More Joy These Days!

Back all of those years ago when I was in medical school learning about infectious diseases, I never thought I would see a pandemic let alone live through one. SARS-CoV-2 has been a great teacher for me. While others have experienced despair, I have found learning at every step along the way. I have learned more about human behavior. I have learned more about inner strength. I have learned more about experiencing fear but trusting what I know about science.

I am one of those folks who has been in the midst of Covid-19 since it was first described. I count myself fortunate in that I have not become infected with this virus and was one of the first to receive an early vaccine that has protected me well. My excellent health and physical condition along with good and safe practice (masking, hand-washing, social distancing) have been and continue to be my daily routine. I have also learned to express gratitude for staying SARS-CoV-2 negative as I treat patients who have either died or become gravely ill because of this virus.

Some of my colleagues have elected to leave medicine/surgery because of this pandemic. I would argue that they wanted to leave the profession before the pandemic but with the pandemic, they made a choice. I also remind myself that I am not heroic or anything even close to being heroic but eternally grateful in that I can help others who are in dire situations. I am also grateful that my simple life has served me well during this pandemic.

I have kept to my physical conditioning for the most part. The added stress of this pandemic has resulted in some weight gain for me and interrupted sleep patterns but outside of that, I am healthy and strong. The weight now comes off but my sleep loss is still something I work on constantly. For me, a challenge (getting back to sound sleep) is something I will continue to work toward. For me, increased strength to fight the loss of muscle mass and gain of body fat is something to work on controlling too. I am grateful for these challenges.

I have learned to appreciate the simple and sheer joy of good friends and colleagues. I tell my friends often how much they mean to my life and work. I find new pleasure in teaching my students the nuances of science and curiosity along with observation. There is joy in learning and connecting with patients.

I have found peace and vigour in living a simple life of service and practice. I eat simply, I run and walk everywhere I can, and I take pleasure in every act that I can show kindness when my patients are not kind. Kindness is all about me and not about how others treat me. I can forgive, move on, and keep moving forward with experience and acceptance.

Rather than look at how much the pandemic has taken from our lives, I choose to look at how much this pandemic and the next pandemic will enrich my life. Our survival as humans will take learning, experience, and science. For me, I am grateful for the opportunity to learn, experience, and utilize the tools of medical science to help others that’s such a simple thing these days. Every day, try to find one simple thing for which you can express gratitude which will become a useful habit always.

Residency Application, Interview and the Pandemic

For many medical students, the pandemic adjustments have been crucial and imposing. Just when one has adjusted to virtual learning and virtual everything else, the pandemic seemed to ease a bit but at this point (2021 changing to 2022), we are at another series of Covid-19 spikes and more adjustments. Let’s look at a couple of things that might be out there, maybe new or maybe a revisit:

The virtual interview process: this might be in your past or in your future as a replacement for the physical interview. Some institutions have gone to this method and more than a few are contemplating going to a virtual interview. What does this mean?

If you have been anywhere other than under a rock, a virtual interview means that you must get your energy and personality across via a video medium. If you have no formal training in video acting or participation, you need to do some practice to see how you relate to this medium. For me, as a professor who had to move to virtual lectures, the first thing I noticed is that when I am sitting, I tend to slouch after a short period of time. Even if I am taping a lecture, I do better standing rather than sitting.

One has to be aware of good and poor camera angles and lighting. While these elements can be dynamic, they are still present. Make sure you test your lighting and correct what needs to be corrected before your interview begins. I would also caution about using “ring lights” with a darker background because the light rings tend to reflect in the pupils (resembles a cataract at times). Get a pal to help you with making sure your lighting is good. Often moving near a window is ideal but don’t put the window behind you without adequate light on your face.

If you are using a laptop computer (or even a desktop computer), make sure your camera is at eye level and not below. Even the loveliest person can come across as menacing with a low camera angle. Get the camera angle and height correct with the proper distance. Also, remember your background as your cluttered apartment is likely not where you want to interview. See if your library has a nice room that you might use.

