November 6, 2017

“Someday, one of your patients might be me. So study hard!”

Filed under: "Me" updates,Med School and the MSTP,MS-3 — sanguinemare @ 3:15 pm
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Today, I happened to be off shift (I’m doing my Emergency Medicine elective right now), so after lectures this morning, I went to the Military Medicine Interest Group’s talk on Navy Medicine.  A DNP (doctor of nursing practice) told us a little of his experiences in the Navy and in Iraq, and showed up some pictures about the medical set-up and such they had there.  But what really stuck with me was what he closed the talk with, which I’ve put as the title of this post: “Someday, one of your patients might be me.  So study hard!”

I think as a medical student, you do sometimes lose sight of the bigger picture a little bit while you are trying to learn what you need to medically relating to whatever service you’re on, and meanwhile also navigate the hierarchical structure without overstepping your boundaries (since different attendings and residents have different levels of interest in teaching/interacting with med students, and in some services, you have a lot more turnover in who you’re interacting with than others.  For example, on Emergency Medicine, it’s almost a new resident and/or attending every single shift.)  It’s not really that one doesn’t think about the patients themselves, but I think partly because we aren’t allowed to do a lot of the aspects of actually doing anything for the patient directly (putting in orders for medications, consults, etc, or even writing notes on some services), sometimes one can feel somewhat impotent and not very useful, either to the patients or the residents/attendings for whom one is supposed to be helping on a team.

I think that’s the biggest issue I’m having right now in EM actually, which is that since we’re often not allowed to do much, depending on who we’re working with that day, and particularly when all the rooms are already full by the beginning of the shift with work-ups mostly done and just waiting for a room, I’ve felt like I’ve done the least out of any service I’ve been on so far.  The residents are nice and say that me seeing a patient and giving a quick H+P actually is useful, but sometimes it’s hard to see whether I’m making any difference in that situation (though I have definitely helped push to get some psych patients admitted for suicide ideation and other issues when they seem they might have otherwise been written off… and in part that’s because our hospital seems constantly overflowing with people with psych needs – something I could write a whole entire post about in itself).  Suffice to say that it’s sometimes difficult to be motivated to even learn more when one feels like they aren’t really able to contribute.  But the quote from the end of today’s talk was a good reminder.  We’re training to be doctors who will be the ones actually responsible for people’s lives someday.   And as a physician, people will look to us for answers, and we’ll be the ones making the important decisions for their healthcare and ability to live good quality lives.  So it’s important to forge ahead, study hard, and learn as much as we can, so that when we are someday on our own, we will know enough to take good care of our patients.

Also, my apologies for the sporadic updates – most of the rest of my surgical rotation (through mid-October) basically left me so exhausted by the time I’d get back that I’d literally get back to my place, get in a quick shower, and decide to get in a “quick nap”… and then end up waking up sometime around 10pm-12am being very disoriented, decide whether or not I’m hungry enough to get something to eat, and then plopping right back to sleep.  So I pretty much actually did not start studying for the surgery shelf exam until literally 2 weeks before the test.  Thank goodness I had medicine before surgery because otherwise I probably really would have failed that.  (They say the surgery shelf is mostly medicine and not surgery.  They are absolutely correct.  In fact, even though they say there’s a lot of trauma and GI on the test, there was basically almost nothing relating to almost anything I saw on either of my three services I rotated on surgery, which included trauma surgery, orthopedics trauma, and acute care surgery (mostly appendix issues, gallbladder issues, or small bowel obstruction).  Sigh.)  I did, however, do a little more digging to understand the shelf scoring system because I also really felt like I failed this shelf if we were going by raw score standards too, but still somehow managed to pass.  So apparently the shelf score is actually not a raw score, but based on how students have done on the test in the past.  Here are some of the NBME’s answers about shelf scoring from the AAMC in 2013.  Additionally, here’s an explanation by benwhite, who is a physician in Texas according to his website, which I found helpful.  Luckily, I don’t have a shelf to study for during this current elective, so it’ll be a good time to catch up on all those USMLE medicine questions I never got around to!  (And to also finally get my eyes examined… I developed some strange eye infection during my first week or so of surgery, and it’s continued to reoccur throughout the last 2-3 months, even after stopping use of my hard contacts.  Finally got a time scheduled with an ophthalmologist today for Thursday, so hopefully we can finally get to the bottom of it!  This is the one time I hope my symptoms will still persist until then instead of being in one of its minor remission stages so they can figure it out, haha.)  Wish me luck!

