At some point in your career, you will “fail” at something. How you recover from that failure speaks volumes about your work ethic. I am going to explore some strategies for preventing and recovering from failures (or just poor performances).
At some point in your education, you will fail (or not perform well) on a course exam. Your first stop is to look at why you failed the exam. Was your preparation not detailed enough for the questions asked? Did you put off studying until the last minute and hope that you did enough to pass the exam? Did you approach the material from a position of “fear” rather than a position of “mastery”? In any of the above instances, you have to go back, correct your study methods and strive to perform better on the next course exam. Correcting your study methods means that you have to shove your ego aside and take an objective look (often best done with a professor), at what you need to add to your study session or how you have to change your approach to the materials. This is not the time to “make excuses” but this is the time to make sure that you hone your approach and add in any strategies that you may have missed the first time around.
If you are having a difficult time understanding your course material, then look at your background (or pre-requisite) preparation for the course. Most undergraduate science courses require a solid grounding in college algebra and trigonometry. If you mathematical preparation is not sound, you are likely going to struggle through much of your physical science courses. Courses such as physical chemistry (if you are a chemistry major) require a solid working and application knowledge of calculus (through multivariate). In short, make sure that you have the math preparation for the coursework that you undertake so that you are struggling to master both the math and the scientific concepts (a task that is formidable for the best students).
You also need to make sure that you reading skills are sound when you begin college-level work. If your reading skills are poor, specifically comprehension, take skills courses and upgrade your reading efficiency (speed and comprehension). If you anticipate the study of medicine, you must be able to read efficiently and understand the concepts as they are presented. Again, struggling with basic skills while attempting to master a large volume of materials is going to cause early burnout and lead to a poor performance in coursework both at the undergraduate and graduate level. Additionally, the Medical College Admissions Test (MCAT) requires strong reading comprehension skills for a solid score. Many medical college admissions committees will focus on the Verbal Reasoning skills portion of the MCAT as a means of deciding whether or not to admit a candidate.
Strong reading comprehension skills can be achieved by taking coursework that forces one to constantly and consistently analyze and critique different types of writing. Good writers without exception are good readers and good readers are usually very strong writers. It is a sound practice at the undergraduate level to challenge yourself with academic, scientific and scholastic writing experiences and courses. It’s also a good idea to read a variety of disciplines as an undergraduate. While it is expected that a physician will be able to read and evaluate medical literature, it is also expected that a physician will be able to incorporate new information and evidence-based medicine into their practice in an efficient and accurate manner.
Standardized Exams are well-represented in the career of physicians. Many of these exams have severe consequences when a test takers performance is not strong. Many students will have their first experience with standardized testing with the Scholastic Achieve Test (SAT) or the American College Testing (ACT) Test. Many people were able to take prep courses (expensive) and many people took one or both of these tests more than once. With most standardized tests in medical school, there are no “do-overs” unless you fail one of the steps of USMLE or COMLEX. If you go into one of these licensure board exams with the idea that you are going to fail (or do-over), you have put your career in serious jeopardy.
The key to a strong performance on USMLE (COMLEX) is through mastery of your medical school coursework and a thorough review before taking any of the steps of these exams. A review course does not overcome a poor knowledge base from poor coursework mastery. If you struggled with one or more of your courses (or clinical rotations), then you need to make sure that you review and shore-up that knowledge deficiency. Your test preparation needs to include going to the websites of these standardized tests and learning everything that you can find out about the test. What is the topic base being tested? How are the concepts tested? Are their retired exams available for practice? (Practice questions can be a good addition to your preparation strategy but you can’t memorize these questions because they are “retired” meaning that you won’t see them on the actual test). Don’t get “hung up” on material that is review material if you don’t know the concepts in the first place. This is why a potential test taker need both a knowledge base and a review not one or the other.
Your mindset going into any type of achievement or licensure board exam has to focus on taking the test one time and performing your best. The best way to insure that you have a strong performance is to not have an emotional reaction to the material on the test but to plot a sound review strategy once you have become eligible to take a licensure board exam. Many people focus on what they will do if they fail or what they will do if they don’t get a good score or what how they feel going into the exam (no one ever feels 100% ready but you have to ensure that you have done a thorough and sound prep). If you have been objective about what you need to review and learn and you have not attempted to take “short-cuts”, then you should be able to take your licensure board exams with the confidence that you can handle any concept that is presented on these types of exams. If you have mastered the concept and can recognize how the concept is being tested, then you can answer the question. If you can’t outright answer a question, ruling out possible wrong answers can be in your favor if your knowledge base is sound.
I know I am not ready but I will take the exam for “practice”
This manner of thinking is a huge mistake on any standardized achievement exam. These types of exams are not designed to be taken for “practice”, thus consequences come with practicing on actual exam sessions. If you feel that you need practice exams, then spend the money on test prep center practice exams but don’t use an actual MCAT, USMLE or COMLEX exam session as a practice. If you take these exams and score poorly or fail, you have greatly compromised your future career in medicine. A string of mediocre MCAT scores even coupled with a strong undergraduate GPA will not yield success in medical school entry. In terms of USMLE/COMLEX, residency program directors are very wary or people who have multiple attempts at any of the steps in these licensure exams. All specialty residency programs have yearly in-training exam and specialty boards for board certification. If an applicant is struggling with USMLE/COMLEX, they are likely going to struggle with certification exams which will reflect back poorly on the residency program. Don’t take any standardized licensure board exam unless you are ready to pass the exam. There are no exceptions to this rule. In today’s world of residency slots being competitive in specialties that were less competitive even three years ago, you can’t afford to make yourself less-competitive because you took a USMLE/COMLEX step for “practice” and planned on repeating the exam. Get the “repeat” mentality out of your vocabulary and thinking.
