Medicine From The Trenches

Experiences from medical school, residency and beyond.

Some Thoughts for Those Starting Medical School this Month

As you get settled into your first-year coursework, I want to share some thoughts that come to mind:

  • Remember that you are fortunate to be on the doorstep of pursuing a magical profession. For everyone who achieves a seat in medical school, there are many who wish to be in your place. Honor them and remember them as you gather the knowledge that will make you a good physician.
  • Medicine is not easy, especially the study of the art of practice. There are many “all-or-none” tests along the way. There is a large volume of material to learn, master and apply to the practice of medicine and as such, you must make peace with that volume of material.
  • There are no “short-cuts”. This means that you have to make a concerted effort to be willing to take the long road. If you are looking for a short way around your work, medicine likely isn’t the profession for you. Get out early rather than later because medical school is expensive and quite unforgiving.
  • You are going to be working on people and not pathology. While pathology is interesting, always remember that the person with that pathology is loved by someone. Be willing to put yourself in the place of the patient or their loved one and treat them as you would wish to be treated.
  • Don’t believe what you hear but trust what you experience. Don’t go into any class or any rotation with preconceived notions of how it will be. Medicine is interesting and absorbing. Allow yourself to learn with a fresh approach and with fresh energy. While people who go before you will tell you horror stories about certain professors and certain subjects, it’s up to you to figure out and navigate them. You may be pleasantly surprised at how much you will enjoy this process.
  • Take some time to do something outside medicine at least once per week. Go to a movie, visit a museum or attend worship services. These outside activities keep your studies in perspective and keep your brain alive.
  • Keep yourself physically fit. Walk the stairs, take a 30-minute run daily and eat/sleep well. These physical activities will decrease stress and keep you healthy in the long run. Junk food, while quick, can make you overweight, sluggish and prone to picking up infections. Take time on weekends to prepare healthy (minimally processed) food and freeze it for ease during the week. You will save money, something that is always good.

Don’t forget to enjoy the process. Remember that you WANT to be here. Before you complain/gripe about something, try to figure out a couple of solutions or if the complaint/gripe is worth your time. If not, then focus on your studies and keep moving forward.

15 August, 2016 Posted by | first-year, medical school | , , | 1 Comment

Starting medical school- The First Week

Reprint of a previous post

You have received your acceptance letter and sent in your deposit. You now know where you will be attending medical school in the fall -or should I say late summer. The next step in your adventure will be Medical School Orientation Week. Why does it take a week? How about Orientation Day and then you can get to the business of getting started with first year of medical school.

Orientation Week usually starts out with some type of “check-in”. In my case, the Dean of Students called names from a roll. We had previously been warned that if we were not present for roll call, our “seat” would be given to the next person on the wait list. Needless to say, everyone was present and accounted-for that morning. Following roll call, there was the obligatory introduction of the Deans. This was followed by a speech given by a speaker that was chosen by the second-year students the year before.

By the time the introductions and speeches were over, the greater part of the morning had disappeared. There was a meeting of your second-year advisers (second-year medical students) who would share their advice on navigating the curriculum. This meet-and-greet was filled with horror stories about certain professors and warnings about behaviors to avoid. With some of the tales of woe, I wondered how anyone survived the first year and made it into second year.

My own second-year adviser was a lovely but quite young lady. She was the daughter of a registered nurse and was very enthusiastic about all of the adventures that she had experienced in first year. She and her tight-knit group of friends, gathered us together and spoke to us (their advisees) as a group. We were able to get the benefit of a collective experience rather than single reports. This turned out to be a blessing. My second-year adviser also led me to her car where she presented me with a cardboard box of old exam, used and filled-in course syllabi and her books from first year. “I started putting this together for year after my first exams last year”, she said almost apologetically. I was speechless but thanked her profusely. That box turned out to be one of the major keys to my success during my first year. I happily passed on her stuff and mine to my two advisees when I became a second-year student.

After our meetings with our second-year advisers, it was time to get our photographs done for the student directory. We lined up and had out photos taken by the medical photography service. Following the photo for the student directory, we were taken to the Student Services building for photo identification cards. Our physical examination papers were collected along with our immunization records as we moved from Student Services to student health. Once we had accepted admission to medical school, we were told to bring proof of immunization and undergo a physical examination by a physician. (My uncle took care of this for me, had his office staff copy my records and put together a nice package).

During the evening of our first day, we were bused and car-pooled to a local park where the second-year students had prepared a cookout for us. This was our first introduction to the wonderful world of “free-food” in medical school. Our first day of orientation ended around 8pm.

On the second day, we were introduced to our microscopes and course syllabi. Each of us was issued a microscope (if you didn’t have your own as I did ) and were issued thick syllabi for Biochemistry, Gross Anatomy, Introduction to the Practice of Medicine and Psychiatry. In addition, we were given a couple of hours to purchase books (already furnished by my second-year adviser). We also had lockers issued (I could actually stand in my huge locker) where we could store our necessities. On this day, the student health department singled out students whose records were not complete and gave them strategies for getting their immunizations and records done. This meant downtime for me. At the end of the day, free pizza courtesy of one of the student organizations.

On the third day, which turned out to be a Thursday, we were treated to a morning meeting with Financial Aid and Student Organizations. The Student Organizations had set up tables with sign-up sheets for us to join groups. I signed up for the American Medical Association and new organization called “Students with Families” (a non-traditional student organization). The afternoon was spent organizing our class and electing temporary class officers. We elected temporary officers because we actually didn’t know anyone and would elect permanent officers later in the year. I actually volunteered to become the Vice-President for Education in charge of note-service because I had some experience from graduate school with running a note service.

The Dean’s Reception was held on the evening of the third day. This is where I met my best friend from medical school. Over the four years, we would share triumphs and tragedies but it was at this reception that we met the various Deans up close and shared a line or two of conversation. In addition, there was more free food and an opportunity to wear something other than our jeans and T-Shir’s that had become our orientation outfit.

On our last full day of orientation, we had information sessions from the chairmen of various departments. This gave us an opportunity to mingle with the faculty. We were also introduced to the school’s computing system and issued laptop computers if we didn’t already own a suitable laptop. Again, that locker was getting full. For students who were not immune to Hepatitis B, there was the first in a series of three Hep B vaccination shots (thankfully, I could bypass this step too). On the evening of our last day of orientation, there was a White Coat Ceremony where we were cloaked in our white coats by graduates of our medical school and issued the Hippocratic Oath.

