How to Stay Focused in Med School

Keeping your focus, studying, and avoiding a distractions is a big part of being successful in medical school. This post from Jenna details some strategies for achieving that goal.

The medical school system is designed to try and break us as early as possible so that the weak are weeded from the herd. It’s a cruel way to live, but in the end it ensures the best for our patients. Even so, it’s hard to deal with that kind of pressure. Even the best and most positive among us can become disillusioned and depressed (1).

This is why it is important to do everything you can to stay focused and to keep your eyes on the prize: being a doctor. Here are some tips to help you do that.

Write the Letter
As soon as you get accepted to med school, while you are still riding that high of getting into the school you wanted, write yourself a letter. Talk about how you feel right now and remind yourself of why you’re going to med school in the first place. Encourage yourself to keep going even when things get hard. Then, put that letter in an envelope and hide it away. Pull it out and read it whenever the stress of med school starts to get to you and you start to forget why you signed up for all of this terribleness. That letter will do a better job of reminding you why you’re doing all of this than any pep talk anybody else can give you.

Make Friends
Med students are notorious for trying to go it all alone. Many see their fellow students solely as competition to be bested or resist the urge to bond because they don’t want to have to worry that a friendship will get in the way of their getting ahead. Here’s the truth: your classmates are going to pick up on things you don’t. They are also going to better understand what you are dealing with than anybody “on the outside.” (2) Make friends and support each other. Medicine is a competitive field, but it is also a collaborative one. Remember that.

Have FunWait, what? That seems counterintuitive, doesn’t it? Med school is supposed to be about 100% dedication and focus on your studies, right? No. Everybody needs a break from time to time. It’s good to put the books away once in a while and just hang out and have fun. If all you ever do is study, you will burn out. Trust us on this.

Set Firm BoundariesAt the same time, be firm with the rules you set for yourself. Do not let yourself get tempted into blowing off a study session for a movie when you know that you’re having a hard time in a class. And don’t let your desire to be the first in your class get in the way of your connections with your family and your friends. Set a schedule, stick to it and commit to it. Learn to be okay with saying “no” sometimes, even if it is to yourself! This is the other half of the socializing coin. You can’t be everything to everyone and to yourself. It’s okay to be selfish.

Stay SoberMed school will run you ragged. This is a given. It is also a given that you are going to be tempted from time to time to look for help staying awake, staying energized, staying focused. And when coffee stops being enough, it’s tempting to turn to something stronger. Resist this urge. Studies show that people who use drugs actually increase your feelings of disinterest and distraction. (3) You might be more awake, but you won’t be able to put that energy to good use. Plus, addiction is harder to beat than med school. Trust us on this.

Everybody has heard that the deluge of information you are expected to smash into your brain is so intense it’s like “trying to drink from a fire hose” (4).This is absolutely true. Know this going in so that you aren’t surprised and overwhelmed by it when you get to school. Advance prep is a good idea. The aforementioned schedule is another. Take steps to keep the fire hose from drowning you.

Sources:

1. "How a Doe-Eyed Pre-Med Student Changes into a Jaded Doctor." Medical School Success. Web. 29 Apr. 2015.  http://www.medicalschoolsuccess.com/how-a-doe-eyed-pre-med-student-changes-into-a-jaded-doctor/
2. DeCoste-Lopez, Jennifer. "Med School Friendships from Classroom to Clinics." Scope Blog. Stanford Medicine, 9 Apr. 2014. Web. 29 Apr. 2015.  http://scopeblog.stanford.edu/2014/04/09/med-school-friendships-from-classroom-to-clinics/
3. "The Impact of Education on Addiction - Michael's House Treatment Centers." Michaels House Treatment Centers. Michael's House. Web. 29 Apr. 2015.  http://www.michaelshouse.com/drug-addiction/impact-education-addiction/
4. "What Is Medical School Like? Think Fire Hose!" Happy Hospitalist. Web. 29 Apr. 2015. http://thehappyhospitalist.blogspot.com/2009/09/what-is-medical-school-like.html

Ultrasound Technician Online Classes

Our guest post today talks about the exciting field of ultrasound and online ultrasound technician classes: 

The field of ultrasound technology is focused on utilizing advanced equipment to direct sound waves into a human body and analyzing the outcome images to diagnose medical ailments. Ultrasound technicians, also known as sonographers, must be well acquainted with sonographic instruments as well as human anatomy and the physics. Online ultrasound technician course offers students insight into different sectors of sonography including echocardiography, abdominal sonography, ob/gyn sonography, and vascular sonography. These courses allow students to improve their critical data analysis, manual dexterity, administrative, communication, and computer skills.