Bottom-line Work Ethic
You have to be willing to let go of your ego, change some things that you have become accustomed to and objectively look at yourself if you want to move past an exam failure. If you failed any of the steps of USMLE/COMLEX, you have to let go of your “dream” of a lifestyle or surgical specialty and realistically look at what specialty (likely primary care) for which you are competitive. This means that high-achieving academic university programs in Internal Medicine, Pediatrics or even Family Medicine are going to be out of your reach. This means that community based programs in primary care which often require more self-learning are going to be the basis of your training. If you have a very strong work ethic, a community-based primary care residency program will be a great place to thrive and learn but you have to be willing to put in the work and you may have little choice in the location of your training program. You also have to be prepared for the strong possibility, especially if you have not received invitations for residency interviews which may herald that you may not match into a PGY-1 position, a state that is fraught with stress and pitfalls.
If you find that you have failed a course exam, you have to do the following with speed and purpose:
- Seek out your exam and your professor so that you can review your exam and correct your preparation mistakes
- Shore up your deficiencies in your coursework and keep up with your class so that you don’t fail another exam
- Attend any tutorial sessions and office hours even if you believe you are on track with your exam prep. Checking your learning is a very good idea to make sure you don’t get off track a second time
- Put any negative thoughts about your previous failures behind you. Every test is an opportunity to change your thinking and upgrade your performance.
- Remember that you are in competition with yourself to do the best job with your coursework that you can achieve. There are few opportunities for “do-overs” in health care professional learning.
- Stop comparing yourself to others in your classes or school. You have to do what you need to get the results that you want. What works for others, may not work for you so adapt and apply so that you get what you need for yourself.
By doing the above, this becomes your work ethic and sets the bottom-line for future success. If you can’t adapt and learn for your educational experiences, you will have a tough time moving forward with your training under any circumstances.
“We choose to go to the moon. We choose to go to the moon in this decade and do the other things, not because they are easy, but because they are hard, because that goal will serve to organize and measure the best of our energies and skills, because that challenge is one that we are willing to accept, one we are unwilling to postpone, and one which we intend to win, and the others, too.” John F. Kennedy at Rice University on Sept 12, 1962.
Why choose medicine (or any profession in health care) if the work and preparation for that work is so hard? I asked myself why I spent hours in chemistry, physics and biology lab when my friends who were business and marketing majors were spending their weekends enjoying the club scene and knew the latest shows on the telly? Why was I putting in the hours making sure that my organic chemistry lab reports were accurate and complete? Why did I choose to study advanced applied differential equations, multivariate calculus and higher algebra (math minor) when I could have stopped with integral calculus? In short, why did I deliberately choose a rigorous college education in math and science where I demanded only the highest performance from myself when I could have taken a far easier route? The answer for me was pretty simple, “I had to know how things worked” and setting a hard goal energizes me and my skills.
Yes, my majors in undergraduate were considered difficult by some people but they were sheer heaven for me. Every minute that I spent in lab and applying math theories was not a chore but a pleasure. I had always loved to “figure things out” and I had parents who challenged me (and my siblings) to always do our best work no matter how many hours the job would take. From undergraduate to graduate school (I was a research scientist before medical school), I could focus in on a problem and see many alternative methods to solve that problem. I wanted to explain mathematically, how energy from a laser was transmitted via a heavy mineral acid matrix to a delicate protein in order for that protein to become ionized. I wanted to understand the mathematical model for that phenomenon and others. Fortunately for me, science allowed me to go where my mind could take me and then some.
So what does that mean in terms of medicine? This means that all of my previous studies from primary school to secondary school to undergraduate university to graduate university and medical school are all aimed at understanding why and figuring out how things work especially the human disease phenomenon. One simply has to have a grasp of the whole picture and the whole person in order to have a strong perspective as to how to best help that patient. Medicine is not like business in that one can take a “shortcut” and still get to goal. Medicine is like preparing for a marathon or to lose 100 pounds in that one has to see the long-term goal, work constantly and consistently at a high level and one has to remain vigilant or the goal slips away. This doesn’t mean that the path toward the goal isn’t pleasant because the journey is great fun but the most enjoyment comes when one sees how building upon a knowledge base and application of that knowledge base actually solves a problem for a patient.
I remember spending hours as a third-year medical student in the anatomy lab as I was perfecting my suture techniques. I sutured the skin of cadavers much to the chagrin of the first-year medical students who had spent hours removing or dissecting that skin. I would come into the lab before my surgical rotation started (I was there at 3AM); practiced my suturing and tying techniques and was off (smelling of formaldehyde) to write my morning notes before rounds. Yes, it was “hard” to get up on a cold and snowy morning when it was dark outside and head to a cold anatomy lab with cold steel tanks all around. No, I didn’t “have to” get up early and practice my suturing and tying but after I knew that I wanted to be a surgeon, I knew that I had to put in the time and hone my skills.