Orientation had taken the better part of a week. Many of us were not ready to just get down to the business of attending classes and adjusting to the course schedule. Our syllabi need to be filled in and mastered, our textbooks read and highlighted. On the next Monday, we would be “going live” in terms of our classwork.
Over the first week, I came to have a list of things that I could not do without. These things were carried in my backpack and spread on my table in front of me during lectures. These were:

  • My laptop computer for downloading power-points and the professors writing on the “smart board”.
  • My pens of four colors: black for notes, red for emphasis, green for projects and blue for notes from the text book.
  • My Easy Reader book stand that held my looseleaf notebook that contained pages from my textbooks that were cut and 3-hole punched.
  • My highlighters in four colors: bright yellow, pink, green and blue.
  • A micro tape recorder (now replaced by a digital tape recorder) for making sure I didn’t miss anything if I fell asleep in class.
  • A sweatshirt as the lecture room was always freezing even if the outside temperature was above 100F.
  • My travel coffee mug and a thermos of fresh coffee (Starbucks was a short walk from the lecture hall).
  • A liter-bottle of water (kept me awake in the afternoon).
  • My Walkman (now replaced by an MP-3 player).

These were my daily companions during first and second year of medical school. Even today, I always read and study with my pens and highlighters handy. My Easy Reader book stand is also with me as is my Sony Viao laptop computer for making notes and reading the myriad of PDF documents that I have downloaded.

Other things that I would learn but not mentioned during Orientation Week, was not to worry so much about not doing well on my first set of exams. I more than passed every exam but I saw many of my classmates head into a “tail-spin” after receiving their first failing grades. On our first Gross Anatomy exam, 85% of the class failed the exam. For some students, this was their first failure ever and they had difficulty shaking it off and moving on. In my case, I remembered that my wonderful second-year adviser had said, “You are going to encounter something that will give you problems, ask for help and put your failures behind you fast.”. She also encouraged me to help my fellow students who as she said, would “become colleagues that I would refer patients to in the future”. She was right because the more I helped my fellow students, the higher my grades became.

We all survived that first semester but we lost a couple of students at the end of second semester. One of my classmates decided that he wasn’t going to spend another moment doing that much studying for anything. Another had illnesses and just wasn’t able to keep up with the material. In the end, we all experienced the molding that would mark us as physicians.

25 July, 2012 Posted by | academics, first-year, medical student. | Leave a comment

Taking Stock of the First Semester

For most people in school, it’s the end of your first semester of something. That “something” might be your first year semester of medical school, college, clinicals or even the first half of your first year of residency. With the end- of -year holidays brings a time of reflection and adjustments for most people. My first thoughts are to tell anyone who is doing a first semester “post-mortem” to make sure that you don’t forget that you actually were able to survive your “first”. The next thing to do is to figure out what might need to be tweaked, removed or started. For most folks, no major changes are needed but don’t be surprised at how a small adjustment in one area can reap huge benefits in others. It turns out that life just works in that way.

There are some things that I have been telling my patients to institute for the last two weeks of 2011. I don’t call these “New Year’s Resolutions” because they can become habits for the new year rather that something that will be forgotten by the second week of January. These are:

  • Perform at least 10-minutes of exercise of some type per day.
  • Give up meat for three dinner meals each week
  • Don’t patronize any restaurant with a “drive thru” window (Sorry Dunkin Donuts!).
  • Don’t add salt (NaCl) to any food before tasting it
  • Try a new vegetable each week (most stores have a great selection).

Taking each one of my goals

I know that every study out in the news media states that one needs at least 30-minutes of exercise 5 to 6 times each week but I know that if one strives for 10-minutes, they will increase to 20 minutes and get to 30 pretty quickly. I am a person of small increments of change working better than one large increment that does not work. Like your studies, exercise can be divided into small manageable bits that can be checked off and mastered. A 40-page paper is written one letter and one page at a time. Daily systemic practice of one small change can lead to larger and better results as that practice becomes a welcome habit.

I also encourage my patients to allow their 10-minute exercise break to be a time when they don’t multi-task. This means that this break should be a true break from cell phones, tablet computers (well maybe the I-pod/MP-3 player) were the mind can be refreshed and renewed. Couple that with getting one’s heart rate up and you have a true “mini-vacation” that decreases stress and makes the rest of your day more efficient. If you want more of a challenge, go up flights of stairs on your 10-minute break. Your brain and joints will be grateful for the movement.

In getting to know vegetables/fruits again, one can develop a relationship with color, texture and anti-oxidants. While I know that fast-foods are wonderful time savers, those heavy fat meals are terrible for keeping alert later in the day. If one does the burger/fries routine for lunch, the rest of the afternoon is spent trying to overcome “food-coma” so that you can get through the day. If you do the burger/fries routine for dinner, one finds that “food coma” can make your studying particularly inefficient. Try making a nice light dinner/lunch of rice noodles and grape tomatoes which can be appealing for the eye and add some “zip” to your taste sensations. One can also have a bag of cut and uncut vegetables, carrots, bell peppers (red and green), carrots and those lovely grape tomatoes in your backpack so that you can snack on something that won’t put you into nap time during your study time. One can also invest in great spice mixtures, curry powders and chilis for waking up taste buds and mental clarity.

If I have one vice, it’s a hot, fresh cup of Dunkin Donuts  (DD )coffee. I just have to stop by the shop, get out of the car and walk in to get my steaming cup. I can drink this coffee black and enjoy its rich aroma and flavor. For me, DD coffee is less harsh than Starbucks (though I will drink Starbucks when I can’t get DD) and is a nice break during my day. In the late afternoon, I often reward myself with a nice hot cup of coffee or tea (Twinings Earl Grey) rather than something fatty or sweet. I try not to drink anything with caffeine after 5pm if I anticipate getting into bed at my usual time. Since I get up around 3AM most days, I find that I need to be in bed before 11PM most night for sleeping. If I am on call, all bets are off and I enjoy my coffee/tea at any hour. When my favorite Dunkin Donuts shop put in a drive thru window, I had to change shops because I don’t want to break the drive-thru habit.

Finally, the NaCl habit is one that most of my patients need to skip. The American diet has increased the love of that salt taste in most people in this country. Since most of my patients have more than a passing experience with hypertension and diabetes, I do encourage them (and my students) to tread lightly where sodium is concerned. This is why most “fast foods” are not good diet choices. Couple the high sodium content with the high fat content and one has a potentially troublesome combination. Do keep in mind that it takes some time to get used to eating foods without salt and to lose that love of salt. For me, it was difficult to get used to eating baked potatoes with no added salt but now I use pepper and happily enjoy munching on the potato (with skin) with nothing other than pepper added to this vegetable.