Knowledge Gained

Online ultrasound technician classes offer students with knowledge in various sectors, including:

• Abdominal Sonography: Students may learn to use noninvasive imaging to detect and analyze medical ailments within the organs and structures of the abdominal area. This area of study includes the spleen, kidneys, urinary bladder, pancreas, gallbladder, and liver. 
• OB/GYN Sonography: Classes concentrated on ob/gyn discuss the fields of gynecologic sonography and obstetric sonography. The gynecologic sonographic deals with the organs of the pelvic region, while the obstetric sonography examines the progress and condition of an expecting woman and her fetus. 
• Vascular Sonography: The vascular sonography classes teach students about the pathology of the veins and arteries of the human body. Students learn to diagnose the diseases of the blood vessels that can cause conditions such as aneurysms, strokes, peripheral arterial diseases, and pulmonary embolisms. 
• Anatomy and Physiology: Anatomy and physiology classes teach students about the structure of body. Through these courses students become familiar with respiratory system, circulatory system, skeletal system, functions, placement and appearance of organs, and many more. 
• Sonographic Instrumentation: Students learn about the physics and different advanced sonography equipment. Typically the coursework of sonographic instrumentation include digital imaging station, EKG machine, and ultrasound transducer/probe. 

Skills Developed

The online sonography classes help students to develop their skills in various areas including:

• Communication: It is a must for potential ultrasound technicians to master the medical dialect. They must be able to communicate properly in a hospital setting, deal directly with patients, and convey the condition of patients to superiors properly. 
• Administrative: Students learn to do the administrative tasks which go along with the technical activities. They learn how to prepare various reports, record results, participate in the maintenance of laboratory accreditation, and organize tight schedules for the specific machines. 
• Computer Skills: The computer classes teach students about the current medical technologies. Students are taught about the software which is required to create ultrasound waves and turn them to proper digital images. 
• Data Analysis: Students learn how to analyze and interpret the data returned by the ultrasound frequencies and differentiate between pathologic and normal findings, as well as the different sorts of phenomena that can take place during imaging such as propagation artifacts and attenuation artifacts. 
• Dexterity: Students learn to manipulate the transducer around different areas of human body, maintain advanced sonography equipment, and take care of other related health care materials. They are also taught to place the patients in proper position for imaging procedures. 

Kenneth Miller is a career counselor and a blogger. He has written lots of articles about online education and training. Find out more on his blog.

Do Medical School Rankings Matter?

Every year medical students agonize over medical school rankings. Specifically, like "AHHHH! MEDICAL SCHOOL RANKINGS ARE COMING OUT SOON!" Pre-Med students are famous for being Type A "gunners" who are at high risk for obsessive compulsive disorder. An exaggeration to be sure and not true of all, but the fact remains that data about rankings in the hands of people who are geared for high achievement tend to produce more angst than relief. 

The simple fact is: one cannot boil medical education down to a single ranking! The U.S. News And World Report's Best Medical School Rankings does not even try. It actually breaks the ranks down into research and primary care lists. Oddly enough, most people focus on the research rankings, despite the fact that primary care is what medicine is all about! Taking a look at the two sets of rankings and you quickly realize that the correlation between the two is far from perfect.