When I was in the hospital on overnight call, I went to the library and read about my patients’ problems. I refreshed my knowledge of pathology, I reviewed every medication that they were on and I made notes of how the disease process should progress. Was this easy? No, it was far easier to grab a nap because the Trauma pager would be going off practically continuously after 9 PM and I would be in the emergency department almost constantly until 5AM when it was time for pre-rounding. I learned to cat nap on call (sleep no more than 20 minutes), read when I was exhausted (putting my feet up was better than sleeping for hours and hone in on a surgical procedure while the rest of the world slept. Was it easy? No but I had set a long-term goal for myself and I was determined to get the job done with the same work ethic that my parents instilled from day one.
Conquering Hard Goals
Excellence becomes a habit if it is practiced on a hourly basis. This was the first thing that my parents instilled in me. When self-doubt creeps in and procrastination begins, remember that you can turn around your thinking in the next instant. Why is it so easy to NOT do something well when it is just as easy to DO that something well? There is always more than one way to do anything and any method that one chooses that brings about excellent results that are safe and ethical is the method to accomplish something. In one’s academics, there is little time to spend on “thinking” about how inferior/superior you are in relation to one’s peers if one is constantly striving toward a long term goal of consistent excellent performance. This doesn’t mean that one wastes time on being “anal” or a “perfectionist” because these two traits carried to an extreme waste too much energy. Consistent excellence means building upon a foundation and linking prior knowledge to present knowledge to setting the foundation for future knowledge.
Sometimes one needs to get a different perspective. If you are finding that you are “spinning your wheels” on a task that seems insurmountable, break that task into more manageable pieces and tackle each one in turn until the whole task is done. Again, if you have 100 pounds to lose, you have to lose that weight one pound at a time. You can’t spend time hating the process (takes away from time that could be better spent working toward the goal) and you can’t afford to indulge in self-pity “Why is it so hard for me and so easy for everyone else?”. In short, your goals and challenges are unique to you and trust me on this one, everyone has goals and challeges that you may or may not be able to see or appreciate. You are no lesser or no greater than any person around you but you can make better or worse decisions as to how you will handle your challenges and goals.
Look from a different perspective
I have been fortunate enough to have spent some quality time looking at the world from the cockpit of my small plane. When I need to put a problem or goal into perspective, I head “up top” and look at the wonders of the world below. When I fly in a commercial airliner, the world below is much smaller at 37,000 feet (on a clear day), than at 3,000 to 6,000 feet where I can mentally interact with things below. The people below are not insignificant at that altitude and the world below becomes more than just the day in and day out tasks of getting things done. In short, find something (for me, it’s flying) that can take you out of your world for a short period of time and help you refocus. For me, flying takes focus and concentration but the pay off is worth the effort. It’s a challenge for a person who thrives on challenge.
You can see the goal (the runway) down there and you can take the steps to line up and get down there to that runway. Flying for me, is a metaphor for meeting the challenges that I encounter on a daily basis. Again, I learned to fly not because it was easy but because it was a hard challenge” that it “serves to organize and measure the best of (my )energies and skills ” and it allows me to accept, willingly, other challenges (not postpone them) that I meet in life.
Well, for most people, it’s nearing the end of the first semester of school for this particular year. It’s a time to complete the projects, papers and assignments that are needed to complete the year strong and it’s a time to start getting organized for those final exams that are looming in the future. This is not the time for berating yourself for not performing up to the standards that you created when you began the semester. For all students, there is quite a bit of “life” in between the start and end of any semester (or any period of time) in the educational process. Over any period of time, distractions and immediate needs/problems will get in the way of your learning. How you manage those distractions/problems is something that you can change to help you in the next semester. In short, as soon as you are done with your work for this semester, take an honest appraisal of what you would like to change and keep the things that worked for you.
Every person has a tendency to compare their lives with what they perceive as the life of another person. That other person might have been your sibling as you were growing up. ( I thought my sister was smarter, more beautiful and more talented that I could ever imagine). That other person might be someone in your class (I see that X or Y is at the top of the class and he/she doesn’t even have to study) or that other person might be someone you see on the telly or in the movies that you perceive would have a better life or greater abilities than yourself. This practice of comparison is a huge time waster because the only person that you can compare yourself to (in any way) is your previous self. Only you know how to live your life and only you know what you need to succeed in getting what you need to live your life. It’s always easy to believe that others are somehow innately “better” that you are but in reality, they can’t live your life as well as you can live your life and you can’t know what challenges them.
The stress of school, especially medical school or any professional school, can send many students into behaviors that they would not even consider if academic stressors were not present. Assignments, tests and projects seem to be endless. The time that you thought you would have at the beginning of the semester, at this point, seems to have evaporated faster than dry ice. You find that you feel overwhelmed and rushed to complete things often feeling less satisfied that you have been able to give your work your best efforts. When this happens, stop and take a minute to prioritize the upcoming tasks. This is a good time to make a very simple list of the things that have to been done immediately and the things that can wait until you have a bit more time. This is also a good time to pencil in at least 30 minutes of time daily to just reward yourself for keeping up with your semester/academic tests as best you can. That daily 30-minute reward should be something affirming (not self-destructive) that you can keep coming back to when you need to take a short retreat.