Taking Stock

Be willing to forgive yourself for doing things that were counterproductive to a strong performance in your academics or in any area of your life. Everyone, even the person who has the highest grades in class, would like to perform better and more efficiently. Efficiency comes with experience and with adaptability. If you can make some shifts and learn from things that didn’t work well for you, then your efficiency and performance will increase. Remember that every day is another chance to do better than the day before. One test, one semester or even one year do not define a lifetime. One can just decide to change your thinking about any subject or taking one step ahead rather than remaining stagnant. No one’s past defines them but the past does allow one to have thousands of experiences to draw from and to learn from.  As you move into the new year, look at one or two small things that you might like to try to do differently and try a to change them one day and one small experience at a time.

16 December, 2011 Posted by | academics, first-year, organization, study skills, success in medical school | , , | 7 Comments

Textbook Reading in Medical School

Introduction

Once you have started your coursework in medical school you quickly realize that there are many things to read and master in a very short period of time. If your reading skills are not excellent, your reading efficiency goes down markedly. Fortunately, reading skills can be upgraded with regular practice and fortunately, your efficiency can upgrade along with your reading skills. Your first strategy is to have an open mind and a willingness to do something different and practice that “something different” on a regular basis. In changing any study technique or tactic, go slowly and practice your changes regularly. After all, it took years of practice for you to have the skills you are presently using, thus change doesn’t need to completely revamp in a weekend. Make any changes slowly and sparingly unless you have a large amount of free time (not likely in medical school).

Adding textbook reading to your learning strategy

If you have been using your textbooks for exercise weights only, open one of them and take a look at how the book is organized. Most textbooks have a Table of Contents in the front and an Index in the back. These are always the first things to look at when you purchase a new text (or review book for that matter) so that you may become familiar with the book’s content and organization. The index gives an idea of the detail and the table of contents gives an idea of the breadth and scope of the text. As a surgeon, I always evaluate a surgical text by their treatment of rectal prolapse. If a surgical textbook has a complete and well-organized treatment of this topic, generally other topics in the text are well-written and organized.

When you move into a specialty and have acquired mastery of medical concepts, pick one, relatively obscure topic and do a quick perusal of a text’s treatment of that topic. This practice can be a quick means of evaluation of a text (or review book) while you are standing in the bookstore. If you are an online purchaser, I would not invest more than $40 in any textbook/review book that doesn’t provide a sample chapter/table of contents and index for preview. Wait until the book arrives in the bookstore so that you can scan it before making a sizable investment.

If you have a required textbook for your course, be sure to read the material assigned. Most medical school professors do not assign reading to “occupy your mind with busy work”. If the reading is assigned, get it done before you go to the lecture. Not only will you get a better grasp of the lecture material but you will have completed at least 1/3rd of you study of that material before you have actually heard the lecture as attending a lecture “cold” is worse than not attending the lecture at all.

You will hear your classmates brag and boast about “never cracking” a textbook but look past that strategy. You have one shot at not “screwing up” your coursework thus you need to get every dollar’s worth of tuition out of your classroom/course experience. Not only will you do better on your board exams, but you will do better in your coursework. Applying for residency with a string of just passing or nothing distinguished on your transcript is not going to help you get into a good residency program. Without having a good knowledge base that has some depth, you won’t interview very well either. Resist the temptation to just study a review book and Powerpoint lectures as they are not enough for boards or your course exams. In the medical education process, just passing or short-cutting is not a sound method for future practice.

Another strategy for getting your textbook reading into your study schedule is to read your text assigned readings the week before the lectures. This doesn’t mean that you waste time outlining a chapter and memorizing every word, but becomes more meaningful if you have an idea of where the details of a process are located in the text and if you have an idea of how important a particular topic might be to a body of knowledge. For example, it’s very difficult to master cardiovascular physiology if you do not throughly understand the Frank-Starling Principle. Most medical physiology texts will have plenty to explain concerning this principle but you need to know how this principle affects cardiac function in a very detailed manner. How does this principle translate in terms of myocyte function? How do pharmacological agents affect heart function within the context of this principle? How does cardiac innervation affect this principle of heart function? In short, you have to put new concepts within the scope of all of your didactic coursework and not just memorize the physiology for the sake of memorization so that you can “spit it back” on a class test. In short, you have to know that principle well enough to apply it across disciplines in medicine. This is where having the knowledge base of your textbook reading before you attend the lecture is crucial. If you don’t have a good base, you can’t listen with a discriminating and informed ear.

Getting overwhelmed

If you find yourself procrastinating because you have not been studying and reading on a regular basis, you can quickly find that you are behind your class and overwhelmed. Immediately sit down and write a schedule to get back on track immediately. Go to where the class is and catch up on the weekend. This means that you sit down on a Saturday and Sunday morning and check off materials on your schedule that you were not able to get around to during the previous week and get them mastered. Never, ever let yourself get more than one week behind in any of your courses. In medical school, playing “catch-up” is the beginning of the end and your grades will quickly fall. Students who are ashamed to ask for assistance are often the ones who will “put off” studying because they don’t understand one principle. If this happens, move to something else in the course material and keep moving forward. Get the help you need as soon as you can and fill in the details that you need but don’t just “quit”.

Reading a textbook chapter

First look at the subject headings to get an idea of what the chapter will cover and how it will be organized. Then look at how much space is alloted to each of the subject headings. This will give you and idea of the importance of each subject in terms of mastery of the entire chapter. Next, look at any chapter questions or objectives that are in your textbook. These are for you to check your understanding of the chapter materials. Many textbooks will have chapter objects at the front each chapter which are great in terms of allowing you to know what’s most important in the reading to come. The last thing that you do is read the material making pencil notes of the important explanations or of any questions that you want to answer in your reading.

One of my strategies is to pose each subject heading in the form of a question and see if I can answer that questions when I have completed reading that section. If you can’t answer the question, then figure out what you missed in your reading. Are you having a problem with the author’s style? Do you need to have a medical dictionary nearby so that you can look up any terms that you don’t understand?  Are you having difficulty concentrating because there are too many distractions in your study location? Are you finding it difficult to concentrate because you are tired, thirsty and hungry? If you are having any of these problems take no more than 10 minutes and get them solved immediately.