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.

June 30, 2017

Week 1 of clerkships, and a little bit about the dissertation submission process

Today marks the end of my 1st week back to medical school, as a 3rd year student on the wards.  (Is it more grammatically correct to say “in the wards” or “on the wards”?  Hmm…) It’s been a pretty crazy ride so far, and I have to say, post-call day was pretty brutal.

So just to walk you through my week, I’ve basically been waking up around 6am this week to make it in on time at 7am (and I’m fortunate that my commute is about a <10 min walk) to be able to look up what happened to my patient overnight, check in with them, and get my thoughts organized before we round at 9am.  Generally I’ve been staying until around 4:30-5pm, sometimes just to go over my notes for the day.  On call day (Wednesday this week – it happens every 5 days), I got in at around the same time, but stayed until ~9pm, and post-call day, I had to wake up at ~4am to get in at 5am to prep for rounding at 7am to go over the patients the night shift team needed to pass over to us.  I still got out around 4:30pm that day.  So as you can imagine, that’s been pretty rough.

After I get back, I’ve been working on revising and sending out our manuscript the first couple nights to a new journal, and then yesterday I got an e-mail about minor edits for my dissertation, so I spent a couple hours fixing that on post-call night (after first taking a nap for a couple of hours), and finally got the final acceptance for that this morning.  Whoo hoo!  That also means I haven’t had any time to study/catch-up yet though, so I’ve been doing pretty poorly in terms of answering questions from the attending/residents.  It’s to the point where our attending didn’t even bother asking me questions when he went over antibiotics with us this afternoon, which is pretty much when you know you’re in bad shape. Sigh.

Anyway, also just wanted to give a brief overview of the dissertation submission process, (at least at our school) since I haven’t had a chance to yet, and did just happen to finish that today.  Basically, ~2 weeks before the PhD defense, you’re supposed to submit your dissertation to all of your committee members.  They review the file, and depending on the department, they’ll either give you feedback before your defense, or after.  My department does that after for some reason, so I didn’t see any edits until after my defense.  Then, you have 10 business days (aka 2 weeks) to make all the edits your committee requires, which can be either minor or extensive, depending.  Mine were pretty minor for the most part, luckily, but since I’m somewhat of a perfectionist, I also went back and fixed wording, added citations, fixed figures, etc.  That last one took an extremely long time to figure out because Microsoft Word for some reason was not converting pictures right, so I tried asking for help, and that person didn’t get back to me until the day before it was due (and actually they made one thing worse and didn’t fix any of the issues at all), so it was quite a bit of a panic there at the end.  Extremely fortunately for me, I was supposed to meet up with a computer engineer friend for lunch that last day, and he finally figured out the rather crude, but effective, method of print-screening the figures really large on a big monitor and copy-pasting into Word.  So there’s a tip for you, if you ever have issues with importing images into Word!

Anyway, after finally submitting it, then we wait until the graduate school looks over it and sends an e-mail with any formatting or other issues that need to be fixed.  I got that e-mail yesterday, made my revisions (and went through everything again with a fine-toothed comb to check for (many) spacing errors and typos), sent it in, and got the e-mail back this morning saying it was officially accepted.  Apparently sometimes that last step can go back and forth for a bit – another MSTP who went back a rotation before me and is now on the same rotation as me said it took him a couple weeks of going back and forth with the graduate school before it got accepted, but I think he also didn’t realize that some of his changes threw off other formatting, so maybe that’s why it took longer.  But anyway, there you have it!  That’s the dissertation submission process in a nutshell.   And it’s past my bedtime nowadays, so goodnight!

June 18, 2015

Learning Communities, Lead Mentors Interviews, and Moving Forward

I am actually pretty excited about the changes happening in our medical school regarding Learning Communities and just the overall culture here.  Learning Communities (LC) are in some ways the med school equivalent of Harry Potter Houses, in a sense – every class upon entering the school gets divided into one of these communities, and then stay with that community for the rest of their time here.

