle school, middle school to high school, high school to college, etc), but in America, where one’s individual choices leads to the promised land, I guess this is one of the few times one feels so very out of control of one’s life and future. I understand that feeling, especially when studying for Step 1 (and in the aftermath), when it finally hit me that one test score could determine my entire future career in a way that is not really readily alterable.  It’s a scary thought.

So in light of all of that, my sincere congratulations to all of my classmates and the graduating class of 2015 that have matched!  I’m glad you will be able to become the kind of doctor that you aspire to be. 🙂

April 7, 2014

Link dump

Since I also have accumulated many many tabs since the last time I posted, here are some medical/science-y related things that I found interesting (this was originally going to be part of the previous post, but I realized I have too many things to share, and the post was getting too long, haha).  In no particular order:

3-D floating, holographic bodies have now been developed at the University of Michigan to help with anatomy/dissection!  I’ve actually seen some of the virtual anatomy lab tables they mention in the article at some of the AAMC conferences before and thought they were really neat (just too expensive for our school probably), but this takes that a step even further!  It would be even cooler if they could add tactile information (like perhaps a pressure glove that can help simulate what things should feel like)

Here’s a really neat article on using Disney to reach an autistic child – which I love both because it’s a very moving story, and because it’s another reason to love Disney 🙂  It show how important it is in medicine/healthcare to think outside the box – how thinking creatively to a problem can help connect people in totally unexpected ways.  Which actually also reminds me of this moving story of Carly.

Here’s a few articles relating to music:
1) Ever get a song stuck in your head?  That’s called an “earworm” – great name huh?  You can thank the Germans for that.  This article briefly outlines what types of songs/conditions get songs like “Let it Go” stuck in our heads.
2)  Here are some random facts about listening to music and how it can affect your life.  These are all presumably based on research (I have to admit I did not go and check all the links for the studies behind these, but at least they have them so you can look them up yourselves if you want to verify the information presented).
3) If you loved The Sound of Music as much as I did growing up, and ever wondered what the real von Trapp family was like (yes, they were real people!), here is a comparison of the movie with the true history/personality of the von Trapps.

Here’s a few articles relating to nutrition sciences:
1) Visceral fat (known as the “bad” fat around your organs, which if accumulated may be detrimental to your health) has been linked to cells expressing the Wt1 gene, which may continue to act as a source of this fat in adults, modifiable through diet.  These cells are also the ones that may develop into the protective lining (mesothelium) around these visceral fat areas. Pretty interesting!
2)  A pretty good article that discusses the use of antibiotics potentially contributing to the obesity epidemic, and also touches upon one of the mechanisms behind it through modification of the gut microbiome.  Something to think about I think, for the future – truly, physicians need to be good stewards of antibiotics and not just give them out to anyone who has the sniffles or asks for them (not only for this reason, but because of the increasing cases of antibiotic-resistant strains of bacteria that are now cropping up due to overuse of these meds).
3)  Apparently, there are two forms of the major milk protein casein that can be dominant in milk – A1 and A2.  According to this article, milk with predominantly A1 protein has been linked to a variety of diseases, such as heart disease, diabetes, and even autism or schizophrenia, while A2 is more digestable by humans.  However, as the article says, “the evidence is far from conclusive”, so take it with a grain of salt (especially given some of the comments below).  I do think t’s an interesting concept though, and one that might merit investigation.

And finally, people are starting to believe the Black Death in Europe in the Late Middle Ages was actually a pneumonic plague (spread from human to human through the air), rather than bubonic (disease form that causes infection through the lymphatic system in humans, spread by rat fleas).  Makes sense to me – I always thought it seemed to spread way too quickly for fleas to be the culprit.

That’s it for now, but there’s a whole other window with even more (older) tabs that I have yet to get to… hopefully that happens soon…

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edit: Well, it looks like I was wrong, and I only have a couple more links (most of the other tabs were funding sources that I was looking into for a potential overseas research thing I was looking into, hah.  So just ended up bookmarking most of those).  So here are the other links:

Here’s a good resource if you’re interested in knowing what the latest consensus is in science about nutrition and how it affects cancers of various types/areas.

Speaking of areas in the body, here’s an um… enlightening article on what the female pleasure areas look like when they wake up, so to speak.  Kind of interesting, and also makes sense.  Share it with your SO’s, folks.