As a pre-med student or medical student, which list do you follow? The simple answer is: both! You have to realize which list best applies to you. Are you more interested in research and considering an MD/PhD or similar joint degree? If so, focus on the research rankings. Do you instead prefer caring for the underserved, working internationally, or perhaps rural medicine? Then focus on the primary care rankings. Not sure yet? Try to see which schools rank highly on both. As a guide, the list below shows the top 10 medical schools in primary care with their research rankings (in parentheses); the list below it has the top 10 medical schools in research with their primary care rankings (in parentheses):

Top 10 Medical Schools Research Rankings (Primary Care Rank)

1. Harvard University (17)

2. University of Pennsylvania (7)

3. Johns Hopkins University (25) 

4. University of California - San Francisco (5)

4. Washington University - St. Louis (30)

6. Duke University (42)

6. University of Michigan (14)

6. University of Washington (1)

6. Yale (87)

10. Columbia University (62)

Top 10 Medical Schools Primary Care Rankings (Research Rank)

1. University of Washington (6)

2. University of North Carolina - Chapel Hill (20)

3. Oregon Health Sciences University (37)

4. University of Vermont (55)

5. University of California - San Francisco (4)

5. University of Colorado - Denver (27)

7. Michigan State University (-)

7. University of Pennsylvania (2)

9. University of Massachusetts - Worcester (47)

10. University of Iowa - Carver (27)

As you can see, there are some huge disparities. The only schools to make both lists are University of Washington, UCSF, and UPenn. Clearly, if you are unsure of your future career focus, you have better odds of finding out at those three schools. While the USN&WR rankings are not 100% correct, they do serve as a reasonable proxy for the actual underlying quality. Ultimately, you have to make a decision from the heart about what place is right for you. 

References:
1. U.S. News & World Report Best Medical Schools Research Rankings. http://grad-schools.usnews.rankingsandreviews.com/best-graduate-schools/top-medical-schools/research-rankings. Accessed December 21, 2010

Should Medical Students Buy The Kindle Fire?

Back in 2009, when tablets and e-readers were first becoming popular on the market, we discussed whether medical students should be required to have tablets like the iPad, or whether one should wait for an e-reader like the Kindle geared towards medical education. Now, two years later, as tablets and e-readers continue to converge and prices fall, Amazon had introduced the Kindle Fire:

What is the Kindle Fire? It is Amazon's $199 color 7-inch tablet that runs Amazon's custom version of Android for tablets. Why does this matter for medical students? Here are a few reasons why the Fire does matter:

• Price - At under $200, the tablet is much more affordable than the iPad for most medical students on a budget. 
• Portability - At 7", the tablet is light and small enough to carry to any lecture hall, or even on wards potentially.
• Color - Unlike prior Kindles, the full color screen lets students get the most out of any medical resources they find online.
• Amazon - Yes, the company selling the tablet matters. Given the huge amount of content Amazon offers and the proven track record of the Kindle family, students who buy the Kindle will not get left behind, unlike, say, buyers of HP's TouchPad, who shelled out 3x as much money just to find out less than 2 months later that HP was killing the product.
• Price, again - Hello, you can buy three of these for the cost of an iPad. 

All that being said, the Kindle Fire is not an automatic slam dunk. Some users find the 7" screen cramped for web browsing and that the browser is slow compared to the iPad's. Also, if you are interested in using apps that only run on iOS, they cannot be used on a Kindle Fire. Even some common Android apps may not function perfectly given Amazon's tweaks to the OS.

So, where does this leave a medical student? Basically right now, first ask yourself whether you really need a tablet and what role it would play in your education. Are the text books you like to read available in e-book versions? Do you heavily use online resources? Is your campus fully Wifi-enabled? If so, a tablet makes sense. But which one? If you have the budget, certainly test drive an iPad 2. However, if your budget is a little tighter, the Kindle Fire seems to be a fitting alternative. Although, for what it's worth, the best bet may just be to wait a little while for the Kindle Fire 2! 

Updated 2015-12-20

Top Medical Titles On The Amazon Kindle

The last few posts have covered the various advantages of the Kindle (Should iPads Be Mandatory?, The $99 Kindle), but as we all know: content is king. So, you may be rightly asking yourself, what titles can I find on the Kindle?