Having been here for starting on 5 years now, with LC’s having started 2 years prior to my entrance to the school, I’ve been able to see it evolve from something that people didn’t care much for and that was seen as just a small social thing, to one that finally, seem to be something people enjoy and that reps are proud to be reps for.  The first years this year in particular seem to really like the system and feel more connected to faculty and each other.  We are also finally going to have funded positions for lead mentors this year!  It’s actually a really big step for us, because not having the resources was one major reason we believe it was hard for mentors to come to events (since they didn’t have protected time) and for students to be regularly engaged with their mentors.  So as part of the LC executive board members at our school, I’ve been helping to sit in on some of the Lead Mentor interviews.  And I have to say, I’m pretty freaking excited about a lot of the ones I’ve seen so far.  They seem very motivated and eager to help students in learning to deal with the realities of a physician lifestyle, including all the hard conversations, life events, and other things that students might have to go through during medical school and beyond.  They’re also often good listeners and very open in sharing their own experiences, which I think will be invaluable for students to hear as they’re going through med school.

One example was a professor who talked about how difficult it was for him to transition into the clinical years after so many years of schooling through college and the first two years of doing very well on tests.  Another today shared about the experience of seeing a fellow medical student pass away right in front of him during a party after a med school test – that student was apparently sitting at the bar when his eyes rolled up and he fell over backwards, never to wake again.  And then they all had to start the next module the very next day.  How do you cope?  Or another experience of a friend whose father had pancreatic cancer and was dying, but that friend saying things like “I hope he doesn’t pass away this week, because we have a final at the end of the week”… which reminded me of one of my own anatomy lab groupmates, whose father passed away during medical school, and he was gone for a while.  We never really got a chance to talk or mourn with him about it, besides checking if he was doing ok a few weeks later when he reappeared in lab.  Or the father of a family friend of one of my growth group members, who she would always ask us to pray for along with her friend, the daughter, who was stressed out because she had a test on top of her dad’s health situation.  It was always a weird dynamic to me, that she would ask us to pray for her friend’s stress because of the test rather than the health of her dad being a main concern, but I guess part of that was this underlying message some people take from med school that grades are everything.  And they’re not, or at least, they shouldn’t be.  Learning the material and understanding how to better take care of a patient should be the main thing, not getting a certain score on a test.

Anyway, I digress.

My main point is I’m really glad that it sounds like we have so many attendings and faculty at our school willing, and really desiring, to get to know the students better, and to guide them through medical school with wisdom gleaned from experience, and to foster a healthier viewpoint of medical school as a whole.  I’m also glad we have a fairly diverse population in such a small group of people in terms of age, sex, race, experience, and specialty (the Emergency Department in particular has been outstanding in presenting applicants, and major props to their Department Chair for signing off on so many of their staff to encourage participation in this!)  Really looking forward to seeing how LC’s grow in the next few years with such dedicated mentors, and how the school’s culture as a whole… or dare I hope, the culture of medicine in general… will change.  I know it’s already starting with all the emphasis on holistic admissions and patient-centered care, but with this new rise in awareness of health and wellness in the physicians and those training-to-be, I am hopeful that we will train up a generation of doctors who are more compassionate, in addition to knowledgeable, than some of their current counterparts, and that they can become proper role models to the patients that they work with in terms of both health and happiness.

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.

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
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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. 🙂

November 21, 2012

More interesting reads!

My blog notes that this has been sitting here as a draft since 6/6/12.  That is pathetic.  My extreme apologies for things in life have been hectic.  As I have much more I need to post, I won’t be able to do these justice, but I’ll at least try to summarize briefly before each one.

1. This article in the New York Times, while not necessarily novel in content, was a poignant piece on how we are so “connected” with each other through technology, that perhaps we have lost the ability to truly communicate and be with each other when we’re actually with each other.  I would encourage everyone to read this and think about how you live your daily lives, and whether maybe it would be a good thing to disconnect with the world in your phone, iPad, or computer, and just exist in the here and now with those around you.  Here is The Flight from Conversation.

2. Gardening has long been a favored pastime of many, but did you know it is actually good for your health (both psychologically and physiologically)?  Apparently one of the bacteria commonly found in soil has been shown to help boost serotonin (a natural “mood-booster” in the brain) in mice!