And finally, just because it’s too good not to share (and since it’s exactly what I’m doing right now, it seems to fit well), here is a non-scientific, but still interesting and very amusingly accurate picture of why people procrastinate.  And also an equally hilarious and illustrated follow-up to the article, including a few words of advice on how to beat the habit.

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!

October 27, 2013

Oral Presentations, Conferences, and Publications – What’s the Big Deal?

Well, that was… interesting.

Today, I gave my first ever oral presentation at a conference.  For those who are unacquainted with how this all works, basically, after you’ve done research, you are in a sense under (ethical/moral, scientific, etc) obligation to share what you’ve learned somehow with the world.  Or at least put it out there someway, somehow, so that should someone develop an interest in whatever minute sector of the vast forest of science you have decided to devote x number of years to, they will be able to access it.

Why is this important?  Well, science would never advance without building upon what others have done, for one thing.  That’s what the whole “we’re standing on the shoulders of giants” thing is all about, after all.  Another very important reason that is related to this is the real-world application of this science, whether using principles of physics to build MRI’s and computers, or how to create poison darts from frogs, or invention of new treatments.  (Although medicine is traditionally actually quite poor on having good, solid, “scientific” evidence for the things they use to treat people… but that’s a different story.  Plus I think that is slowly starting to improve as information gets more widespread and people realize that more rigorous trials need to be done.)

Anyway, back to dissemination of research findings.  Ever hear the term “publish or perish”?  If you weren’t aware, the phrase is a semi-mocking commentary on how anyone who wants to survive in academia has to publish (papers) on a regular basis in order to stay competitive.  Everyone talks about how if there’s a say 3-4 year “gap” where one does not publish at all (for example, during residency), future employers for an academic position will look skeptically at that and wonder if perhaps this applicant was not that interested in science after all, and therefore not fit for the position.  This principle is clearly still very true today, as this conference reiterated whenever we talked about grants or career advancement.  So we publish.

Now, fortunately there are many different forms of publishing – the best of course being a first/primary-authored manuscript with primary data, especially in a high-impact journal like Science or Nature.  (I won’t go into all the vocab/nuances of the different types of journal articles today, but that last sentence was basically a fancy way of saying publishing work that you did yourself, that you wrote yourself, and in a famous and well-established/trusted scientific journal).  But another way you can be “published” or otherwise share what you learned with others (and learn from them in turn) is going to conferences.

The way this works is generally, at various conferences, you have the opportunity to submit an abstract (which is basically a short summary of your work including introduction/background, methods, results, and conclusions).  The people in charge of the conference will read through all the abstracts and decide which ones merit an oral presentation and the rest will end up as just poster presentations.  Sometimes, conferences will also throw in a travel award, which means if your abstract (and/or other assorted materials like a CV/statement of interest/letters of rec, etc) is good enough, they will subsidize either all or part of your travel/stay for the conference.

Now that I’ve given you some background on all this, so far, all of my submitted abstracts have only resulted in poster presentations.  This is not really surprising, given that all of my posters so far are from either 6 or 8 week rotations (which is generally understood to be not nearly enough time to accomplish much of anything if one is doing basic science benchwork – aka lab work – as versus analyzing data or making models on a computer, for example). In fact, I am usually quite impressed by anyone who does get an oral presentation (or a paper!) from a rotation project, which some students actually get, believe it or not, because it means they either worked really hard, were extremely lucky (both data-gathering-wise and timing wise coming into the project towards the end point), or both.

In my case, I think it was probably the latter, and the fact that 1) this conference is student run, meaning students were the ones reading the abstracts, and 2) my abstract fell in the “other” category because it didn’t fit any of the usual departments like neuroscience, cancer, or pathology, and they probably wanted to make sure the topics of the talks were diverse.   (Huh, side note: now that I think of it, I’ve only really submitted an abstract to one other conference, and that was only because I had to in order for our program to fund me to go to the national MD/PhD conference in Keystone after my first rotation… long story.  But yeah, all my other abstracts were just submitted because we have to every year for our school’s Medical Student Research Day, which is not really a conference). ANYWAY, the point is that this was my first oral presentation at a conference.