Here are some key medical textbooks / titles already available on the Kindle specifically for the USMLE exams:

• First Aid for the USMLE Step 1, 2010
  The standard textbook for studying for Step 1 on your ereader. And before you fret, remember the Kindle version still lets you highlight, annotate, and even search the text.
  
• First Aid Q&A for the USMLE Step 1, Second Edition
  
• First Aid- Cases for the USMLE Step 1 : Second Edition
  
• First Aid for the USMLE Step 2 CK, Seventh Edition
  
• First Aid Q&A for the USMLE Step 2 CK, Second Edition
  
• First Aid Cases for the USMLE Step 2 CK, Second Edition
  
• First Aid for the USMLE Step 2 CS, Third Edition
  
• First Aid for the USMLE Step 3
  

Additionally, there are many general medical books / medical titles available as well, including journals:

• The New England Journal of Medicine
  The flagship American medical journal
  
• Harrison's Manual of Medicine
  The premier comprehensive textbook of internal medicine in the palms of your hands
  
• First Aid for the Medicine Clerkship, Third Edition
  
• Case Files Internal Medicine, Third Edition
  
• First Aid for the Surgery Clerkship
  
• The Gawande Collection:
• Complications: A Surgeon's Notes on an Imperfect Science
• Better: A Surgeon's Notes on Performance
• The Checklist Manifesto: How to Get Things Right

Poke around the Kindle Store and you'll be amazed at what you can find. The medical section is surprisingly more complete than one might expect. Have fun Kindling!

Updated 2015-12-20

The $99 Kindle or the Medical Kindle?

The market for e-readers is evolving rapidly. Our last post discussed the iPad vs. the Kindle for medical trainees. However, a recent article in Slate argues that the price for the Kindle will soon fall to less than $100:

All of these trends likely guarantee that Amazon will release a $99 e-reader someday. But why do I think it will do so before the end of the year? If the company is already selling out of its inventory at its current prices, what's the point of making the Kindle even cheaper? The quick answer is that tech companies usually ramp up production and lower their prices for the holidays. Last October, Amazon cut the price of the Kindle from $299 to $259. The day after Christmas, it reported that the Kindle was the "most-gifted" item in the company's history. Even so, the Kindle never ran out of stock in December (as it had in 2008). If it lowers the price this October, you can be sure Amazon will make enough to satisfy the demand.

And at $99, demand will be unbelievable. Last year a Forrester Research survey found that fewer than 20 percent of "U.S. adults online" would consider buying a reader priced at more than $100. When asked about a reader priced under $100, however, nearly 65 percent said they would consider one, and almost 40 percent said they'd buy it within six months. In other words, $99 is a magic price—the threshold where a huge number of customers who are on the fence about e-readers decide to jump in.

Clearly, there are going to be big changes in the Kindle / iPad worlds very soon. And, if the price suits you, go for it.

However, this evolution opens up the possibly of a two-tiered system: a general ebook reader priced under $100, and then special edition customized ebook readers aimed at niche segments, such as the medical market. Imagine a special Medical Kindle, utilizing Amazon's Digital Ink technology, but in *color*, allowing medical students to have the benefit of crisp text of the current Kindles with the full blown color of the iPad. Color is the next big 'killer app' on the kindle, and with a two tier system, Amazon could justify such a move. Here's hoping the race to the bottom for the $99 Kindle opens up room at the top.

Update: It happened:

Updated 2015-12-20

Should iPads Be Mandatory For Medical Students?

The e-reader battles are clearly heating up, with the recent introduction of the Apple iPad (color!), the aggressive marketing of the Kindle with newer models, and the Nook trying to sneak its way into the conversation. What does this mean for medical students? Should iPads be mandatory in medical school?

Joseph Kim of Mobile Health Computing argues that it certainly should be, but I think the argument is not well formed. Of course we want medical students to have the latest whizbang technological gadgetry, but the real question is: what role will this technology play? For example, we could provide all medical students with electron microscopes during their study of histology, but clearly this would be ridiculous: the knowledge yield would not justify the cost at all.