Why is it so easy to believe that everyone else is doing better that you are doing at this minute? This happens because you project your feelings of inadequacy into your thoughts about others as you compare yourself to them. You are no more inadequate than the next person in your class but you may be making decisions that are not productive in terms of getting your academic work under control. Just allowing distractions to eat up your preparation time for study and completion of projects can be counter-productive to doing your best work. If something is so distracting that you can’t concentrate on things that you need to be working on, then take that daily 30-minute reward time and use it to indulge in your favorite distraction (social media for example) as a reward instead of “beating up” on yourself for procrastinating on Facebook. This means that you use your Facebook time as a reward for getting your other work accomplished rather than something that takes you away from what you need to do. In short, make a better decision not to deprive yourself of indulgences but to limit the amount of time that you participate in them.
Another thing that you can do in this minute, is to replace your belief that you are somehow inferior to others with the affirmation that they would have no idea of how to live your life. Only you can live the life that you are living. You were born with all of the tools that you need to make a success of what you would like to be successful in. All skills can be mastered if you put yourself in a position to master them and take each step needed toward a goal on a daily basis. Success is more of a habit rather than something that is “conferred” on a few “lucky souls”. Success in little daily tasks always adds up to overall success in the “big” items. If you attempt to “rush” or “short-cut” your way through your academics/projects, then you WILL run out of time to do your best work. Objective and thoughtful planning, with daily adjustments, works better than waiting until the last minute because you have the idea that “working under pressure” will spur you to work better. Adding pressure to an already stressful situation adds more stress and does little to get your tasks accomplished. Remember, people who are stressed tend to exhibit behaviors that add to stress rather than relieve it.
The other problem with constantly comparing yourself to others is that under stress, you always believe the negative thoughts first. In stressful situations, it’s aways easy to believe that you will “never” understand all of this or that you will NEVER get everything done that you need to get completed. In reality, if any student in the past was able to get the work completed, you will be able to get the work completed. You have all of the tools do your best under any circumstances. There is no other human out there that can life your life better than you can live your life. You make a list of what needs to be done and you plan how you will do it. This doesn’t apply to anyone except you because only you can figure out what you need (and how much time you need) to complete your list. Yes, it’s true that there are only 24 hours in each day (and you have to sleep) but look objectively at your priority items on your list and do the most important items first. This is how we triage patients (we treat the sickest patients first and take care of the less acute patients in turn). If you don’t get everything completed, then you examine how you would change things and take action so that you get the most out of your academics.
Finally, telling yourself that you have “passion” for something is not the same as putting yourself in a position for being successful with something. Passion does not overcome or offset daily work toward a long-term goal. If you seek a long-term goal, realize that these long-term goals are reached by taking regular/daily small steps toward them. There is a path toward a goal and the steps along that path are the challenges that you have to meet. Meet and greet each challenge with the idea that you will figure out what each challenge requires and get the job done in your unique manner.
Put comparison terms out of your mind and replace them with action terms such as ” I can” and ” I will” do what I need to do along with asking for assistance at the first sign of trouble. Asking for guidance or assistance is not a sign of weakness but a sign of logical and careful evaluation of that you need for success. If you needed to lift a car, would you keep struggling alone or would you enlist the assistance of 10 others to help you lift that car? Anyone can lend you a hand along the way because most people are willing to help others if asked. You just need to be able to swallow your ego, ask for assistance if you need it and affirm that you will live your life, taking care of your needs without comparison to others and what they are or are not doing. In reality, those people that you believe are so much better than yourself are more like you than you would believe and have the same challenges that you have. In the end, you are equal to them and better in living your life.
When sitting down for study, one has to have a plan for getting the best results most efficiently. This post is designed to assist any student in getting the best results for their study time in the most efficient manner. In professional school, it is vitally important for a student to obtain a strong knowledge base and continue adding to that knowledge base and refining that knowledge base for the rest of their career. In 2013, when there is so much information practically at one’s fingertips, it is still vital for a modern medical professional to have a strong and refined knowledge base.
Set goals and objectives for your study session
Don’t sit down at that table in the library without having a study plan. It is best to set some goals (and time frames) to accomplish for that particular session. For example, I would plan on studying at least two hours for every hour spent in lecture and 1/2 hour for every hour spent in lab. Depending on the subject matter, I would list the specific items that I planned to study in each session. Next to each of those items, I would place the amount of time, based on my time frame and the amount of time that the lecturer had spent on those items next to each of the times. When I had had completed an item, I would cross it off my list. If I needed more time, I would move that item to the end of the list and add more time before I crossed the item off my list. In short, I always had a study plan. An example: Plan for studying gross anatomy.
- Review the previous lecture items – 30 minutes
- Review the present lecture and organize it – 10 minutes
- Lecture item – 20 minutes
- Break- 10 minutes
- Lecture item-20 minutes
- Lecture item – 30 minutes
- Break- 10 minutes
On my breaks, I could walk around, get something to drink or go up and down a flight of stairs so that my circulation could get moving. If something crept into my thoughts, I would jot it down in a piece of paper and think about it on my next break while I was moving around.
I always made sure that I covered the assigned reading in my textbook before attending lectures. By doing this, I knew what was important in the next lecture and I had an idea of what might be covered. Sometimes, textbook reading is the only way something would be covered that needed to be in my knowledge base. The textbooks would generally put items into perspective that I needed to learn to become a good physician. This meant that I was adding to my knowledge base as well as organizing the materials to be studied. In general, I used 1/2 of my study time on weekends to get ahead in my reading.