So… if you’ve never done an oral presentation before… it takes a LOT of time.  Even presentations for graduate courses take me quite a while, but for this one, I spent at least a couple full days trying to put together the presentation the first time, then presented it at our lab meeting on Monday.  I was critiqued on literally every slide, and spent all of the last week when not in class or doing homework working on the slides, and then a few additional hours on rehearsing.  I have discovered that rehearsing in one’s head is good for putting together the “story” and figuring out the order to talk about things in.  However, it is not enough, because once I started trying to speak out loud, I would realize I didn’t know how to phrase things, or there would be gaps in my understanding of something, or, as one of our collaborators said, I said “um” as a placeholder way too much.   So I wrote notes on the side to remind myself of phraseology, I looked up things I didn’t fully understand, and practiced – while drying my hair, walking to school, walking to the conference, mentally rehearsing when I didn’t have it in front of it, etc.

And despite my efforts, perfectionism on the visuals, and practice, and despite the fact that I had to present my poster the hour beforehand, which theoretically should have helped me practice even more through interacting with people, the actual presentation still turned out less than stellar.  In fact, I would say I messed up quite a bit.  I was nervous, and it showed.  It felt like my tongue kept getting in the way of my words, so I would be simultaneously blurting things out while stumbling and stuttering on pronunciation.  Word vomit, really.  And I remember saying “Sorry, I can’t talk today” at least 3 times throughout the talk after trying repeatedly (and failing) to pronounce a word correctly, as well as literally stopping after a particularly miserable failure, taking a deep breath, apologizing again for my inability to (ironically) say “ability”, and attempting to move on.

In addition, I’m not sure if this influenced me or not, (it probably did subconsciously – I was probably just too nervous about presenting to consciously realize this until later, fortunately) but I think there was literally only 1 person in my room who was from my school listening to my talk, and that person was the guy who is probably my closest friend from the MSTP.  It’s a little discouraging when it looks like everyone in your entire program is not interested in your talk or in supporting you.  But I was grateful that my friend was nice enough to be there, even though it meant he would witness the train-wreck that was my performance today.

So practice doesn’t make perfect. At least not yet.  And practice definitely doesn’t mean people will be interested in what one has to say.  But hopefully that will change as I get more experienced (and when I actually know better what I’m talking about/have my own project that I am leading with more work under my belt).  And while there was a lot in today’s presentation that went wrong, there were a few small victories: I was able to finish in the allotted time (usually I go over), I think I was able to answer the two questions that were asked to me in a reasonable way, and my friend actually said he thought my presentation was good, that I had a good story, and that it was interesting!  That last one made my day, as he is generally pretty analytical/critical (in a good way), is often bored by talks unrelated to his research/things he finds interesting, and he’s pretty straightforward about his thoughts.  (In hindsight, I realized that I didn’t remember seeing him engrossed in his phone, which is often the case during talks, reinforcing the claim that he thought it was interesting. Yay! Of course, it could simply be that my talk was just much shorter haha.  But hey, I’ll take what I can get.)

I’m told I’m lucky my first presentation was at this kind of conference with peers rather than a research-area-specific conference with lots of faculty etc who would probably grill me much harder on the science behind what I did.  Thinking about it that way, I am pretty grateful that I had this chance to “practice” before having to get up in front of renowned experts in my field and deal with hard questions about my work.

Sooo yup!  That is a summary of my first experience of giving an oral presentation at a conference, as well as a bit of background on why publishing and sharing information is so important for us as scientists and researchers (and medical/health care professionals as well).  Conferences are also great because sometimes when you’re listening to a poster or oral presentation, it can give you ideas for your own work and help remind you that what you’re doing actually is pretty cool.  I experienced that for the first time myself at this conference, talking with someone from my school about his work at his poster.  It was actually pretty invigorating – I think I’ll be checking in with him on how his research is going more in the future, and/or maybe consider a collaboration… hmm we’ll see!

Anyway, I hope this post was informative in some way, shape or fashion, and that you have a better understanding of why publishing is so important in academia, how people publish, what it’s like preparing for an oral presentation (n=1 hah), and why conferences are cool.  Thanks for reading!  It’s sleep time for me… goodnight!