Remember that even if your letters of recommendation, grades and board scores got you the interview, it will be the program’s subjective assessment of your “fit” that will be a significant factor in your ranking. Just as you practised for your medical school interview, you need to practice for your residency interview. Make sure you know as much as possible about the programs that interest you (curriculum and educational styles, work-life balance, fellow residents and important geographical considerations). If you have not been able to find out things, be prepared to ask specific questions so that you know as much as possible. Be curious and be specific because you want to make a great decision.

Finally, don’t apologize for things in your application that you believe are less than stellar. Remember that a program would not have invited you for an interview (in-person or virtual) unless they saw something in your application that pointed to you as a good candidate. Resist the urge to do anything other than answer questions honestly, accurately and without apology. Whenever we compare ourselves to others, we are always going to feel that something is lacking. The only person you need to compare yourself to is your former self. You have acquired experience and you have acquired knowledge thus you are better today than you were yesterday.

Finally, remember that this pandemic has affected all of us in medicine. As a practising physician, I have been challenged in ways that I could never have imagined when I was applying for residency or in medical school. What I keep learning is that medicine is more exciting for me today, with the pandemic than I ever could have imagined. I chose this profession because I have a love of learning and a love of taking care of patients.

What Students Have Lost due to Covid-19

As a professor, I have read countless articles about student (medical, undergraduate, graduate) losses due to the Covid-19 pandemic. Certainly there were changes such as going to remote learning that became the only options for teaching and student coursework. There were also opportunities to learn and to keep learning/teaching in the remote options but there was the option to change our perspective on teaching and learning. How did my perspective change?

I found myself remembering my days in medical school. We were in class from 8 AM to 5 PM daily during first and second year with an hour for lunch; usually spent by me preparing for the afternoon set of lectures and laboratory work. When classes and labs ended, I headed for the subway station to get home so that I could study my books, notes, slides and papers for the next day’s work. This usually took me to bedtime with plenty of walks up and down the stairs to break the cycle of sitting. I was never one for sitting hours on end. Even during class time, I would pace in the back of the lecture hall so that I could stretch my legs. I had to keep on the move to keep my brain fresh.

Was sitting in class for hours on end punctuated by some strategic pacing in the back of the lecture hall the most useful means of learning medicine? Well, a few years later, my medical school changed the long days of lecture to a system where some learning was done remotely and less was done in the classroom. Fast forward to 2020/2021 and we are totally remote with some students not making the adjust as well as others. In short, Covid-19 allowed us another opportunity, forced, to evaluate how we teach and learn.

I am a great proponent of face-to-face learning for my students. In the years of practice and teaching at the bedside, in the operating room, and in the lab, I have begun to rely on those cues that indicate a student is struggling even if they are reluctant to speak up. By reading those cues, I learned to slow down the pace and re-explain a concept. I learned to encourage questions. With the pandemic, I lost the face-to-face interaction with my students which has forced me to look for other cues that students might be struggling.

I have learned that many very good students do not have great reading skills which are crucial to remote learning. I have encouraged my students to add some component of reading, writing and recall to their study and review techniques to enhance reading comprehension. Though many of my instructional designers would say that my lectures and demonstrations need to be entertaining, my ultimate goal is for my lectures and demonstrations to be as informative as possible.

I have concluded that even with losing much of the face-to-face learning, students (and professors) have ultimately learned to adapt to a new reality that will be going with us into the future. It is up to me, as the professor to ensure that I create a new environment where students will be more proactive about making sure that they learn what they need to be excellent physicians. With reliable vaccines (and they are quite remarkably reliable), we are going to have medical students back in the classroom and back at the bedside and in operating rooms.

It is going to be vitally important that everyone connected with any educational system be aware that we have to have a cooperation that includes students being more proactive when they do not understand something and professors being willing to encourage as much contact (virtual or face-to-face) for ensuring that students learn what they need. In the case of students who are not good readers, we can give guides for reading comprehension enhancement. The more valuable lesson from Covid-19 is that we are all connected and by virtue of those connections, we have to be cooperative and look for ways to deliver what we need.