If you can’t understand or figure out an author’s style, then you need to check with your professor in order to get some help with your text reading. In short, don’t just sit and “throw up your hands” in frustration but take some immediate action. Consult with your professor in getting a grasp of the basics of your text so that you can utilize this resource regularly This is why getting down to your reading before you attend a lecture is a better strategy than waiting until a couple of days before an exam when you are far behind in your reading.

Use your study time wisely and regularly

Practice reading your textbooks and other materials on a regular basis. Having a large white dry-erase board is good for making concept maps from your reading or listing vocabulary words to look up (so that you can incorporate them into your knowledge base). The action of getting out of your chair at least every 50 minutes and writing something on that board will help to keep you focused. Reading and re-reading the same section or paragraph three or four times with poor understanding generally indicates that you are not concentrating on the task at hand. Don’t let lack of concentration derail your efforts as you just don’t have too much time to waste on being distracted. If something is bothering you, write it down on an index card (or “sticky note”) and think about it in the car, on the treadmill when you work out or when you take a walk.

Don’t sit in the same spot in the library for hours on end without standing up and getting your blood circulating. Just sitting in one spot is a good way to find yourself fatigued very quickly. Get some fluids to stay hydrated and walk around for 5 minutes or so to just let your eyes focus on other things besides your books and notes. If you are in a study room, read a passage or two out loud and take some deep breaths as you recite the material back to yourself. Stretch regularly and watch your posture as sitting “hunched” in an awkward position can cause muscle strain too. This is why getting some regular aerobic exercise plus strength training can actually make you a more efficient student and is well-worth taking an hour from your study to perform. Regular exercise will greatly decreased your natural stress level which will make your study more efficient in the long run.

Finally, practice reading your textbooks early and often. Anything that you practice regularly becomes a good habit. As you become more efficient and less stressed, your concentration will improve too. I am always amazed at how much many medical students will “talk themselves out” of high achievement and scholarship because they haven’t been used to studying at the level demanded of them in medical school. Don’t be one of those students. It’s easy to allow other things to interfere with your studies but planning and efficiency can give you more time in the long run. Learn to say “no” to demands on your time and remember that you have one shot to get the most out of every class. Retaking exams and repeating years is problematic if the reason for your retakes and remediation is poor study habits. Make good study habits a good habit.

28 October, 2011 Posted by | academics, first-year, medical school coursework, study skills, success in medical school | | 8 Comments

New Intern (the utility of listing and lists)…

I am going to relate some of my practices as a new intern. I certainly learned from the best (my love and infinite respect to J-Ro wherever he is) and have generally kept up with the solid patient care practices that I learn from day one on the job.

Lists

Every good intern needs to have some kind of list procedure and I was no exception. Placing those little square boxes beside things to do and frequently checking my list became the “bane” of my existence on the wards. As a newly minted intern, my principle job was to make sure that every facet of patient care was done and assessed in a timely manner. I developed the practice of carrying both a clipboard (clip kept small pieces of paper from falling out) and blank sheets of paper. I would have a master list of patients that were under my care with Post-It sticky notes for things that I had to add to the lists in a hurry.

Daily Routine

When I first arrived in the morning, I pulled up my patient list and busied myself with checking the latest lab values. I scheduled my hospital arrival time based on service and the number of patients that I had signed out the night before. I knew that I would get at least one or more new patients and thus, on a service that contained a large number of patients with complicated diagnoses (or needs), I arrived earlier and on services with more long-term patients, I could arrive a bit later.

I would list my labs, check any imaging studies from the day before (or the middle of the night) and circle them in red (I always carried a 4-color pen or bright pink highlighter). I would want to make sure that the results and plans from these results were in my notes and orders for the day. Sometimes, lab results and imagining study results would indicate the need to change plans for the patients for the day. This is why these were the first things on my list.

My next tasks were generally to check with the night charge nurse for the things that needed immediate attention. Since the charge nurse knew that I was usually the first on the wards, he/she didn’t have any problems letting me know anything that needed immediate intern attention from overnight. In general, the intern that was covering would also have reported to me but occasionally, there was a slight difference in the reports between these two people. I also make a concerted effort to get sign-out from the covering intern as soon as I could so that they could take care of their own patient load and I could get “cracking” on my daily duties. This is a good characteristic to have.

By the time my chief resident (and fellow on some services) arrived on the floor, I could hand them a patient list with the immediate problems (and my handling of them) circled in red. We could then start morning rounds with me (or a medical student) presenting the patient outside of the door, going inside for a look at the wound/incision, and any additional care options that the chief might want to add. These things were  carefully noted and checked by me as I was responsible for everything aspect of bedside care on the service. A medical student could follow a patient or two but the intern has to be sure that everything is checked, double-checked and done.

Right after rounds

As soon as rounds were finished, I would quickly enter any orders that needed to be entered and head off to the OR for cases that had been assigned to me by the chief resident. Usually, unless there were loads of ward patient care duties, I could get to the operating room to do a case or two. I would check the schedule the night before to make sure that I had done my anatomy and surgical atlas work for any of the PGY-1 level cases. I didn’t want to miss any of the “pimp” questions that I was bound to be asked over the incision during these cases.

If patients were likely to be discharged, I developed the habit of dictating a pre-discharge note that I only had to dictate an addendum to when the patient actually left. This meant that I could enter my discharge orders and scripts, pre-dictate the discharge and then release all of the information and scripts as the patient was leaving the hospital. Since these decisions were made during morning rounds or shortly after discussion with the attending, this turned out to be a great practice but one had to keep good records of patient numbers and what had been pre-written/dictated. There was nothing that prevented me from grabbing an order sheet, writing some discharge orders and keeping those orders on my clipboard (dating them when needed).

I also made it a point to go and observe any studies that were being carried out on my patients whenever possible. There were procedures like gastrografin swallow studies and upper gastrointestinal studies that were great to observe in “real time” along with the radiologist. I also made sure that I reviewed all of the CT Scans, cath reports, angiography studies and other studies of patients that were admitted the night before for surgery. I reviewed as much as possible in terms of their care in clinic and why the decisions had been made to take them to surgery. In short, I wanted to be there and get to the bottom of every patient detail as much as possible. Much of this type of investigation work was done on call based on my notes from clinic.

Do you actually know the most about your patients?

I have to say in all honesty, that my best skill as an intern was to know more about what was happening with my patients than anyone else on the service. Most of the time, the nursing staff would call me when a patient went to radiography so that I could slip over and look at their studies. The radiography techs and transporters were also happy to let me know when they had picked up a patient, especially at night. I always wanted to get in and see for myself, what the studies looked like even if it meant that I would lose some sleep. I knew that I would rest better when I had tracked down my studies; knew the results and had discussed them with the chief that was on call so that any plans could be done.

