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 the New Academic Year

Introduction

As many of you head back to school (or begin medical school or university), the time is great for considering some small changes that may make a large difference in your health and academic success. I wanted to list a few things since I am on an extended vacation/adventure and now have a little time to tend to my neglected blog.

Head Check

This is a great time to “let go” of anything negative from past academic endeavors. This is a new start, a new year and a new time to reinvent yourself. Why not spend a few minutes each morning with some positive thoughts (for heaven’s sake, this can be as simple as smiling at yourself or a positive affirmation). When students begin to become overwhelmed, negativity creeps in first and threatens to magnify any problems into significant issues. I have found that my first actions when I start each day are to meditate and begin the day positive with my spiritual thoughts. This places me in the proper frame of mind to meet each challenge as they come.

Consider that in this era of expensive education and limited funds/opportunities, the fact that you are a student is a great advantage. You have a body of knowledge to master and build upon. Keep your mind open and positive so that you take the greatest advantage of your present academic challenges and events. Nothing can limit a determined individual who calmly prepares themselves for anything to come and adapts to changes when they occur. Resist the urge to see your academics as a battle with your professor or fellow students. Your only competition is with yourself to do your best honestly and constantly.

Do not neglect your spiritual needs. Find some form of spiritual outlet, be it something creative or religious (even better do both). If you are in a new location, find a church that speaks to you even if you wind up exploring another religion or belief. Allow yourself the freedom and openness to learn about other religions and beliefs. These explorations can serve to strengthen your own beliefs or widen your spirituality. The fellowship and connection with others, preferably outside of medicine or school is great for your heart and soul. Yoga is a wonderful activity to explore with its calming and peaceful effect on both mind and body.

Body Check

Plan your meals for the week and plan healthy. The pizza and beer may be a wonderful treat but one can’t eat high fat foods and consume alcohol on a regular basis. Good academic performance takes a strong body to nurture sound thinking. Packing snack-sized bags of apple slices, a few almonds, cucumber slices, baby carrots and grape tomatoes are healthier, easy and cheaper than grabbing a high sugar candy bar from a vending machine. High sugar may give one a quick energy boost but in the long run, that boost doesn’t last. Ease up on the caffeine (dehydrating) and go for water rather than fruit juice. If you must have fruit juice, make it within the context of eating the fruit whole such as a whole orange or grapefruit rather than drinking bottled or canned juice.

Perform some type of aerobic exercise where you get your heart pumping for at least 30 or more minutes daily. You don’t have to run for long periods of time as you can break your aerobic work into 10-minute sessions. My favorite trick from residency was to run the steps (up and down) in between my surgical cases or run jog the length of the subway platform several times as I waited for the train. I used climb to the top of the parking garage and just enjoy the air and the birds from the heights (I used to wave at the train engineers from the garage too). You can even park your car far away from the building and hike in for some much-needed aerobic work. Let your aerobic work be relaxation and not competition or stress.

Pumping iron in the gym is also great for stress relief. I will admit that I use my iron work to give myself positive reinforcement. With each rep, I am grateful and thankful that I can perform those reps. I generally don’t have loads of time for the gym but I take advantage of every moment when I am able to get into the gym and get a good weight-lifting work out completed. I also follow-up with a dip in the pool as a means of keeping myself flexible (vitally important in surgery).

Sleep Check

You have to figure out how much sleep you need for peak performance. Trying to “train yourself” to get by on less sleep rather than more sleep is not a sound idea for optimal learning. There are plenty of fitness devices on the market that will give you an idea of how much sleep you actually are getting and the quality of that sleep. Figure out what is optimal and get proper rest.

Anxiety can often cut into sleep and can cause your quality of sleep to deteriorate. This can cause chronic tiredness and can make your study time far less efficient. Find healthy ways to reduce anxiety (not drugs or alcohol) so that you can sleep well. Even herbal supplements can erode the quality of your sleep thus you need to make sure that you are getting proper rest without chemicals unless properly prescribed by a physician for a diagnoses where an anxiolytic is indicated.