I Need to Fly and You Do Too

Yes, we are in a dangerous pandemic and have been in this pandemic for more than a year now. We know that this pandemic is caused by a virus, SARS-CoV-2 that is spread by droplet/aerosol entering the respiratory epithelium via the ACE2 receptor causing variable disease from asymptomatic to severe respiratory embarrassment to death. We know that the Center for Disease Control (CDC) has largely recommended non travel except in emergencies but travel can be done with precautions (commonsense) that reduce the droplet/aerosol transmission of this virus. Moveover, we have almost half of the country (at the time of this post), vaccinated against Covid-19, the disease caused by SARS-CoV-2.

What does all of this mean? It means that we inch closer and closer to getting Covid-19 under some aspect of control but we are not 100% in control of this virus. It means that one has to weigh the risk to benefit of air travel, or any other means of travel at this time which we have been doing by taking precautions such as mask-wearing, social distancing and surface disinfecting for all of our activities including travel. We have been venturing out to do activities such as grocery shopping, exercising, and any number of activities with precautions and mindfulness if safety is our concern. Restaurants, schools, universities, and other places have opened with safety precautions along as long as those precautions are in place.

Why do I need to fly? Flying is my mental health at this point in my life. I am a general aviation pilot; have been since residency many years ago. My most valuable mental escape has been to head out in my little single-engine aircraft for an hour or two, leaving Earth and ground perspectives behind. My hours spent in the air clear my mind and remind me that all problems have solutions. My hours spent in the air remind me that I live in the 21st century where science and technology have allowed me to join birds in being above the Earth and into the air. I need to fly because I can fly.

Why do you need to fly? While you don’t have to earn a pilot’s license unless that is a personal goal as it was for me many years ago, you do need to venture off the ground and into the air because science and technology (vaccines, masks and social distancing) will allow you to do this. You need to do something bold and different from walking around, reading by the fire, and going about your everyday activities. You need to do something that you can’t do every day just for the experience and reassurance that flying is available and safe, same as many of your everyday activities with proper precautions.

Many people such as spring breakers, traveled by air to destinations, some without precautions- something I don’t recommend but I understand because of the last year we all endured. In truth, life is about endurance but life is also about accepting the consequences of our action. If you were a person who traveled during spring break or any other time, I hope you made the effort to be safe with mask-wearing, vaccination, social distancing, and other precautions. If you did these things and traveled safely, you know the mental escape and well-being that your trip afforded you. You returned and you continued to go about your life with mental renewal and vigor because that what human being do.

I need to fly because I need to venture to the other side of the country into the desert and for my mental renewal. I am not going to fly myself but I am going to allow one of my favorite commercial airlines to transport me above the clouds and into a world where I can take a few hours to enjoy getting to my destination- the southern California desert with its heat and lack of humidity. I need that heat and I need to feel the sand shifting under my feet as I run while I visit with those cactus plants and palm trees that are not part of my East coast everyday experience. I need to fly to the desert because I can do this with safety.

If flying to a destination is not for you, then do something else that gets you into a world you don’t experience every day. Leave your everyday experience behind for a day or two and venture into something that is good for your mental health. I received an email from one of my friends who is post renal transplant. He has been largely sheltered in his home alone because he lives alone. He has described his “existence” as a “black hole” from which he has not emerged. For him, a gifted and brilliant actor-director-producer, this pandemic has been one of his ultimate mental challenges. I have faith that he will move into a better state mentally but I fear for him with every breath. He’s tough and resilient which has allowed him to survive a devastating illness that robbed him of renal function, come back to teach, act and direct plays but this pandemic has been another difficult challenge for him.

In summary, find something like flying, that takes you away from your everyday as soon as you can. For me, it will be in the air at 565 mph and 37,000 ft. For others, it can be on the ground but I highly recommend getting into the air. Your brain will be richly rewarded and so will your work in the long run. I want to sweep my friend up and take him with me but for him, that may not be possible yet (yes he’s vaccinated and quite safe). We all have to survive this pandemic but we have to boldly resolve to move toward our pre-pandemic lives by doing something outside our comfort zones wearings masks and social distancing. For my patients and my medical practice I need 37,000 feet this time.