So, let's consider what we want our ereaders to do. Clearly, Kim wants a Swiss Army Knife type tool - a tool that lets students become fully engrossed with their study materials, interacting in a way that was never possible before. One can easily imagine an iPad with a digital cadaver, first years carefully "finger dissecting" away layers to reveal deeper structures, or sweeping their fingers to rotate and pan the images to see other angles. Because its digital, such anatomy could much more easily linked to its practical application in medicine via linked diagnostic images, intraoperative findings, and even path results.

But, is this what we really want? Or rather, is it the only thing we want? Clearly, even with all this neato technology, there is an ocean of information to absorb and comprehend in a limited amount of time. Sorry, first years, but you will still have to spend hours in the library pouring over textbooks. This is where the argument gets a bit murkier, primarily because of technological issues. The iPad is backlight; the Kindle is not. For medical students spending hours staring at text, the Kindle actually provides a much better user experience. And, imagine being able to carry the entire library in this one lightweight device! Yes, the iPad can do it too, but do you really want to read an iPad for that many hours?

The question of whether devices should be 'required' of medical students is not a new one. Ever since portable devices became popular, medical schools have struggled with whether to mandate that their students have a laptop, or PDA, or now, e-reader. Until technology advances far enough that we can have all the functions we desire in one device with a user interface we like, medical schools may be better off simply supporting the purchasing choices of their students without mandating any particular device. Let students choose how they like to learn, and what tools they want to use to accomplish that, and they will be the better for it.

Updated 2015-12-20

What To Buy For Medical School (Or Not)

As a medical student, you are often faced with various offers for tools and resources to further your medical education. Are these worthwhile offers? Does one really need to have this latest gadget in order to treat patients? Well, here is a quick guide on what to buy for medical school, and what not to purchase. 

What To Buy As A Medical Student:

* First Aid for the USMLE Step 1
* Pocket Medicine

* Stethoscope

* ... that's about it. Almost everything else you can borrow and then return once the course or rotation is done.

What Not To Buy As A Medical Student:

* Fancy Ophthalmoscope - You will spend hundreds of dollars on a tool you will use only once or twice your first year. Then, you'll enter clinics and realize that the places where you really need an ophthalmoscope, they will provide one free of charge. Your scope will collect dust at home. And you will probably never see the optic disc properly anyway. 

Heh, unless of course you want to go into ophthalmology (or do international work). Then, by all means, please buy a real good ophthalmoscope so that maybe someday you'll see that disc!

* Heavy physiology textbook - Oh, your cover was so shiny; your illustrations, very clear. I used you for two weeks, passed my test, and now have a $80 door stop. Thank you, heavy physiology textbook.

* PDA - You were personal. You were digital. You were assistant-y. Yet, I never could whip you out fast enough to prevent the lacunae in my knowledge to be unveiled during a pimp session. 

* Beeper - Beeper, beeper, wherefore art thy beeps? I used to lie awake at night, waiting for that stat page from the intern, summoning me and my massive intellect to the ER. Yet, the page never came. Sadness. Also, why is it that in this day and age, only medical personnel and drug dealers still use beepers? Hmm... 

There you have it: Scrub Notes Medical Student Guide On What To Buy For Medical School (Or Not). Enjoy!

The Robot Who Smiled

Jules the Robot is the first humanoid robot (see video at bottom of the page after the jump). This isn't particularly related to medicine, but I just found the video so eerie I thought I should post it:

Scientists have created the first 'humanoid' robot that can mimic the facial expressions and lip movements of a human being.

'Jules' - a disembodied androgynous robotic head - can automatically copy the movements, which are picked up by a video camera and mapped on to the tiny electronic motors in his skin.

It can grin and grimace, furrow its brow and 'speak' as his software translates real expressions observed through video camera 'eyes'.

As I said, this isn't directly medically related, but one can envision this technology being used to make more realistic robots for students and residents to train on, with the "patient" robot grimacing if students examine it too roughly, or laughing if they're being tickled. Advances like this also make me wonder whether medical ethics can keep up with the pace of innovation.