When I became a resident physician, I read at least 30 minutes per day (no matter how tired I was) and a minimum of 3 hours each weekend. I kept a running list of the articles that I read from journals and the subjects that I covered in my surgical textbook. By the end of 6 months, I had completely finished Sabiston Textbook of Surgery and had kept up with my journals. I always had something printed out to read over lunch or while I was waiting to begin a case. I kept notes on cards and summaries of articles that were pertinent to my rotations/practice goals. When I completed my surgical textbook, I re-read the sections that I felt were most important for my practice so that my knowledge gained from the textbook could be incorporated into my long-term memory. I also covered any topics in the textbook that were covered in conferences and grand rounds.
It is important as a physician for one to keep up with the literature of one’s practice. This habit started in medical school when a medicine professor challenged us to read the New England Journal of Medicine each week. I started with the case of the week and moved to the review articles and then the original research articles. At first I understood very little of what I was reading but in a few weeks, I was used to most of the language of medicine. I kept a medical dictionary on my desk and looked up words that I didn’t understand. Not only did I start to understand upcoming changes but I started to learn which journals were important to my future medical practice.
I had completed graduate school before medical school and knew the importance of learning the literature of one’s subject area. I soon came to love and appreciate Nature Medicine (lot’s of basic science here) and Physiological Reviews (very dense review articles but great reading). If you are at the undergraduate level, get used to knowing how to read and understand original research in the journals of medicine and your field. It is vitally important that even before attending medical school, one has to be able to read and critique journal articles. One also has to become comfortable with evidence based practice which should begin long before medical school with reading and critiquing the literature of your particular field of study. If you are a non-science major, you should force yourself to read and assimilate some of the journals of basic science (biology, chemistry or public health). I am always puzzled with a medical student will be sitting in my office offering being a “non-science major” as an excuse for not knowing how to read and evaluate the literature of medicine. Once you walk through the door of medical school, you have to become familiar with the language, science and art of medicine no matter what you studied as an undergraduate.
The best part of the weekend is that generally you have a bit of extra time to review and refine your daily study habits. In medical school, I used the weekend to plan my next week’s work. I also used some of my weekend time to review the materials from the previous week. This meant that I was on my third pass of materials that I had previously studied in the week before. Yes, my studies might cut into my relaxation time but in medical school (and any school for that matter), one gets one “shot” at not “screwing up”. I still had plenty of time to shop, explore and party but these things were not the purpose of my weekends. Even today, since quite a bit of my time is spent preparing lectures and curriculum for my students, the weekends are still used to review and refine materials from the week before.
I generally kept the same sleep/wake schedule on the weekend as I utilized during the week. It becomes highly disrupting to keep changing a sleep/wake schedule. This generally means that if I go out for a late night party, I still have to continue with my weekend schedule. On my vacations, I might “sleep in” a couple of hours but I utilize my early morning hours on vacation to read books and enjoy a movie whereas during work time, those early morning hours are used working or keeping up with my professional reading.
Social Media, Television and so forth…
It’s great to have Twitter, Facebook and other social media sites to keep up with friends but these sites can’t become major distractions during your study time. If you have to keep up with Facebook on a regular basis, then utilize one of your study breaks (the10-minute ones) to post and catch up. If social media is more important than your schoolwork, then you might want to consider changing to a vocation that doesn’t require as much reading and study as medicine. There is plenty of time to do things on social media, as I am proving now as I take the time to write this post, if you plan the other things in your day accordingly.
Having a recorder on my telly has been wonderful. I simply look at the log for the upcoming week and decide what I want to watch so that I can set the DVR to record it. If there is a football game that I want to watch, I simply have my I-Pad with me so that I can multi-task. I have always been able to answer correspondence and read while enjoying a sporting event. Needless to say, I don’t get to too many live games (unless I am one of the physicians on the side lines) and instant replay is one of my best friends. Once I started undergraduate work, my telly watching become a very secondary entertainment event. Even today, I usually end up erasing shows that I just can’t get around to watching but everything comes up on Netflix or Hulu at some time in the future so I don’t think I am missing many things.
Meetings can cut into your study and reading times but I have learned to treat most meetings like conferences. In administrative meetings, I look at the agenda and listen to the things that are of greatest importance to me or my division and let my mind go to my I-Pad (substitute any tablet, smart phone or paper) when things do not concern me directly. When I am conducting a meeting, I set strict time limits and stick with them. I don’t like my time being wasted and I respect the time of others. Sometimes, I have to decline meetings that are just not a useful way to spend my precious time.
If you have to have a meeting, try to schedule them over breakfast or lunch so that one can eat and meet if necessary. Having a meal also helps to keep a meeting from running off the “rails”. I find that administrative academic meetings can quickly affect my clinical time. I have to make sure that my administrative colleagues understand that I have to keep my clinical hours, my office hours and my practice (OR) hours. This means that I am often leaving meeting early and usually can’t go overtime. Learn to conduct a concise and informative meeting and learn to say “no” to things that interfere with your professional/personal life. In short, one has to learn to set priorities.