Diversity, Equity, and Inclusion

Diversity, Equity, and Inclusion have become the new “buzz” words for those of us in education. I have been to several lectures by people who deem themselves experts in education and not diversity, equity, and inclusions but it been my nature to question them. My questions are not comforting to them because they are seen as something of a threat but actually my questions are challenges. How dare I, a student in educational matters, question an expert? For me, I have been questioned all of my life in academics, and medicine. To become comfortable with questions is to adapt and to consider another way of thinking-a step toward diversity, equity and inclusion.

If one champions the individual then one has to champion diversity because every individual is different. To believe that those differences are valid and amazing is to have equity and to include everyone. How many times are patient problems dismissed or invalidated because of the physical appearance of the patient with the problem in front of us? We bring our prejudices and experiences with us into the examining room but being aware of those prejudices will allow us to question and challenge our thinking about our patients.

We can’t let the pressure of seeing as many patients as possible (administrators want us to make a profit for the company) dismiss anyone who comes into our care. We can let our preconceived notions about a patient by virtue of their age, sex, language, or appearance (clothing, hygiene) send that clinical algorithm that starts in our heads in a direction that leads to a mistake. This is where we have to challenge ourselves to keep an open mind and be on guard to change our thinking in the next second. It might likely be this but surely it can be that.

I pulled a chart from rack on the outside of the door of one of the examining rooms in my surgery. The first thing stated on the chart was that this patient is a 69-year-old woman who presents with… What does a 69-year-old woman look like? What is running through my mind in terms of treating someone who is 69? My assistant had carefully placed a sticky note stating that this patient should go to dermatology and not be under our care because she looked like a problem. I enter the room, find a lively, engaging woman who had a skin lesion that I removed without difficulty. My assistant wanted to turf her but I elected to treat her as she came to my care. Treating this woman brought joy into my day because I could easily solve her problem and get her on her way. I brought her in.

What about the student who has difficulty understanding a concept that is key to mastery of a part of pre-clinical medicine? This student sought help for another professor but came into my office out of frustration. I elected to teach her how to tie a two-handed surgical knot as I listened to her understanding of a concept. She easily mastered the knot and when she left my office, she had mastered the concept. Sometimes seeing that one can learn a new skill reminds us that we can learn anything with another approach, another way of thinking.

We, as physicians and educators, have to be mindful of groups of people of varying ethnicities but those groups are made up of individuals all of whom are valuable to the group as a whole. Appreciation for the uniqueness of every human in terms of age, sex, appearance, cognitive ability, skin color, or any one of thousands of unique factors is the wonder of medicine and of teaching. Seeing ourselves in our patients is key but seeing our prejudices is another key. We always have to challenge ourselves to reflect on our feelings about those we serve. Medicine is a profession of service to others, inclusion of all and appreciation for the diversity of all which is true equity.

Trauma for an Actor

In the decades since I have become a surgeon, my training is muscle and brain memory. Those thousands of lessons learned in the trauma bay, operating room and on the wards will begin as soon as I get the notice that I have a patient who needs treatment. My brain focuses on the task in front of me, my hands and body follow very quickly. This is how long hours of study and training work for a surgeon; perhaps for anyone in medicine.

My profession as a physician does not permit me to put myself or my family in front of those who need my help. This fact is woefully exploited by hospital administrators and others who look upon me as a money-generator for their organizations. Those administrators have the luxury of enjoying a comfortable and secure life because I am forced to compartmentalize my life for my profession.

Early on, I knew that I was well-adapted for my chosen profession in that I need little sleep; maintain a very high state of good personal health, and I keep focus/concentration with little effort. For people who have attention-deficit, surgery is not a good choice. As a surgeon, I must relentlessly keep every detail in my mind; every step of a process as it unfolds. My attention does not waiver.

My challenges today, after years of practice, are to push myself out of my comfort zone as much as possible. I study acting for more awareness of my physical body and more awareness of not being automatic in things that I must do in my profession. Acting has forced me to consider why I make every movement and every gesture as I work and live. For me, acting class has been quite similar to Trauma encounters.