Sign Out

One of my colleagues replaced my folded paper system with an Excel system that I still use today. On this system, we kept a running log of patients, locations and things to do and check. An intern covering my system could easily check the sign-out sheet (done by printing out Excel sheet) or check our files on the service computer. I always kept this backed up on a jump drive too.

I never signed out anything that I could do or check before leaving. I knew that the night float intern would have a huge patient load ergo, I made sure that all admissions and post-operative checks were done by the time I left. Unless a patient was still in recovery (in which case, I checked on them anyway to fill anticipated needs), I didn’t sign out discharges or new admissions. If I had to stay a bit longer, then I stayed a bit longer (signed out earlier) and updated the night float just as I left the hospital.

There is no substitute for making your own rounds and checks in the late morning between cases, in the afternoon to see that everyone got home OK and just before signing out to the night float (or receiving sign-out if you are on call). It is things that are signed out that are most often missed. On-call folks get busy and emergencies come in that will delay things. In short, I tried not to sign out anything that I could do by phone or that was routine (should have been done earlier in the day).  My regular walking around solo rounds usually kept me on top of things.

Going off service

Another very nice thing that I always accomplished was an “off service” note that summarized the care of a long-term patient. There were many times when a patient (especially a burn patient) had been hospitalized for months. When I received such a patient, I wrote a summary of care up to when I started and a summary of the care while I was on service. If the patient died or was discharged a couple of days after I left the service, my “off service note” would assist the new intern in doing an accurate dictation on that patient. This type of note would also help them get up to speed when they came on too. I always appreciated when someone did this for me and readily returned the favor. An “off-service” note is one of the best things for good continuity of patient care.

24 December, 2009 Posted by | first-year, general surgery residency, on-call | 5 Comments

First Semester of Medical School (it’s over and done)…

For many people, the first semester of medical school is complete. By today – barring being snowed in and delayed at one of the east coast airports – you are on your way or at home for the holiday break. Many folks worked harder this first semester than in any aspect of their previous academic endeavors only to find that they didn’t do as well as they wanted or anticipated. The good news is that the semester is over and the bad news is that you have to go back and face second semester in a few short weeks.

My first piece of advice is to take a bit of time to assess what worked (and didn’t work) in terms of getting the material mastered for this past semester. There is little use in anguishing over grades (you get what you get when you get it) or what you “could have done”.  You put everything regardless of good or bad, behind you and move into the next semester renewed. If you failed, it’s behind you until you have to re-mediate. If you passed, it’s behind you and you have to move forward. That’s one of the great things about medical school in that it carries you along at a relentless pace.

As you take stock of the things that worked well for you, see if there is something that you can do to enhance your efficiency. You are going to have to be more efficient in the upcoming semester and into next year so why not take a look at what you can “tweak” to make better. If you are totally satisfied with your work, still look at adding some activities such as physical conditioning or stress relief. Trust me on this one, stress can come out at any time in medical school no matter how well you are doing. Having some kind of a stress relief plan is a good thing. Even if you walk around the block a couple of times, it will just relieve some of the stress.

Resist the urge to try to study for Boards during this holiday. You NEED rest and relaxation. If  you feel that you must do something, then have a cursory look at First Aid for Step I but there is little that you can do that will make any meaningful “dent” in what you will have to review after next year is done. Your best prep now is rest and relaxation. Don’t even try to use these next couple of weeks to “read ahead” for the next semester. Work on a plan for increased efficiency but you know that you will have ample time to study for the next semester of coursework.

Take this time to catch up with old college mates who have gone into something besides medical school. I found this practice most fulfilling because they wouldn’t allow me to “talk shop” during our get-together. I could hoist a brew or enjoy the holiday lights without feeling compelled to study something or plan to study something. If you were fortunate enough to complete your Gross Anatomy course, relish in the fact that you can burn those formaldehyde-scented scrubs now. See, there is always something to put behind you. If you are not done with Gross Anatomy, well, you are at least further along that when you started.

I also used the holiday break to catch up on some of the latest movies, non-medical reading and other nice non-medical pursuits. Even today, as I have completed submitting grades and evaluations for the students that I teach, I am contemplating the movies that I will catch up on this week. I have some holiday clinical duties but as I have posted in past posts, I actually enjoy the hospital during the holidays. The patients are grateful that you are working in addition to the wonderful decorations everywhere. I love to take a couple of minutes to sniff the branches of the huge lobby Christmas tree just to get that holiday feeling.  I also enjoy hearing the Christmas carolers strolling the halls to serenade the few patients who are left in the hospital.

In short, take the time to enjoy your time with your family and friends, to celebrate that you have gotten through your first semester and to face the upcoming semester with some anticipation.  Try to remember that this whole “medical school thing” is a process and not a commentary on your worth as a human being. My bet is that you are far more complicated than your studies. 

If you didn’t get the grades you wanted or feel that everything you have learned has “leaked out of your brain” relax because that hasn’t happened. You definitely know more than you think you know. Every medical student feels that they are forgetting everything that they have learned. You may not remember every tiny detail but the neural pattern is there and can be recovered with a bit of review. In short, relax, that knowledge is in there and will be there for you. Next semester will build upon what you went through this semester but isn’t dependent upon you having done a “perfect” job with this semester’s material. You will have another shot at anything presented this semester next year and for Step I study. Again, this is why you can relax right now.

Finally, to those who may have to re-mediate, put off the self-flagellation. You have learned what not to do so concentrate on thinking about what you will do differently. Assess what worked and resolve to hone that what worked for you. Don’t be ashamed and don’t keep running thoughts around in your mind that you have closed any doors to having a fine medical career. You haven’t closed off anything. Remember that the vast majority of medical students will have something to face in the future that will cause a hiccup or a step-back. If you had your hiccup now, you are done. Put it behind you and know that you are going to move forward to enjoy a great career.

Happy Holidays!!!!!

21 December, 2009 Posted by | academics, failure, first-year, medical school coursework, success in medical school | 3 Comments

My First Week of Medical School

Many people have asked me, “What was medical school actually like?” “What was you day-to-day schedule?”. I will attempt to describe my first day in medical school from the time I woke up to the time I fell asleep in this essay.

I woke up at my usual time of 4:30AM. I was raised on a farm and getting up early is as much a part of my life as brushing my teeth every morning and evening. I am fortunate that I actually have always had less of a sleep schedule than most of my buddies and thus, I generally awaken around 4:30AM without the need of an alarm clock. I also roll out of bed and hit the shower while my single cup of “Joe” is brewing.