When things come undone
When your can’t keep up with your schedule, within reason, it is time to look at your priorities. A schedule can’t be so rigid that adherence starts to cause stress. If things are so stressful, take a look at what you can do to unload some of the demands. You still have to schedule in some reasonable relaxation time. If you are not getting some relaxation/recreation, you become less efficient and more prone to interruptions that take you off course. If you have too much recreation/relaxation, you can’t get things accomplished. In short, refine and revise as you go along. You have to realize that emergencies will happen and have a means to get back on track once the emergency has passed. Again, weekends are good for “catching-up” if this needs to happen. If something gets you behind during the week, go to where you need to be and catch up on the weekend. If you stay a bit ahead, an emergency need not completely derail you and your schedule.
As the new school year begins, I am receiving requests from premedical students about shadowing opportunities. I am happy to honor some of these requests and I am happy to pass some of them along to my colleagues so that as many students as possible get an opportunity for a shadowing experience. What can a pre-medical applicant do to prepare for a shadowing experience? I will offer some suggestions in this post. These suggestions are based on my requirements for shadowing and on some of the requirements of my practice institutions.
Do Your Homework
When you contact a physician (or physician assistant) for a shadowing experience, be sure to ask about dress requirements, paperwork and expected times of arrival. It is a good idea to contact the person (or office of the person) that you wish to shadow a minimum of a week in advance to make sure that all arrangements are in place. You want to have the best experience possible thus you need to ask about the schedule for the day, logistics of when and where you should arrive and what you should bring. Many places like for you to bring a copy of your resume (or CV), your personal statement (write one if you don’t have one ready) and a list of questions or goals for your visit. Remember, you are not going to a party where you are expected to be entertained, you are collecting valuable information as to your future career. Shadowing opportunities are become more difficult to obtain (patient privacy and liability concerns) thus you need to make the most of any opportunities that you can.
Be sure that you know something about the profession of the person that you expect to shadow. If this person is a physician, then you need know about the practice of medicine as it relates to this particular specialty. As a surgeon, I am not interested in hearing how you don’t like surgery but are only with me to get a letter of recommendation. I am likely not to write a letter of recommendation for a person who first, has no experience in surgery, other than perhaps as a patient, and who doesn’t understand that whether or not you become a surgeon, any physician needs to know something about surgery other than just not liking it. I don’t expect everyone to want to become a surgeon but I do expect every pre-medical student to have at least an intellectual interest in the practice of all aspects of medicine.
Do come into a shadowing experience with some knowledge of the process of entering medicine. Again, the time of the person who has generously allowed you to have this experience should be respected. If you have no idea of what you need, go to the AMCAS website and check out their Aspiring Docs pages. This should be the minimum knowledge in your possession before you seek shadowing experiences. this page also gives you some ideas of what you may want to request from your shadowing physician at the conclusion of your visit.
Most physicians arrive at their offices early in the morning. It goes without saying that you don’t want to be late. Do a “recon mission” and figure out traffic, driving directions, parking and the like. If something catastrophic happens, you also need to have a number where you can contact the person that you are supposed to meet. You don’t want to be the reason for an entire day getting off to a late start. If you are unavoidably delayed, the person you are meeting may be able to reschedule or make arrangements for another person to meet you so that both of your days are not ruined. If you know that your experience is going to involve observation in the OR, be sure to arrive early enough to change into scrubs and other operating attire. It’s always better to be early and wait rather than have a busy professional waiting for you.
Before you select that new outfit, keep in mind that most physicians wear business attire in the office. If you are a female shadower, wear comfortable shoes that you can stand and walk fast in. Ultra high heels with slick soles that clack on floors are not acceptable. You have to be able to keep up with the person that you are shadowing. Keep makeup, jewelry and perfume to a minimum as you may be in contact with patients who are ill. I remember a young lady appearing in platform heels and ultra-short suit with large hoop earrings ready to make rounds with my surgical team. Not only was she not able to keep up with us moving from room to room, her earrings made noise as she walked and she missed a great deal of the morning rounds experience because the rest of us were going to the next room while she was applying Band-Aids to the blisters on her feet. Moral of the story: wear comfortable, well-broken in shoes and clothing that will allow you to move. She was dressed fine for a business or law office but not for medical rounds. Minimally, wear low heeled shoes, comfortable suit (slacks) with shirt and tie (men) , comfortable blouse and jacket. You may be given a lab coat to wear for the day so pick something that will go under a lab coat.
One of my hospitals will not allow pre-medical students in the operating room but offers some of the best clinical experiences for shadowing students. If I am doing surgery at that particular hospital on the day that a student is shadowing, I have to abide by the rules of that institution. If you are at an institution that does not allow you in the OR, the you wait in the surgeon’s lounge until the case is over. I do try to avoid having shadowers if I am operating at that particular hospital. If you are allowed in the operating room, make sure you introduce yourself to the circulator, ask if this person is not pointed out. The circulator will tell you where to stand. The operative word here is stand though you may be given a stool to sit as long as you are far out-of-the-way. If you are standing, keep your arms folded in front of you or at your sides and don’t touch anything. Most of the circulating personnel that work with me will make sure that you can see as much as possible. Eat breakfast, use the rest room and get something to drink before you enter the Operating Room. You can’t afford to be dehydrated or develop a case of low blood sugar just as the incision is underway. Often the anesthesiologist will invite the pre-medical student to sit at the head of the table. If this happens, again, keep your hands close to your sides and follow any directions. Last direction, if you feel faint, notify the circulator so that this person can take care of you quickly. Fainting happens and most people know when they are going to faint. Just say something.