Unplug from your electronics

I have been guilty of keeping the smart phone next to the bed on most days. Now that I am on vacation, I started to turn off the phone and rely on my natural clock to awaken me. I have discovered that I don’t over sleep and I am more peaceful. My phone is in my purse which is across the room so that I am not tempted to grab it first thing when I awaken. I plan to carry this practice into my work life when I return home.

I have many wonderful connections with my friends on social media and enjoy those connections very much. I have learned to treat my social media times as part of my recreation time. Social media is a means for me to connect with colleagues and friends and not to iron out political problems. More times than I would love to admit, I have “UN-friended” someone because they are bent on berating me for my beliefs. I just don’t have time for that much stress these days.

Consider that during this time of emphasis on academics and school, you have a limited amount of energy which should be spent on your studies rather than being outraged about things that you may not be able to affect. Yes, you need to be aware and informed but gossip, shaming and bullying take too much energy and produce negativity. Support causes that you believe in but not to the point that you are consumed by your causes.

Finally, these are a few things that I am “tweaking” as I go along. As an attending physician, I take myself far less seriously than I did as a resident physician. I have come to embrace my humanity and to embrace the wonder that is the humanity in others.  There is tremendous joy in medicine and patient interaction especially when your patients begin to see that you care about solving their problems and you connect with them. At this point in my life and career, my patients, my students and the residents me teach me so much. For that I am eternally grateful.

24 July, 2015 Posted by | academics | , | 8 Comments

What do I have to know in medical school?

Introduction

If you are asking the question,”What do I have to know in medical school?” then you have already started at a disadvantage. Medical school is not about “what” you “have” to know as much as it is about application of a body of knowledge to problem-solving. Sure, you can sit down and attempt to memorize a bunch of lecture notes so that you can repeat them verbatim but that isn’t going to get you past USMLE (any of the steps) or through residency. Medical school provides a foundation of knowledge that you can build upon. The more solid your undergraduate preparation, the easier you can add to your knowledge foundation that will enable you to treat patients.

Many medical students get into the “whine” about why they have to know so much detailed information when vast information resources are available at the “whisk” of a finger. In truth, the internet is as much of a blessing as it is a curse. No amount of information at your fingertips is going to be very useful unless you know how to evaluate that information and how to apply that information to clinical problems. While many undergraduate institutions are adept at getting students into a mode of being able to “memorize and regurgitate”, they fall far short in terms of providing a solid foundation in research and problem-solving. While there is no lack of information, learning what information to utilize and how to utilize the information that you learn is the biggest hurdle for most pre-clinical medical students. In short, all of the things that are on the internet are not useful or helpful when it comes to patient care.

Becoming an efficient learner in preclinical medicine

Many students start out with the idea that they are going to go home every night and re-copy their notes in order to memorize them for the upcoming exams. They quickly find that this strategy is neither useful nor efficient. The notes are generally an outline of what needs to be mastered in detail with the details largely coming in the form of the information that is stated in class between the bullet points on a lecture outline. Simply recopying notes will largely get one to the point of being a good “clerk” but generally doesn’t provide much of a basis for the depth of understanding that is needed for knowledge base mastery. In short, the Powerpoint lecture notes and the review books are just not enough by themselves for a thorough understanding. One just cannot “memorize the bold heading” and expect to be ready for board exams or course exams for that matter.

What is “efficiency” in learning pre-clinical medicine?

Efficiency is largely making the most of your attention span plus making sure that you synthesize and incorporate new knowledge within the context of the knowledge that you came into to school with. Many students who didn’t major in the sciences will lament that they just don’t have the background that their fellow students would have in subject A or subject B but an efficient learner will not only have the background regardless of major but will be able to add to that base with ease. In short, everyone who takes the pre-med coursework, has the background knowledge base to do well and be efficient in medical school.

If a person majored in biology as pre-med, the upper division biology courses required General Biology as a pre-requisite the same as Gross Anatomy and Biochemistry only require General Biology and General Chemistry as pre-requisites -note that I didn’t mention anything about Organic Chemistry as Biochemistry is far more related to General Chemistry than Organic Chemistry. If a first-year medical student didn’t major in science, they are at no more of a disadvantage as long as they know how to add to their pre-med base and build upon that base. In short, it’s a good idea to stop “talking” or “thinking” ones self out of a strong performance because of perceived perception that upper division science courses give an advantage. In short, the upper division science courses are only advantageous to folks who anticipate graduate school in that  subject matter.