Over coffee, I usually catch up with the newspaper (online) and then I headed out the door for my walk to the subway station. This walk generally took about 20-minutes and was a built-in source of exercise for me for the first couple of weeks of medical school. My coursework on the first day consisted of Introduction to the Practice of Medicine Class at 8:AM- 10AM, Psychiatry at 10AM to noon. Lunch was from 12 noon to 1PM. Afternoon was Gross Anatomy Lecture from 1PM-3PM and Gross Anatomy Lab from 3PM to 5pm.

All of our lectures were in 50-minute blocks with 10 minutes of break in between each lecture. This allowed us to get a drink, walk around and prepare for the incoming lecturer. It also allowed the media person to set up in between the lectures as our lectures were available for download and all PowerPoints were down-loadable from out seats. Most of us took notes on the Powerpoint slide sheets or just listened in class.

Our syllabi had been handed out during orientation so that we knew the objectives and content with each lecturer. We also knew which textbook readings were to be covered. My Introduction to the Practice of Medicine course had a syllabus that contained an outline of the lecture. There was no text reading for this opening lecture that included the duties of a physician, how to fill out a death certificate and how to gather and interpret vital statistics for a locale such as birth rates, death rates and rates of disease.

With all of my syllabi and text books, I would remove the covers, take the books to Kinko’s and have the bindings removed. I would then have three-holes punched and I would place these sheets in large 3-ring binders. I had a binder for each course. In the evening before each course, I would remove the syllabus sheets for that course, remove any textbook pages that I thought I might need and place them in a small 3-ring notebook along with sheets of lined notebook paper (for taking notes). This was the notebook that I brought with me to school. I would have the subject matter divided by separators so that I had all of my information with me for the day.

I would download my PowerPoint slides and place copies of these in my subject notebook when I got back home for the day. My lecture notes (or copies of note service) would also go into each subject note book. My textbook pages would go back into that textbook three-ring binder.

On my first day, I took notes and placed them in my Introduction to the Practice of Medicine binder when I arrived home at the end of the day. For psychiatry, again, the lecturer had no slides but discussed Erickson’s stages of development and Piaget. I took notes but knew that detailed explanations of these subjects were in my textbook.

For Gross Anatomy, I had the text pages with me and made notes in the margins of the material presented by the lecturer. I also made a few notes on photocopies of my Netter plates for use in our lab. During Gross Anatomy lab, I had my list of structures that I had made from scanning the dissector. I had also reviewed the relevant plates in my Netter atlas and had made photocopies of these plates. My photocopies were stapled to my list of structures.

In our first Gross anatomy lab, we studied the bones of the vertebral system and skeletal structures. We were also given instruction in how to work with the diener to keep our cadavers in good condition for the entire semester. We were also introduced to our cadavers and our tank groups (each was six people).

After lab was over, I took the subway back home (45-minutes) and walked from the subway station to my house. I then took an hour, made dinner, ate and begin to study and review the material from the first day’s lecturers. As I studied, I made notes an questions in the margins of my books, syllabi and note sheets. Since most of my notes were typed, I printed these out and placed them in my subject binders. I also studied and memorized the relevant bone structures using my bone box that was issued to me during the first day of Gross Anatomy laboratory.

My next task was to preview the notes for the next day’s subjects and do any readings/problems that had been assigned. After my previewing, my textbook pages, relevant notes and syllabi pages were placed in my daily notebook which went into my backpack. My next days courses were Biochemistry, Microbiology and Microbiology lab.

My day ended about 11 PM and I hit the bed because I knew that my next day would be starting at 4:30 AM. Since Tuesdays and Thursdays were shorter days (class started at 8AM but ended at 4PM) I actually had an extra hour on these days. We also had a Microbiology Discussion session on Tuesdays and a Biochemistry Case Discussion session on Thursdays where we would discuss clinical cases from the standpoint of these subjects. Our instructors would bring a case, present it and then we would discuss these cases in detail from the standpoint of the basic science involved.

When we started to actually dissect the cadavers, my Mondays, Wednesdays and Fridays included 2-3 hours of dissection in the evening after class was done. I would get some dinner at school and then get into the dissection laboratory to study and complete dissections. The extra dissection/study moved my bedtime back to after midnight on these nights.

I also studied in the dissection laboratory and with my study group on Saturdays. We would have an early breakfast (at one of the nearby churches to help them raise funds) and then study and quiz each other until noon. We would then study and quiz each other in the Gross Anatomy lab after lunch and generally until 3 or 4pm. After that, we would do another group session in Biochemistry and Micro and then head home around 8pm.

Sunday’s were generally my day of rest. I would spend a couple hours in the evening putting together my materials for my Monday classes but most of my studies would be completed in the time that I had put in Monday through Saturday.

If this amount of study time seems extreme, it was extreme in some ways. I would not stop until I felt I had mastered the material. I also made the crucial mistake of neglecting my physical conditioning in favor of my studies when I should have incorporated my studies into my physical conditioning routine. I ended up gaining a considerable amount of weight but my grades were excellent. At this point in my life, I know that I have to strike a balance and now I am in excellent physical condition with no neglect to my academics/reading.

Medical school was all about balancing my studies with my life. I learned to multi-task and I learned how to focus on getting things mastered and completed. I also learned the value of discipline. My schedule didn’t allow much “downtime” but the “downtime” that I had was utilized to an ultimate degree.

It becomes easy to procrastinate in medical school because the days are long and the material seems voluminous. I fought procrastination by asking myself, “Why are you avoiding getting on with this task?”. Since I never had a good answer for this question, I just broke the task into smaller tasks and checked them off until they were done.

As I have said in other posts on this blog, the telly went by the wayside. I would spend a bit of time on Sunday scanning the log for shows that might be of interest. I would program my recorder for the shows of interest and watch them the next Sunday if I felt like a bit of relaxation. In most cases, my relaxation became hanging out with my classmates and the telly wasn’t much entertainment. I still tape shows that I love or documentaries that might be of interest to my students as I am teaching more these days.

Other things that tended to waste my time in medical school were phone conversations. I seldom use my telephone more than 5 minutes per week and tend to use e-mail communication more. I also pick and choose the meetings that I attend. Many times, academic committee meetings can be a total waste of time and energy and thus, I pick and choose whenever possible. If something is mandatory, the organizers generally will time the meetings around the schedules of those folks who are attending.