When I bring a shadower into the operating room, I usually introduce them to the circulator and to the anesthesiologist (anesthetist) so that everyone knows who you are and why you are there. I usually give the circulator a card with your name and why you are there-for their records. The circulator will help you understand what is going on and will explain things once the case gets underway. Also, be aware that the patient on the operating table is our main concern so that you understand that we are not ignoring you but are performing patient care in a very specialized manner. When the introductory procedures are completed, scrubbing, anesthesia induction and other pre-operative procedures, people are willing to explain things. (Do keep in mind that I will have already informed the patient that you are present and sought their permission for you to be present.). Every patient has the right to refuse having unlicensed personnel in the operating room or clinic when they are being seen. Most patients are happy to be part of your experience but not all patients.
Keep in mind that sometimes things become tense in any clinical situation. If this happens, move out of the way and allow anyone and everyone to handle the situation. There is nothing personal about this but we always have to be prepared for the unexpected. You may observe some things that are not planned and may be tragic. Under patient confidentiality rules, which many institutions will have you sign, you are not allowed to speak about anything that you observe. The unexpected and the tragic are part of medicine more often than in other professions but keep in mind that the confidentiality and safety of the patient is our first and foremost job. We will get back to you as soon as the emergency has passed.
Bring a card so that you can write down the names of everyone who was part of your experience. It’s a nice gesture to write a short note of thanks to the office managers, operating room personnel and others who have helped to make your day as informative as possible. Most professionals who are in health care are happy to provide information to people who are cordial and interested in joining their ranks. A short note of appreciation is very welcome and let’s them know that you appreciate what they do.
A shadowing experience is a chance to see health care professionals do their jobs. Enjoy the experience and learn as much as possible. Actual work in medicine is not like what is on the telly or in the movies but is fairly routine for us who are there every day. While things are never routine for the patient, they are our main focus. We are all happy to have you learn and join our ranks but keep in mind that we enjoy our routine days. The best surgical experiences for me are those where everything goes according to procedure and the patient’s outcome is excellent. Take in everything and don’t take any comments personally as that is never the case. Some people are stressed on any given day and may not be a cheerful as you would like but are capable of teaching you something new and exciting. Make sure that you are in a position to learn which is why you are there in the first place.
Many thanks from the blog wellnessrounds for this post. It is well worth reblogging here because there is something for everyone. This was posted on OnSurg, a notable and necessary site for anyone who is in their surgical rotation in medical school, in any surgical residency specialty and in practice. Enjoy some of the notable and excellent writing out there.
Originally posted on wellnessrounds:
The following guest post waswritten by Daniel Fox, MD with the help of other residents in ENT for medical students applying to otolaryngology. I thought it was so outstanding that I asked his permission to publish a minimally edited version that would apply to all medical students applying in the NRMP match.
The application process starts with knowing and understanding the rules. The following are the websites that will help in this process:
Match Statistics hhttp://www.nrmp.org/data/index.html This will give you an idea about the qualifications of candidates that match into each specialty.
ERAS https://www.aamc.org/students/medstudents/eras/.This website is for applying to residency programs.
NRMP http://www.nrmp.org/.This website is for submitting your rank list.
FREIDA https://freida.ama-assn.org/Freida/user/viewProgramSearch.do. This website gives some very basic information about individual programs, but overall is not very useful.
Residency Program Director Survey (38% response rate) http://www.nrmp.org/data/programresultsbyspecialty2010v3.pdf. This gives you an idea about what program…
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Many procedures in medicine are like landing a plane at an international airport. You have to learn “how” to perform the procedure safely, know the complications and obtain informed consent. If any of these things go wrong, well, the Asiana flight at SFO comes to mind. Enjoy this post by a very articulate airline captain who explains how to land at San Francisco International Airport. Use it to think about how you perform procedures.
Originally posted on JetHead's Blog:
Here’s how you land at San Francisco International. First, the view over your left shoulder as you cruise “downwind” for your arrival into San Francisco International. You’ve arrived from the Pacific side of the airport, so you can plan (they’ve probably advised you already) on landing on runway 28L, which is the runway you’re paralleling on downwind. Yes, there are 2 runways that you are paralleling, but the logical one for you is the one on the left. Here’s what the airport diagram looks like, with an arrow pointing to 28 Left:
Let’s talk about all of the runways at San Francisco International (SFO), because their are simultaneous operations on all four runways, so your landing runway is not operating independently or simply–nor are you as a pilot landing at SFO. Those two runways intersecting your landing runway will be launching aircraft out of SFO even as you are landing:…
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Many students enter healthcare with the idea that they will “memorize” their way to academic excellence. This strategy is useful for short-term memory of things such as pharmacology formulas that one can write down quickly in the exam margin until needed or a pneumonic such as “Mrs. Ass” for remembering whether a heart murmur is systolic or diastolic. Yes, rote memorization can get to a certain level but strong academic performance and life-long learning requires mastery of conceptual learning.Conceptual learning involves linking of information and building upon a knowledge base. When I entered medical school, my school’s curriculum was “classic” in that first year we learned “what was there”; second year we learned “what can go wrong” and third year we learned how to fix things that go wrong. (Fourth year was refinement of first, second and third year). First year set the concepts and basis for our mastery but we had to build upon those concepts and integrate learning from second, third and fourth year in order to have the tools to become competent and knowledgeable physicians.