3.  This one is for all the pre-med’s out there – things are changing in the world of doctors.  No longer are the brusque surgeons the mold – instead, the AAMC and medical schools are starting to look for people who are more understanding of others.  As the MCAT has been revamped with two extra sections (and I have heard removal of organic chemistry, although that may just be hearsay) , this will likely affect the classes pre-meds are expected to take in the future, and potentially change the patient-doctor interaction drastically in the future.  For more information, visit the AAMC website on the new MCAT (offered in 2015).

4.  Ever wonder what that smell is every time you go to your grandparents’ house?  Here’s an article on the phenomenon of “old person smell.”

5.  Last on this post is this crazy story of probably the youngest doctor in modern times.

More links to follow shortly (hopefully!)

March 24, 2012

Updates and onto GI (Gastrointestinal module, aka the gut)

Filed under: "Me" updates,Med School and the MSTP — sanguinemare @ 4:55 pm
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Terribly sorry to have been so MIA – this spring semester we have started our organ modules, on top of which we had our medical school’s annual skit night to prepare for, so as such I have been a bit out of touch.  That, and… I still don’t have internet at my place.  Frustration.

Anyhoos, we have flown through the cardiac (heart) and pulmonary (lung) modules through the first two and a half months after getting back on Jan 2 (our winter break was a very short 2 weeks sadly).  Each of those modules was 5 weeks long, and this one will be as well.  Apparently, pulmonary is the easiest module we’ll ever have in our med school career, so it only gets harder from here.  Especially GI (stomach/gut) and renal (kidney), which are our next two modules. GI is tough partly because it’s one of the first modules to test us completely in Step 1 USMLE style questions, and also partly because there are so many organs covered in the same space of time as the single organs in cardio/pulmonary (7 total: salivary glands, esophagus, stomach, small/large intestine, liver, gallbladder, and pancreas).

In terms of MSTP stuff, I’ve also been trying to find a lab to work in for the summer, which has been quite difficult, mainly because I’m one of those people who are interested in almost anything, so my searches are very broad.  I’ve looked through all the faculty (sometimes up to 30 or so) in at least 5-6 different Centers at the school to narrow down the list, and have met with maybe 10 or so.  Scheduling meetings with professors is tougher than it looks, because sometimes they are out of town because of conferences etc, sometimes they can do a certain time in a week but I’ll have class, etc. so it’s been a long process.  Most of my MSTP colleagues in my class (if not all) have already found their lab mentors for the summer, and one of them has already started going to lab meetings!  So I’m feeling a bit behind, but hopefully, I’ll be done a couple weeks and figure that out. 

Housing is another thing I’ll need to worry about – definitely need to move out from my place – it smells of smoke (from a past tenant I guess), the trash can collector sometimes comes at odd hours, there are sketchy people outside the alley sometimes behind my place because it’s behind a bar which sometimes plays music until 1-2am, even on weekdays occasionally… so yeah.  Definitely need to move out.

Anyway, to give a few interesting tidbits about the GI tract so far, here is (according to our lecturer’s slides) the reason the study of GI is important:

  • ~70 mill people in the US visit their physician for a GI-related complaint every year.  5% of the US suffers from chronic digestive disorders.
  • “Abdominal pain” and “diarrhea” are among the top 7 reasons for doctor visits, and there are 0.9 million hospitalization for diarrhea alone in the US
  • ~4 million people have ulcers, 11 million have hemorrhoids, and 5 million have constipation.
  • In 2010, the top selling drug was Nexium, which is a proton pump inhibitor used for ulcer treatments ($5.28 billion).
  • Estimated direct costs in the US per year: $87 billion ($20 billion indirect, like from loss of work days, etc).  

To give you some perspective, the US has about 300 million people (311,591,917 according to the 2011 US Census Bureau).   So percentage-wise, things like ulcers and constipation aren’t that major, but of course are still of concern.  70 million people having a GI-related complaint is pretty significant though.

I do enjoy the interesting stories we’ve been told in GI by our module director so far.  On the very first day, we were treated to a story about how Holy Roman Emperor Frederick II of the 13th century learned how to best digest his food.  Basically, he fed 2 men a large, delicious meal, and sent one of them to hunt and one to rest.  He later had both of them executed and removed their bowels to see who digested the food better.  Lovely, isn’t it?  For those who don’t know, the one who rested had better digestion, since more of his blood flow was able to be directed to his stomach, rather than to his muscles (like the hunter’s).