One of my medicine professors encouraged us to read the case reports in the New England Journal of Medicine every week from the first day of medical school. He said that we might not understand all of the aspects of each case but that this habit would prove invaluable as we moved through the curriculum. He was totally “on the money” with this one. I can’t tell you how studying and reading these cases helped me on all steps of USMLE and in residency too.

Medicine requires that you read and keep up with the journals of your discipline. I strive to read selected articles in New England Journal of Medicine, Journal of American Medical Association weekly. I also read American Surgeon and Archives of Surgery regularly along with Nature Medicine (excellent articles to be found in this journal). I keep a computer log of the articles that I have read and their sources. This keeps me current with the literature as much as possible.

16 June, 2007 Posted by | first-year, medical school, medical school coursework, organization, study skills | 9 Comments

It’s On to Medical School!

You have managed to go through the medical school admissions process and you have selected the school that you will attend. At this point, approximately two months out from actually starting classes at medical school, what are some of the things that you might want to place in order? Graduation from undergraduate is behind you and those wonderful celebrations are over. It is now a good time to look at some of the basic necessities that you are going to need in order to start your freshman year of medical school off on a solid foundation.

Have you found a place to live? The ideal “home” for a freshman medical student should include, a bed (mattress on the floor doesn’t work well), a desk with good lighting (preferably in front of a window), a bathroom with both tub and shower, and some manner of kitchen facilities. If you are doing the “dorm” situation, a small-refrigerator and coffee/tea pot are bare essentials if you don’t have access to a kitchen or kitchenette. Other “niceties” are a sturdy bookshelf for organizing your textbooks, a filing cabinet for papers and notes (2-drawer is fine) and a comfy chair with reading lamp for change of position. A large-sized dry erase white board (60-incher) is good for concept mapping and writing down upcoming test dates etc. You can fall asleep while looking at one of your concept maps. Leave the telly at home but an MP-3 player and radio are good to keep on hand.

You won’t be spending loads of time in your “crib” so you don’t need to load up on creature comforts. You home should be something of a sanctuary but you don’t need to spend thousands of dollars on furniture for your apartment and an interior decorator. You will be basically doing the three “Ss” in your apartment(shower, study and s–t) and rushing out of the door on most days. Even on weekends, you life is going to center around your studies for the most part. If you have a family (or significant other person in your life), then you may need to make more sophisticated provisions but in essence, medical school is going to make your life pretty simple and fairly routine.

Your home should be an easy commute to your medical school. Hours of sitting in traffic or hours of driving to and from school are a very bad idea. There will be days when you are just exhausted and traffic/commuting will be the very last things that you will want to contend with; not to mention having enough energy to hit the books and notes after you have battled traffic. When I was a freshman medical student, I had a 45-minute subway ride into the city each day. I used that time to preview lecture material or just relax and listen to the sounds of my environment. I definitely would not have put that much time into driving. Before starting third year, I moved much closer to school and my clinical rotation sites.

Most of your time will be spent in and around school. You will attend classes and you will study your notes and books in the evening on a daily basis. The more information that you have to remember, the more organized you want to be in every aspect of your life. I planned as much of my day as possible around my classes and study schedule as I became the ultimate multitasker. It was always my goal to get ahead of my professors and stay ahead of them as much as possible. This task became the goal of my organization skills.

If you have an automobile, you need to scout out parking as soon as you hit town. It may work out that you end up parking your car further away from your school and getting a short but brisk walk to school and a secure parking spot that you can count on. At my school, parking was such a premium that taking the subway daily was a better option for me until third year. It just wasn’t worth the money to park or the worry that my car might be broken into as several of my classmates discovered. If you school has safe and secure parking, again, park far and walk more. Your nerves and stress level will appreciate the extra exercise.

On weekends, I would drive into school for sessions in the Gross Anatomy lab or study groups. Since I didn’t have to deal with traffic on the weekends, driving made more sense those days. Having the car also gave me an option of finding a great restaurant for a good meal as a reward for getting my studies done.

I also made sure that I had at least three months of expense money in my savings account for any emergency. Things that might come up would be your financial aid being delayed or an extra expense that you didn’t budget for. I kept a very strict budget and could account for every penny of my expense money. Again, not having to pay for parking saved loads of change for me. I also had the option of working on holidays which added to my stash of emergency cash. I would work any holiday as keeping up with my studies gave me holiday time as extra days. In addition, holiday pay was very very lucrative for me. (I was a registered respiratory therapist with a specialty in pediatric critical care). I did not work during the regular school session no matter how thin the budget was stretched. It was difficult but my studies came first.

During the summers between my first and second year and between my second and third year, I had either a paid position (in addition to my contract work) or a paid fellowship. I would leave a couple of days to do absolutely nothing but I could not afford to do too much vacation during these summers. The summer between my first and second year, I was a peer tutor for our pre-matriculation program. The other summer, I had a pathology fellowship. In both cases, I furthered my career and honed my knowledge which proved great for boards.

Food turns out to be a fair expense for most medical students. The worst thing that you can do is rely on fast food. It has too much fat and you end up paying with your health and energy level. I would limit my eating out to once per week and explored the ethnic restaurants of my city. I would eat Vietnamese, Ethiopian, Jamaican, Thai, Japanese and Cambodian food every Saturday evening. My study group loved to go for breakfast (or Sunday dinner) at a nearby church. We would get a good home style meal and support the community which, loved having a table of hungry medical students. We learned to be very careful because “food coma” could be a major problem after one of these great meals.

If we were studying at one of our houses, we would “pot luck”. Sometimes it would be a mixture of supermarket “take out” but we tried to keep our “study meals” nutritious and non-fattening. The worst thing would be those late night sessions before an exam when the Nacho Cheese Doritos would be out on the table. There is something about crunch snacks that fits well with study time.

Collect your favorite study supplies and stock your desk as soon as you can. I had colored pencils, different colored highlighters and my favorite four-color pen. I also had a large cork board above my desk for pinning notices and sticky notes. My other favorite technique was to cut the bindings off the back of my text books, punch three holes and carry only the pages that I needed to read instead of the entire book. To this day, my pathology text (Big Robbins) is divided into two notebooks. I did the same with my Gross Anatomy text, Pharmacology text and all of my syllabi too. Kinko’s can do this little task for you.

Another essential piece for my desk was a kitchen timer. I kept one in my backpack and one on my desk. I would set the timer for 50 minutes and study for those 50 minutes. I would then take a 10-minute break and back to another 50 minutes. This kept my mind refreshed and kept me more efficient. I would also check off each subject as I studied them. This check-off was more psychological so that my mind would see that I was making some progress. During my study breaks, I would walk around, get some water or just look out the window and let my mind rest. (See the purpose of having your desk in front of a window).