Image Credit: The Daily Mail

Medical Student Burnout

Pauline Chen
(Source: Boston.com)

Surgeon and author Pauline Chen recently wrote about medical student burnout in the NYTimes:

Medical school was not easy for me. I knew that I wanted to become a doctor to help people, but I had given little thought to the process. I was poorly prepared for many things: the pressure to excel in ways that seemed so far from caring for people; rapidly mounting debts I signed off on every semester; a roller coaster existence from chronic lack of sleep; hazing from the more experienced students and residents; and the realities of patient suffering despite my best efforts.

Even surgical residency, despite the relentlessly long hours, seemed so much closer to what I wanted to do.

Some of my professors tried to “humanize” the process. They invited us to dinner in their homes, supported our extracurricular efforts to set up health screening clinics in low-income neighborhoods, and tried to make our basic science courses more relevant to working with patients. But sitting where I am now, as someone who teaches medical students and who loves helping others as a doctor, I can understand the challenge they faced. Given the fire hose of information medical students must learn in just four years, how does one ever gently take a sip?

Despite my teachers’ efforts, I was about as miserable in medical school as I had ever been. I felt alone. Neither I nor my classmates could admit to failure, and the last thing I wanted to do was to let anyone but my closest friends know just how unhappy I was. Success in medical school was the first step to a future of helping others, and I was not about to jeopardize that.

What implications does this have for these students' performance as physicians?

In a third study, Dr. Dyrbye found that when tested for empathy, medical students at baseline generally scored higher than their nonmedical peers. But, as medical students experienced more burnout, there was a corresponding drop in the level of empathy toward patients.

Not too surprising when you think about it, but to have concrete data underscores the point. The especially distressing part was that about 10% of respondents to their surveys had considered suicide at some point during medical school. The article notes that the LCME has advocated having "Wellness" be a focus of medical education, but from my experience, simply providing the resources is not enough. Medical schools need to emphasize more socialization and honest communication between students, residents, and faculty. Without this, simply naming someone a counselor or providing a resource will not reverse this trend.

Common Things Being Uncommon?

Often in medical school we learn about esoteric things, in order to prepare us for the "once in a lifetime" occurrence when we may see it. The training is important, but sometimes we go too far, to the detriment of more common presentations. Here is an interesting example of things you don't learn in medical school from one ER physician's blog (via KevinMD):

Emergency Medicine is notable as much for its drama as for the pedestrian and mundane things that come through the door. Every time I meet someone new and tell them what I do for a living, I always get the "Is it as exciting as it is on TV?" question, or some variant.

Truth is, of course not. Headaches, abdominal pain, weak & dizzy, etc account for a substantial majority of our cases. In fact, the critical care stuff is generally less than 10% of what we do. Now sure, if I see 16 patients per shift, then yes, I do perform critical care daily. But it turns out that the simplest cases can be the most challenging.

You see, in residency, there's a lot of focus on critical care. I spent months working in the cardiac ICU, the medical ICU, the pediatric ICU, the surgical ICU, the burn ICU, the OR, anesthesia, and on the floors. I could line, intubate, and resuscitate in my sleep (and did, on a few notable occasions). I could recite the Killip classifications for MI and knew the DeBakey versus the Stanford classifications for aortic dissections. So I was well prepared and very comfortable with caring for severely ill and unstable patients, which is an important qualification for the job. Internal medicine also was highly emphasized: complex physiology, the key things not to miss in chest pain, electrolyte management, etc.

All this prepared me very poorly for some of the more mundane elements of my practice in "the real world." Stuff you might call "family medicine," though I don't know if that's the right phrase. For example, I remember the first time I saw a new mother bring in her week-old infant who was vomiting blood. Holy crap but I was scared. I knew all about GI bleeds -- in adults -- and vomiting blood was really bad. I didn't think kids even got GI bleeds. I was wracking my brain over it, wondering if the baby had some sort of vascular malformation in the stomach, and the nurse just stared at me when I told her to put in an IV and draw blood. "Why would you want to do that?" she asked

Keep reading to find out why the nurse questioned the ER doc's actions. You gotta love ER nurses - they've seen everything.