September 22, 2013

Crossfitters, beware

Filed under: Med School and the MSTP — sanguinemare @ 10:03 am
Tags: , , , , ,

Here is a great post about the dangers of overexercising, and of Crossfit in particular.  There is too much of a good thing.  This got on my radar from another medical student in my school’s facebook post, and while it’s not surprising that this happens from a physiological standpoint, I was surprised that this otherwise rare condition was so common in the Crossfit culture that the first thing a trainer would ask when hearing about someone being hospitalized was “is it rhabdo”?

A statement could be made about the fact that if trainers know about it, I certainly hope they would inform their trainees about the importance of proper rest and how to recognize when they’ve reached their limit, and if the issue is that not  all trainers know about it, then I think there is definitely a problem.  However, the only thing I can do is repost the blog post and hopefully inform both trainers and trainees alike not to let the culture of Crossfit (and other similar programs) drive one to the point of rhabdomyolysis – basically where your muscle breaks down from too much abuse and the resultant spill of proteins and contents (especially myoglobin) overwhelms your kidneys and it is potentially fatal.  Yes, fatal.

So if you notice that suddenly your muscles are suddenly weak and useless, or have suddenly swollen a day or so after a workout and are no longer the ripped, lean muscle that it was, please go to a doctor and tell them you’ve been training hard.  Better yet, don’t even get to that stage – make sure you protect yourself and rest when you need to, despite what you or anyone else might think of you.  Take care.

September 21, 2013

Turning back the hidden curriculum, how reading novels improves your brain, and one of the keys to happiness

In the medical profession, people talk a lot about the “hidden curriculum”, which is the message that we as medical students get indirectly from peers, faculty, residents, and other higher-ups in the hierarchy chain.  This can be anything to lecturers casually slipping in jokes about how everyone in the profession drinks to things like how being a primary care physician is both too easy and too hard to do well (that is in itself another discussion).  But one thing that also trickles down is the unspoken expectation that doctors need to be “professional,” which sometimes may seem synonymous with “emotionless,” which over time translates to jaded physicians.  This is something I sometimes worry will happen to me when I come back from my PhD based on stories from friends, and something that I actively want to fight, even during my PhD.  That’s why what this article in the NY Times is talking about, as well as the Healer’s Art course mentioned in it, is something I strongly agree with.  I think this is a dialogue that should always be kept open among students and faculty alike.  Healing is not merely about the healing the physical body, but also the mind and soul as well.

Here’s another interesting article about how reading something affects your brain, and helps your brain process information in a similar way as if you were actually experiencing the action physically.  I also like this paragraph, as it somewhat justifies my love of fiction hehe 😛 (and also supports my belief that children should not be allowed to watch TV all day, especially at a young age): “Dr. Oatley and Dr. Mar, in collaboration with several other scientists, reported in two studies, published in 2006 and 2009, that individuals who frequently read fiction seem to be better able to understand other people, empathize with them and see the world from their perspective. This relationship persisted even after the researchers accounted for the possibility that more empathetic individuals might prefer reading novels. A 2010 study by Dr. Mar found a similar result in preschool-age children: the more stories they had read to them, the keener their theory of mind — an effect that was also produced by watching movies but, curiously, not by watching television.”  Of course there’s always the argument that fMRI’s are not that great of a way to determine what’s actually going on, as it’s mostly correlation and depends heavily on interpretation, but still an interesting thought nonetheless.

And lastly, here is a fun, touching experiment that helps validate a scientific study that one of the things we can do that is a key contributor to happiness is expressing gratitude.

June 8, 2013

Random Step 1 find of the day – Growth hormone

So… you know that growth hormone stuff that are used to help some children grow (if they are legitimately deficient in it) and that some athletes abuse?  Well, it used to be made from either animal carcasses, or ground up and extracted human cadaver pituitary glands.  Ick!  Which also meant that if it was taken from someone with Creutzfeldt-Jakob disease (aka a prion disease), people who got the growth hormone (GH) could develop it 10-15 years later (and die in a not-so-pretty, rather quick, fashion).  This actually happened to some people, apparently. :\

Thankfully, according to wikipedia, that old method of getting GH has been done away with, and now there is a biosynthetic one one on the market.

Also, other causes of Creutzfeldt-Jakob disease (that are known, according to UWorld) are apparently contaminated corneal transplants and implantable electrodes.  And of course if you happen to handle brains in some capacity (neurosurgeon, pathologist, in the morgue…)

Moral of the story: be careful with what medications/treatments you’re getting!  Might be a good idea to check out how they’re made (and any side effects too, as a general rule).