While the script for any Trauma encounter is ABCDE: Airway, Breathing, Circulation, Disability and Exposure. Repeat ABCDE as many times as needed to get the information crucial for treating the patient in front of me; sometime dropping back from C to A as the patient’s condition changes. With every change, my training allows me evaluation of what is needed and how I will solve the problem. My mind never allows interference or feelings for that matter.

How does Acting help this process? My Acting class has been a period of intellectual growth and new learning. Just as I plow through a mountain of continuing medical education materials, journal articles and books for maintenance of my knowledge base, I plow through a script of monologue for cues and evidence to master a character. In the case of Acting, I have some creative license; surgery is rarely creative.

My training in surgery allows me to move toward situations where others would freeze because of their inexperience. While I am quite inexperienced in Acting, my surgery allows me to push my knowledge base in Acting for my goal. What I lack in Acting is critique from those who have more experience. In surgery, I am the one with more experience most of the time.

My Acting experience has allowed me to evaluate how I perform every task in Surgery; how I interact with others and patients; how I must be clear in moving toward my goal. What Acting has not done is allow my mind to relax at any point. I am acutely aware that I can’t remove my profession of Surgery in the same manner as I can complete a play or character analysis. I am always a Surgeon.

Acting has pushed me to give the people who train under me the necessary critique of what they are learning. It’s always good to have someone with more experience evaluate what has taken place. Some of the resident surgeons on my team find criticism difficult while other see criticism as an opportunity to learn. It’s the resident surgeons and medical students who look to improve their learning that will thrive in this profession.

Acting and surgery are not for those who have egos. An ego in the sense that any criticism is a danger to keeping one’s ego intact will bring much displeasure in the practice of medicine/surgery. Those of us who practice this profession of medicine/surgery must be adaptable to change and adapt to criticism. In pushing one’s comfort zone, one is able to push one’s ease of adaptation.

I never want to be comfortable with anything that involves my profession but I want to become comfortable with quick adaptation. Toward this end, I hope my study of Acting will continue to hone my work in Trauma. As Trauma is life-changing for my patients, it had become routine for me. As a surgeon, I resist any routine and seek constant change and improvement. When something becomes easy in Surgery, mistakes and the consequences of those mistakes become paramount. I refuse to allow this and seek those situations where I am not at ease; my Acting.

Clinical Trial- SARS-CoV-2 Vaccine

I made the decision to participate in a clinical trial for a SARS-CoV-2 vaccine. This is my first experience as a participant in a clinical trial but it is an important experience in my life. I considered that I am a very, robustly healthy individual who takes great care to keep myself healthy. I also considered that I am a physician/scientist who has conducted clinical trials as a designer but had never served as a participant. I wanted this experience and I want to learn from this experience.

The magic of medicine for me has been helping my patients preserve their health or get back to health when illness has occurred. Helping patients is the reason I entered medicine many years ago and a sense of helping others is still of paramount importance. Participation in this trial is but another way for me to see the magic of both medicine and science.

I heard admonitions from people when they learned that I had decided to participate in a vaccine trial. “Why put yourself at risk? Someone else can do this,” was the most common reaction from the few colleagues that I informed of my decision. Well, if not me, then who? This has been my answer to those who ask why I do this. I have always sought experiences and I have always been a soul who will seek experiences even if there is some risk to me. I minimize that risk by following directions and continuing to be safe.

Recently on social media, some people have taken to perpetuating their beliefs, certainly not based in scientific evidence, that vaccine cause many diseases and disorders such as autism. As a scientist, I know that this is not the case based on scientific evidence. The most effective vaccines help to control diseases that would be far worse if not controlled. Our yearly influenza vaccine is an example of the positive utility of a vaccine.

For the past month, I have experienced the participation in a Stage 2 clinical trial. There has been no change in my robust health. Since this trial is blind, I don’t know if I received the vaccine or a placebo; can’t tell from how my body reacted to the injection. I still run every early morning (before light), I still work every day (seven days per week because I am a physician) and I continue to practice behaviors that will keep me safe from this virus (mask-wearing, social distancing, staying home and good hand-washing).