Another story we were regaled with two days ago was on the pairing of William Beaumont, a local army surgeon with no medical degree, and Alex St. Martin, a French-Canadian fur trapper who had the misfortune of being such a jester that a fellow fur trapper accidentally shot him in the stomach after laughing too hard at his joke and dropping his loaded shotgun.  The moral there is to not be too good a comedian, I suppose.  Or to make sure your friends don’t carry loaded guns.  Anyway, the year was 1822 and Beaumont did his best to heal the wound.  By the 5th week, healing had begun, and a year later, everything was scarred over and healed except for a small hole in the stomach that provided a window of sorts to the outside (he had had a fistula – an abnormal connection of tissue – between his somach wall and abdominal wall)

Beaumont then started experiments with St. Martin including dropping food on a string into the stomach opening for a while, then pulling it out and seeing how much it was digested.  Thus, was born the first physiological experiments on the stomach.  He paid St. Martin ~$160/year to do this, and despite disagreements sometimes (such as those culminating in St. Martin storming from the room in exasperation and only agreeing to come back after Beaumont agreed to pay him more), they did this for quite a good while.  (Wikipedia says that St. Martin actually didn’t do this to thank Beaumont for keeping him alive, but actually because Beaumont made him sign a contract to be a servant (St. Martin was illiterate).  That’s pretty terrible, even without IRB approvals and such…)  St. Martin ended up outliving Beaumont, and lived until 1884 (or 1880 according to Wiki).  So there you have it – you can have hole in your stomach and apparently still live to be quite old.

Anyway, it is about time for me to restart (aka begin) studying, since I’m taking my midterm early on Wednesday so I can leave for a conference.  Hope you enjoyed the stories, and may you all stay well and healthy until next time!

Oh, and just in case you’re curious, here’s an overview of what we have in our 5 weeks of GI:

  • 56 lectures
  • 10 lab sessions (5 anatomy, 2 histology (although I only see one in our schedule…), 2 pathology, and 1 microbiology)
  • 2 small group sessions (Ulcer/GERD (aka acid reflux/heartburn), Liver)
  • 2 large group sessions (Radiology I and II)
  • 2 patient presentations (Hepatitis/Cirrhosis and Congenital abnormalities) – these are where patients are brought into the class and we first get a mini-lecture to learn about their diseases/mechanisms of disease, and then have a Q and A session with them about their lives and what it’s like living with the disease.
  • 3 optional review sessions (including 1 2-hour anatomy lab review that I will unfortunately have to miss because I’ll be taking my midterm at the same time.)
  • 70% attendance required (yes, we have started an attendance policy at our school as of a year or two ago so that lecturers don’t feel odd giving lectures to an empty room.  Generally the attendance policy is 80%).

September 21, 2011

Money matters (… or does it?)

Filed under: Med School and the MSTP — sanguinemare @ 10:09 am
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One thing that we don’t have to worry about, as MSTP’s, is money.  It was one of the reasons I took a year off last year, so I could get a minimum wage job to see what it was like to have to work for and worry about money.  However, I don’t know if being so secure in my financial situation is a good thing.

As we go through school, and through conversations with peers, it’s obvious that most of the class, and most of the professors who are teaching the classes, are/have been on loans to get through med school.  Med school is not cheap.  For in-state residents, our school’s tuition costs a over $22,000 a year.  Add to that the cost of living expenses and fees/books/supplies, and you’re up to around $45,000/year.  And if you were out-of-state, like I am, the tuition itself is about $59,000.  Per year!  And that’s before interest!  That’s a pretty hefty amount. (Wow, I didn’t even realize the actual figures until I looked it up just now… that’s crazy.  Which exactly proves my point about us not having to worry about this.)

What all this means is that most medical students, excepting MSTP’s, people on military scholarships, or the uber rich, will be in at least $150,000-$200,000 in debt by the time they graduate medical school.  For out-0f-state-ers, the numbers are probably in the $240,000-$330,000 range!  No wonder people are talking about still being in debt 5 years out of residency.  Here’s a NY times article on the hidden costs of med school debt that one of my med school friends sent me at the beginning of school.