In one wants to become an efficient learner, the subject matter is fairly irrelevant but the study techniques are quite relevant. One has to have an approach to new information that is devoid of emotional reaction, self-deprecation and a willingness to adapt to whatever comes next. Adaptability is a very useful characteristic for learning new material and thankfully, your brain is “wired” to adapt to new situations if you allow it to do the job without emotional checking. One has to have the confidence to dive into what needs to be learned, master what needs to be learned and to readjust if their first attempt at mastery falls short.

Confidence, the best learning tool

When I speak of confidence, I don’t mean that one boasts or constantly “pats their own back” but I mean that one has to have the ability to move past and learn from those myriad of small mistakes that will come with adjusting to any type of professional school. Some folks mistakenly believe that once they achieve a “high” board score or a good grade on a course exam, that they are in the upper echelons of medicine and can’t make any mistakes. Being able to bounce back and learn how NOT to do something is a valuable as knowing HOW to do something.  In every aspect of medicine, it’s the experience that will trump anything read in a book or in lecture notes but with experience should come making mistakes and making adjustments from those mistakes. In surgery, for example, skills are honed from practice and more practice but experience with practice is the best teacher and the best method of learning.

Learning in isolation

I hear over and over from medical students that they are just “not group studiers”. In medicine, one has to learn to interact, learn from and teach other members of the healthcare team. Nothing in medicine is done in isolation which means that the sooner one gets used to working with a variety of others both friends and colleagues, the better they become as physicians. I always remind the residents who are rotating with me on my service that it was a physician assistant who taught me the skill of closing the chest. This PA had spent years doing chest closures and knew how to teach in a manner that was great for a resident who was in the learning stages. My thoracic surgery attending was brilliant and guided me in many ways but that cardiothoracic PA taught me how to handle sternal wire efficiently and safely in the step-by-step manner that a junior resident needs to be taught. In short, the best physicians learn to appreciate knowledge from any good resource and learn to appreciate anyone on the team who is dedicated to the perfection of their craft. This holds most importantly for pre-clinical medical students as well as residents who are further along in their learning. Work with anyone at anytime who is willing to share their knowledge with you or who needs the benefit of your counsel. The ability to work with others and learn from them  will pay back in the years to come.  One cannot afford isolation in any part of medicine.

Getting along with others

While most of your learning is your responsibility, you have to be able to work with potentially any number of diverse people on a health care team. I vividly remember overhearing one of my fellow medical students  who was from India talk about a resident who was from Kenya. This medical student joked about how he “had it made” because the attending on the service was from India and the resident’s opinion wouldn’t really “count” in his grade for the rotation. Well, that medical student was pretty surprised to find out that his “honors” didn’t materialize because he just wasn’t receptive to learning from a resident whose ethnicity was different. He appealed his grade to the attending and to the dean of education but it stood because he wasn’t ready to work professionally with another person who had earned the right to be a resident and who attempted to teach. In short, professionalism means that one has to be able to work with a broad range of people and treat a broad range of people with respect.  The first mistake that many medical students will make on a rotation of any sort, is believing that they can’t learn from anyone except the attending physician who is in charge of the service or that they can treat anyone associated with patient care in a manner that is disrespectful.  I will often question nursing assistants, environmental service workers and nursing staff about the manner that students and residents treat them on a day-to-day basis. In short, everything on a clinical or in pre-clinical coursework always “counts”.  It’s just as easy to treat everyone  with respect (becomes a habit after a while) and not have to worry about offending  (or impressing) anyone.

So what DO you have to know in medical school?

You have to KNOW:

  • How to be an efficient and self-directed master of course materials.
  • How to work within a very diverse population of patients and healthcare workers.
  • How to make adjustments after trying something that didn’t work as well as you thought.
  • How to recognize that every experience is a learning opportunity and be open to the learning.

13 December, 2011 Posted by | academics, difficulty in medical school, medical school | | 4 Comments