My participation in this trial is with the hope that by studying me and my response to the injection that I received, I will help others. Though it has been only one month, I am committed to participate until the end. For me, it’s a matter of ‘who better than a very healthy woman’ such as myself, to be a participant. If not me, then who? I do this for the people I love and for my patients. I keep going as this has been my experience and my world since I was born.

New Habits and Learning

In the twenty years that I have practised medicine/surgery, nothing like this COVID-19 disease epidemic has been my experience. I was practising in Washington, DC during the attack on the Pentagon on September 11, 2001; a time when I thought nothing could be worse. Well, this viral pandemic is worse because many people only listen to what that WANT to hear rather than what the NEED to hear. I see the worst examples of noncompliance in those who had little trust for science and medicine in the first place.

Having performed bariatric surgery on a population of people who have dire mental health and physical needs, I see many of the same behaviours in people who are not adapting to this 2020 pandemic. I see hoarding behaviour; a sign of anxiety. I see anger; a sign of depression and I see fear; understandable because this is a new situation for all of us in this country.  Most frightening for me is seeing large non-compliance in simple matters that will affect how this virus can spread.

Some of my undergraduate students boasted that they are strong and healthy thus they don’t have to worry about COVID-19. Some of my neighbours had a birthday party with 20 guests using the rationale that they couldn’t bear to disappoint their son or daughter. Some have blatantly questioned that this pandemic is even “real” because the news media always tries to frighten “good” people. For me as a practising physician who cares for the health of a community, the non-compliant people are frightening.

I developed some automatic self behaviours long ago such as removing my shoes when I enter my house; washing my hands often (I am a surgeon); not touching my face without washing my hands and cleaning my house from top to bottom weekly. My sweetheart calls me a “neatnik” because I constantly remove clutter both in my offices and on my computer. These are habits ingrained since childhood but I add to them with keeping a bottle of hand sanitizer next to my front door and keeping a table on my porch for packages that are cleaned before they come into my house.

Along with my neat and clean environment, I add making sure that I exercise a minimum of 30 minutes per day (I usually run 90 minutes at 3AM daily); eating well-balanced meals (easier now that restaurants are not open) and getting a solid amount of rest/sleep (harder because I am working longer hours). I practise mindfulness when I feel stressed though long ago I learned that regular aerobic exercise removed much of the stress from my life. I practise yoga and calming in a minimum of two sessions daily.

I have learned to relish my reading time more and more but miss attending plays and productions. I miss the NHL and NBA along with rooting for my university basketball team. A quick listen to news reports brought a sense of grief that while I hear birds singing, there is no baseball. I have replaced my love of watching sports by watching cooking shows where I learn new combinations of spices and foods. I have picked up a couple of novels to read and enjoy because I have completed my journal reading more efficiently these days.

Finally, this virus gave me a chance to examine every automatic gesture and movement when I am in a patient’s room. I am constantly vigilant about maintaining a social distance for the safety of my patient. When I am in contact with a patient, I make sure that I am wearing safety devices because we don’t know who is positive or who is negative for this very contagious SARS-CoV-2 virus. We use universal respiratory precautions for all patients for the safety of every healthcare worker. I remind my colleagues to go home, interact with their families and to be safe. This is our new normal for the months to come but still, there is joy in practising medicine and serving others in this time of increasing danger.

Medical Education in the Age of a Pandemic

Here we are at the beginning of a pandemic with a new virus here in the United States. I returned from a much-needed vacation in the southern California desert where I took the opportunity to re-educate myself (a surgeon) on dealing with a new respiratory virus that now appears more contagious than the influenza virus; a threat but not the end of the world as we know it. Back at home, my institution of higher learning let me know that we would be going to remote learning for most of our students.

For me, here’s a real-time lesson in first, why I took the Hippocratic Oath to first do no harm. I had been telling my students for months, to exercise good and proper handwashing and to stop touching their faces. I had emphasized the need to get and stay in the good physical condition and I had emphasized regular vigorous exercise to reduce stress along with a diet that is lower in alcohol, junk food and high-fat foods. There is nothing new about doing these things to keep healthy. First, do no harm to oneself.