Inevitably, with so many resources being poured in just to be able to go to med school, one of the choices med students have to make when deciding residencies and careers is the question of money.  How am I going to pay back my loan?  Sometimes in class, this is clearly reflected in the questions we get for guest lecturers.  “Will insurance pay for that procedure?” “What is the reimbursement like?”  I often wonder about those people and think about all the stereotypes about people who go to med school only for the money, because these questions are things that are not even on the radar for me.  But then I catch myself and realize that I am probably one of few who have the luxury of not worrying about the next paycheck or how to pay back back my loans because I don’t have any.  Not many have the luxury of idealism that I do.  But is this a good thing to be able to have?

Sometimes I feel like it’s almost better to have to think about these tough questions, and to be pressed for money and time.  It seems people are more sure of what they want to do, or take school much more seriously because of it.  They study so hard and care a lot about the material (and some stress out significantly more…), and they are driven.  Motivated.  And for the most part, truly interested in what they are doing.  I, with all my financial worries taken care of, seem to be a little less focused, less driven, and very unsure about what I’m doing here or what I want to do with my life. 

Ah well.  I hope at least I’ve given a bit of perspective in the costs of medical school for you all.  Time to go back to class.

August 11, 2011

Guess who just finished her first med school exam?? and mini-rant on computerized tests

Filed under: Med School and the MSTP — sanguinemare @ 12:19 pm
Tags: , , ,

We just had our first medical school test this morning.  We were separated into 3 groups by last name, and took the test at 3 different times this morning.  The third group should be going by now.  I caught myself almost violating the Honor Code because I almost slipped and mentioned what topic I should have studied more on when I was chatting with a classmate who hadn’t yet taken the test.  A slightly awkward silence ensued, and was politely covered up by both of us.  Oops.

I did fairly well, especially for not having studied much.  I got a little distracted with a new comedian I discovered on Youtube, and with talking with a friend about how much we miss my home state.  He also convinced me to finish my Wards reflection essay instead of continuing to study last night (which I will probably be posting on here at some point), because as he said, I wouldn’t want to work on it after finishing the test.  He was right!  Haha.  So yes, didn’t get much sleep, didn’t study that much, did fine.  The fact that we all knew we only needed a ~12% on the test and that no quartiles were being formed yet for the class was a major stress reliever.  Although I hear some students still spent the whole last week studying… guess that shows who the hard workers are.

There seems to be a pretty big dichotomy here – those who study for hours and “don’t have a life” and people who think it’s boring, a waste of time, and still have fun every day.  Of course, this may just be a last hurrah for the latter before the real grind starts, but it is interesting to see.  I personally am somewhere in the middle – I think some of the topics are interesting (otherwise I wouldn’t post about them haha), but I also subscribe to the feeling that “real” school hasn’t started yet.  We shall see how we change throughout the next year I suppose.

On a slight tangent, I really hate taking computerized tests. Why? Let me list the ways:

  1. Inability to use a pencil and paper, which is my preferred method of taking notes or tests.  A lot of stuff goes with this, as you will see in 2, 3, 5, and 6.
  2. Inability to fill in bubbles!  This goes along with the first one, but I used to love filling in bubbles for multiple choice tests.  There’s just something satisfying about it, and erasing and re-filling a bubble if you need to change an answer.
  3. Inability to mark the sheet when you are unsure of an answer.  Yes, I know, you can “flag” answers, like we had today, but it’s not the same.  And you have to scroll through a long list of numbers to find a particular marked question, instead of just quickly scanning a sheet that has everything laid out right there.
  4. Infernal clicking from all corners of the room, which interfere with thought processes, both when trying to figure out the answer, and when trying to read the actual question in the first place.  Perhaps I should invest in some good ear plugs.
  5. Inability to take notes/use the test question booklet as scratch paper to draw on the diagrams, etc to help figure out the problem.  This requires having to either supply your own scratch paper and redraw any figures, potentially difficult for those who can’t draw and wastes precious time, or having to do things in your head.
  6. Along with that is the annoyance of having to move your head up and down as you try to solve the problem on a piece of paper, then looking at the answer choices, then going back to the paper if you messed up, then looking back at the screen to click the answer. And repeat.  Much easier if you just write and fill in a bubble right on your desk.
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