June 4, 2013

2 more weeks

Filed under: Med School and the MSTP,Step 1 — sanguinemare @ 2:13 pm

Just got off the phone with one of my school’s advisors since I obviously can’t meet them in person, being halfway across the country as I am haha.  Definitely feeling the burn-out – I’ve hardly done any studying the last 3 days, but that’s partly also due to a personal issue that kind of came rearing it’s ugly head… doing a lot better now though I think.  Praise the Lord.

Took a practice test yesterday – probably my last one (2nd test of UWorld) and my score was actually the same that my school’s practice test predicted back at the end of February!  Funny.  I really hope I can do better than that on the real thing though, given where I want to end up.  The good thing is that it was 20 points better than the last practice test 2 weeks ago, so hopefully I’m getting somewhere. 🙂

After talking with my advisor, I decided to go ahead and push my test back 1 more week, so I have more time to study in between blocks.  Right now I’ve just been doing blocks in untimed, tutor mode, which is great for efficiency because you don’t have to spend an hour on questions first and then go through each one after, but you can instead see the answers right away after you click.  The bad thing is that you don’t get time to come back to your answer choice and change it later, like you would on a real test, so the mechanics of taking a test are not realistic on that mode.  That’s why I’m planning on doing timed normal mode the last week.

So I’m just going to lay out the plan I talked with my advisor on here for reference later if I need it. Before that, some calculations.  At this point, I have 1280 questions left in UWorld (that’s 58%), and need to make up about 4 test block answers from yesterday + 2 kaplan test blocks from the 8-hour long simulated test, plus about 2-3 question blocks worth of stuff that I didn’t finish reviewing before moving on to the next block… = a total of 1280 unused questions + (9 blocks x 46 questions each = 414 answers to go through).  414 x 5 min a question = 2070 minutes/60 min = 34.5 hours.  Goodness gracious, just making up stuff is going to take 3 full days of studying!  Ack.  Better get cracking.

Anyway here’s the plan she suggested based on my last test scores:

  • Take the next few days to do renal blocks only – maybe 1 in the morning and 1 at night, with studying BRS phys on Renal and First Aid in between  (I’m amending that to start after I spend today and maybe tomorrow making up going through the answers of stuff I haven’t done yet)  She says it’s probably my most high-yield because renal is a pretty heavily weighted section in Step 1 so working on that will help a lot.
  • Next, go back to random blocks, on tutor mode.
  • About a week before, do another “practice test” of 4 blocks straight through, with Q-bank.  She says I can send her the results and we’ll make another plan based on that.
  • Then do timed, normal mode blocks (with review right after) and then another block, review, etc.
  • Continue until a couple days before the test (should be mostly done w/ Qbank by now).  The last couple days, just do focused review, rapid review sheets, etc. Do 1 question block (for an hour) max.
  • Daily pharm review which should help boost my scores a lot (pharm is one of my weaker points).  She suggests doing integrated review, meaning focus the pharm review on the system being studied that day, rather than doing random pharm.  She suggests not too long – maybe an hour a day at most.

What I’ve been noticing weaknesses besides pharm (and renal I guess) are heme-onc, repro, and lately respiratory and GI seem to be fluctuating quite a lot (either hits or misses).  Talking with her though, it sounds like heme-onc and repro are focused on much less relatively, and my respiratory scores in the practice test happened to be high so she said not to worry about that as much.  Actually now that I look at the bars I’m not sure why she didn’t say to focus on GI, since that was way lower than renal… hm… but maybe she thought it wasn’t that big of a difference?  Anyway, so first priority sounds like renal and daily pharm, then maybe heme-onc and GI, and not to worry so much about repro or endocrinology, which she says exposure (to UWorld questions) should be enough.

She also said to make sure to take breaks every day – a couple hours of non-studying (hah, I have no problems with that!) and to have a protein-full meal on the day of the test.  She also suggested bringing some juice for the last blocks of the day for a last burst of energy (non-caffeinated).  I think that’s a good idea because I can definitely feel my energy flagging in the afternoon.

And that’s about it for today I think!  Hopefully I can stay relatively on track!

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.

Advice

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. 🙂

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