Purchase a good medical dictionary such as Stedman’s Medical Dictionary so that you can look up words and terms as you come across them. I made it a point to look up any words that I did not recognize and keep a running vocabulary list. I also obtained a subscription to the New England Journal of Medicine on-line. I would print out the Case Reports and read them on the subway. The medical dictionary came in handy for these articles. I also learned how to present patients and increased my general medical knowledge. I also read the review articles and any original research that was of interest to me. I would scan JAMA in the library but NEJM was my daily reading in some manner.

Other supplies for me were ringed binders, large coated paper clips, erasers, No. 2 pencils, an electric pencil sharpener (I love sharp pencils) and narrow ruled notebook paper for written notes. I usually took class notes on my laptop computer. I used a mini cassete recorder (I have now replaced this with a digital recorder) for those days when I found myself dozing in class. I would make study drill tapes and listen to them when I walked or exercised.

15 May, 2007 Posted by | first-year, medical school, organization, stress reduction, study skills | 2 Comments

First Year of Medical School

A short while back, some of my pre-med students asked me about memories of medical school. I thought it might be fun to write about some of those here as well as residency experience so here goes from the beginning…

My medical school had a classical curriculum with problem-based-learning intergrated. We had the typical first-year, second-year types of classes. Lectures went from 0800h to 1600h daily. We had some Tuesdays or Thursdays when we would be able to get out earlier but we spent loads of time in class (way more than students currently attending). Some of my classes had computer-based-learning exercises and some had laboratory projects that had to be completed. In short, school was the equivalent of a full-time job with much time spent on weekends reviewing and keeping up with the pace. The best thing was that all of my classes were very interesting.

My first lecture of medical school was in Biochemistry. The professor essentially covered an entire Organic Chemistry course in a 50-minute lecture. The material was extremely detailed and presented in volumes. This particular professor had a reputation for “rocket” lecture delivery and he got the job done. The great thing was that I understood everything well and could see that this was the basis of the next 50-minute lecture which started off with lipid biochemistry.

My next class was the first part of Gross Anatomy. Our lecture was on surface anatomy and types of neurons. Each lecture was 50 minutes followed by a 10-minute break. I think those 50-minute lectures were the beginning of my 50-minute attention span. After lunch, Gross Anatomy lab started with a brief introduction and then a long laboratory on the vertebral column. We were all given bone boxes (containing human bones) to take home for further study. Every bone was present except the skull bones. Needless to say, we were required to learn every bone and every part of every bone.

By the time the day was done, I had received the equivalent of about 3 weeks worth of undergraduate lectures on one day. Since I had my syllabi, I knew what would be covered in lecture and I knew what readings and material would have to be previewed for the next days lecture. After each lecture was completed, I would quickly fill in any gaps in my notes and briefly scan through my notes for completeness. Over lunch, I would start to memorize as much of my morning lecture as possible too. We had an hour for lunch so I would grab something quick and then spend the rest of the time pouring over my notes.

On the way home, I would study some more or just watch people. I took public transportation because I didn’t want to worry about driving. My commute time was my time to relax and think about the day or plan my evening. When I got home, I would grab my gym bag so that I could get a quick swim in before dinner. I would dine with my fiance and then hit the books for a couple of hours. By that time, it would be around 8pm so I would go to bed. I would wake up at 2am and study until 6 am. I would then take a shower and get off to school.

When I was studying, I would finish studying the material that had been presented that day. I would then review the lectures for the day before and preview the materials for the next day’s lecture. On the weekend, I would review the entire week’s lectures in addition to reviewing an entire week’s dissection in the Gross Anatomy lab.

I made study tapes to drill structures and notes so that I could listen to them while I was walking or running. I would also make concept maps and fill them in on large sheets of paper as I went through biochemistry. I always wanted to keep the “big” picture in mind as I studied.

We had an exam week about every five weeks during the semester. There would be two “reading” days (read catch up) and then exams would begin. For Gross Anatomy, we would have the lecture exam in the morning and the laboratory practical exam in the afternoon. Between the exams, I would go to the art museum and get completely away from campus. I couldn’t stand to be around people who were so stressed about the exams.

In addition to Anatomy and Biochemistry, we had lectures in Psychiatry and Introduction to the Practice of Medicine. The Psychiatry lectures were always interesting and covered topics like development, personality disorders, sexuality, psychiatric drugs and the roles of various types of psychiatrists. Lectures in the practice of medicine covered topics like law and medicine, types of practices, alternative and complimentary medicine, history of medicine and medical education models. Psychiatry and Introduction to Medicine provided a bit of relief from the rigor of Biochemistry and Gross Anatomy but we were tested on these subjects so they required our attention too.

Our first semester ran from the middle of August to the second week of December. I can promise that the time goes by very quickly and soon Christmas vacation upon us. At the end of the first semester, we were done with Gross Anatomy and Biochemistry but still had more lectures in Psychiatry and Practice of Medicine. In addition, we had Histology, Microbiology/Immunology and Neuroscience lectures too. Second semester had a bit more material and more lectures. In addition, we had to dissect brains and spinal cords in Neuroanatomy. We were also given slide boxes with every type of tissue for histology. We would learn to recognize tissues and electron micrographs of every type of cell.

By the time second semester is over, we had learned a huge amount of material. Most people were happy to get exams done and get home for the summer. I was selected to become an instructor for the students who would be coming into our pre-matriculation program. I would be teaching Biochemistry primarily in addition to Gross Anatomy and Immunology. It was an honor to be asked to instruct in this program and I knew that I would enjoy working with these students.

The students who participated in the prematriculation program were medical and dental students with a conditional acceptance into medical or dental school. By successfully completing this program, these students are offered a seat in the school that they were conditionally admitted to. During this rigorous summer, we gave study tips, extensive reviews and got to know some very determined folks. In addition, these students have a huge head start when the actual courses start because they have been exposed to the material. It is a great program and I enjoyed the summer. In addition, we, the instructors are paid very nicely and can get some research done at the same time.

I finished my first year strong with honors and a much stronger interest in medicine than before I started school. When I looked back on all that I had learned, I was amazed. Little did I know that second year had even more to learn and would build upon my foundation of first year.

7 January, 2007 Posted by | biochemistry, first-year, Gross anatomy, medical school | 15 Comments