Conceptual learning starts with a very strong undergraduate experience. I use the word, “experience” because one should acquire the tools to master conceptual learning as an undergraduate. Sure there are plenty of people who will say that they “party all of the time” and then “cram” right before the test so that the material is “fresh” in their minds. My suspicions, borne out by some of those people’s test scores, especially on exams of applied knowledge, supports that they don’t know and can’t remember concepts. In short, they crash and burn- usually stating “I can’t do standardized tests”.
The experience of concept mastery can start with that first pre-med course where one utilizes the syllabus to identify concepts for mastery. Your textbook can also provide valuable information as to conceptual mastery. Many textbooks will summarize concepts at the beginning of a chapter or at the end of a chapter. This doesn’t mean that one sits and memorizes the concepts as a list but it does mean that one utilizes the list of concepts as a “check off” in terms of mastery of a chapter or mastery of material for an exam. Sure, you can “cram” in information for undergraduate work but once one enters medical (or physician assistant) school, the volume of material tends to favor conceptual learning as opposed to rote memorization. For example, you may be studying the treatment of viral illness in particular course block. You have to understand the concepts of viral structure, viral pathogenesis, immunological barriers and cellular reception/structure. After one couples that information with viral transmission and resistance characteristics (host & viral), one gets a pretty good idea of how viral diseases are diagnosed and treated. One also gets the concept that antibiotics are useless against viral illness. As you are standing at the bedside of a patient who is suffering from a viral illness such as influenza, you understand the characteristics of the symptoms reported and the signs that you are observing. You add those to your clinical experiences in terms of a differential diagnosis and treatment plan which is your key to efficiently treating your patient.
In short, if any of the conceptual knowledge is missing, you will not become an efficient clinician and you will find yourself constantly “behind” in terms of “shoring up” your knowledge gaps. This is the main reason that many people become “overwhelmed” quickly by the volume of material that must be assimilated in a short period of time. For example, about the second week of the first year of medical school, I start to see some of the more obsessive/compulsive students begin to “unravel”. Later on, often after the first exam block, I see some of the more “laid-back” individuals start to up their “game” and make adjustments to their learning strategies.
The people who have the shortest conceptual learning adjustment periods are the folks who have been conceptual learners as undergraduates. They are usually the most disciplined students and they are generally the students who seek assistance when needed and they tend to have less “emotion” when it comes to the materials that they need to learn. In essence, they are just building upon a foundation rather than trying to memorize a stack of words and phrases. No matter how a concept is tested, they are ready for the challenge. No matter how complicated the patient disease presentation, they systematically take that presentation apart and develop strategies for patient care.
I recall my experience with Organic Chemistry, one of my least-favorite courses as an undergraduate chemistry major. My passion lie in analytical and physical chemistry rather than carbon chemistry but my goal was to become an excellent chemist. My career plans were not medical school but graduate study in Analytical Chemistry. Since organic chemistry was far from the math-based chemistry disciplines that I loved, I approached this course from a purely conceptual (and practical level). In short, I probably spent more time organizing this course for my learning style than my other chemistry courses but I had the assistance of excellent professors, whose office hours I frequented, and I sought their experience and assistance with my organization of this coursework. To do otherwise in any discipline or course as an undergraduate took away from the knowledge base and experience that I knew that I would need as a professional chemist. In the end, Organic Chemistry was one of my strongest course performances even though I didn’t plan on becoming an organic chemist. (I ended up in graduate school studying Biochemistry and Molecular Biology).
As a physician, I am required to participate in continuing medical education (CME) for the maintenance of my license and for the maintenance of certification in terms of my medical specialty. It would be difficult to participate in my CME/MOC activities if I didn’t have a strong conceptual basis for this coursework. Most of my CME/MOC activities involve week-long conferences with testing at the end in order to receive my certificates. If I did not have the knowledge base, I would not be able to add the new knowledge and assimilate it quickly. Many of my CME/MOC activities center around evidence based medicine which means that I have to know how to keep up with scientific/medical literature and either incorporate into my practice or reject what I am reading or studying. As an academic physician, I am charged with keeping my scientific knowledge up to date and accurate in both my research/teaching and my practice. This takes a strong conceptual basis for efficiency and accuracy.
As an example, new pharmaceuticals are entering practice weekly and one has to make decisions as to whether one will prescribe a newer pharmaceutical versus a pharmaceutical treatment that has been present for years. Drug company representatives will furnish practitioners with plenty of literature – supporting their new and most likely expensive pharmaceutical but one has to have the knowledge base or ability to quickly acquire the knowledge to fully evaluate drug company claims. We have seen plenty of examples where the newest drug is not always the best drug for treating certain disease entities.
Finally, how does one become a conceptual learner? The steps are generally:
· Look at your course syllabus for the course content and objectives. A well-designed syllabus should give you plenty of ideas as to how the information for the upcoming course will be organized and tested.
· Look at your textbook and determine how the textbook will supplement and reinforce the concepts of the course.
· Look at how the material will be tested. Will there be examinations (essay, multiple choice or oral)? Will there be performance criteria for mastery? How does any laboratory exercises and material fit into the grading/testing of the material?
· Take emotions and “what grade you have to have” out of the learning process. If you master the concepts, the grade will take care of itself. If you focus on what score you have to have on any particular exam, you will generally come up short. It’s a waste of time trying to figure out how to “beat the curve” rather than focusing on what you need to learn and how to get it mastered.