Along with taking care of yourself, you have to take “care” of others. This means being calm, well-informed and kind to others. This means moving your focus away from yourself and outward to your patients and relatives who might be frightened and very misinformed.  As I watched people hoarding food and household items, I emphasized to all around me, to be calm and not to panic. Staying safe now means staying relaxed and as stress-free as possible.

Look at the bright sunshine and blue sky. Take a few breaths to relax. In the coming weeks, you will be closer to those that you love and care about. Hold them close and hold yourself closer with kindness and understanding. After that, change what you are used to doing for relaxation replacing with reading something that isn’t medical, catching up on Netflix and keeping grateful for simply having a roof over your head. These are simple things. Take this opportunity to work on setting your study habits at home rather than in a classroom.

Next, if you are in your clinical years, practice excellent use of personal protective devices but don’t panic. Show your patients that you are healthy, calm and ready to care for them. Show your less-educated allied health workers that they don’t need to panic but to be professional and caring. As I walked into my hospital this morning, I greeted everyone with my usual smile and upbeat manner to emphasize that it was good to see most of them. I simply will not tolerate panic and over-bearing stress.

My students need not worry that they can’t complete their education. As an educator and a teaching physician, I will make sure that you have the best opportunity to grown and learn with this new opportunity to study and learn on a daily basis. I will continue to give the best information. I will continue to remind you that you can make the best use of your electronic tools and I will continue to remind you to listen to people who have studied and weathered these “pandemics” with organisms that were far deadlier than this virus.

Now, it isn’t about you but it’s about all of us as a society. This virus has emerged and given us an opportunity to reboot and renew ourselves as we care for others especially the most vulnerable. As I watch people stuffing shopping carts and in some cases, attempting to hoard things, I remember that we all have enough and will have enough of everything except kindness and caring. Relax, care for yourself and continue to care for others with safety and kindess.

The Changes in USMLE Step I

The new proposed changes in USMLE Step I take this test from a numerical score to Pass/Fail. Make no mistake, this exam will continue to be high stakes especially if one fails this exam. By making this exam Pass/Fail, it becomes a baseline standard for assessment of whether or not one has the basis for clinical work in medicine.

While I am happy to see that the USMLE Step I becomes more of a minimal standard that one should be able to meet, I do want to emphasize that failing this exam become more of a liability for medical students. It is my hope that one will plunge into their pre-clinical coursework with vigor for gaining a knowledge base to build upon clinically. I would also hope that this change will allow students to stop using a single score on a single exam as a means of comparing themselves to others.

It has been my experience that exam scores may assess critical thinking skills and knowledge base but no exam can assess grit, determination, and resilience which are as important in medical practice and training as knowing the right answers. This is where I hope the changes will most affect students. I hope that they will pursue their studies with grit, determination, and resilience so that they will gain a knowledge base that will move them forward.

Medical students in this country already know how to learn and achieve. They would not have gained admission into medical school with learning and achievement in their pre-medical science and undergraduate studies. Medical school admissions have tested their resolve to learn and demonstrate that they have a broad range of talents that will get them through their medical school classes. What is very difficult to assess but may be learned in how to become a  physician who can utilize their medical science knowledge in the treatment of patients. In short, one has to learn to become a physician and will constantly learn for the rest of one’s life.

For me, the transformation of becoming a physician is never over. I am constantly observing humanity, connecting with humanity, and challenging myself to do better with each patient encounter. Being able to treat my fellow humans is never routine or boring and as such, never something that I can ever “take for granted”. I have to give everything that I can give to each patient sometimes under duress and less than ideal circumstances. In short, medicine and its practice for me is never perfect or routine but always a wonder and a joy.

My patients don’t care if I am on my 40th hour or on my first hour because when they encounter me, it’s never by choice. I chose the demands of this profession but they don’t choose to be sick. I always have that thought in my brain as I enter each room. While the new changes in USMLE Step I may lessen competition and perhaps, take some money out of the coffers of USMLE prep companies, the changes do not change the ultimate goal and that is to become the best physician that one can become. To practice medicine is to keep practicing until one gets it as right as possible.