Lowered Expectations

"The Doctor" Sir Samuel Luke Fildes
(Source: Wikipedia)

As a medical student, one often has shortened horizons, worried only about the next patient or next pimp question, living from hour to hour, wondering what new challenge will arise next. However, this situation becomes even more frustrating when one is working in an inefficient system, with hundreds of little pauses during the day, time that is wasted and benefits no one. What I have found that helps me get through the day is to have lowered expectations. Whenever I find myself feeling unusually surly in the hospital, I often notice it is because I am the victim of my own expectations.

What does he mean, you wonder? Take one day a few weeks ago, for example, when I once again fell victim to my own expectations. I recently started my Ob/Gyn rotation. By some stroke of luck, I was assigned to the VA gynecology clinic, which as you can imagine, has a relatively low volume of patients. We only have one OR day a week, and on that week, only one case scheduled. The case turned out to be a hysteroscopy with planned polypectomy. I asked my resident when I should arrive; she said 8. I asked her how long the case would be (as I had lectures to attend in the afternoon); she said not very long, 15 minutes tops. So, I dutifully arrived at the PACU at 8am. No resident, no patient. I waited... and waited... and waited. In fact, I saw the attending first, around 9am. He also had seen neither the resident, nor the patient. Finally, around 10:30am, both had been located. Apparently, the patient had not her pre-op chest x-ray. Okay, so waiting was boring, but no big deal. I checked email, surfed the web. The case should be quick. Everything worked out okay, right?

Wrong.

The case dragged on for nearly 2 hours before I finally excused myself to attend lectures. The presumed polyp turned out to be a fibroid, but no one had surmised this after the first hour... or the second. Not only that, but the OR lacked the proper tools to tackle a fibroid. Imagine taking those blunt scissors kids use in kindergarten and try to cut through a piece of rope. The whole exercise was pretty ridiculous. Luckily, in the end, they somehow managed to get it out, but what a struggle.

Why am I complaining about this? Well, I try to temper my own expectations as best I can, but it is shocking to me how wrong residents often are about OR start times and length. For people who work on procedures day in and day out, this should be routine. Sure, complications during the case can affect times, but I would expect that to be true of complex patients undergoing complex procedures. Yet, it is often the "simple" case that ends up taking ridiculously long because no one has the proper expectation for its difficulty level and then end up being unprepared for when the unexpected does occur.

Long story short: never trust a resident's estimate of how long something will take. Never.


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Pimping On The Wards

Pimping on the wards is a common experience for most any medical student. I forget what I initially wanted to write this post about, but I was reminded of the contrived haphazard nature of pimping recently. My attending, who was well-intentioned I believe, was aware that I am taking USMLE Step 1 soon. At our previous meeting, he told me I should bring whatever book I was studying from as he wanted to glance at it (he's a foreign medical grad, I believe), so I obliged. After I had shadowed him, we went back to his office. I assumed he'd just ask me a few questions about how the day went and send me on my way. What I got instead was 30+ minutes of him flipping through First Aid for the USMLE Step 1 and asking me random questions while two other students looked on.

Thirty.

Straight.

Minutes.

Now, luckily I've been studying for a while and had a pretty good familiarity with First Aid, so I got most of the q's right (or at least, made some reasonable sounding comment). And, sure, I need to review and study. But... man, I can't imagine what would have happened if he had tried to do that 4 weeks ago. This episode (among others) leads me to wonder the real motivations behind pimping. Sure, people say it's for educational purposes. I agree that when done in a systematic, relevant manner, pimping serves this purpose. However, someone flipping through a book asking random q's is not that. Heck, the attending even said at the end that the session was like Jeopardy, which was a fairly apt description. So, here are what I think the 5 real reasons are:

5. Showing off - Just because someone has 10+ more years of education more than you and more than enough accolades doesn't mean they don't want you to know how much they know.

4. Schadenfreude - Trust the Germans to have a word like Schadenfreude. Part of me can't help but believe that some attendings experience a bit of joy at our squirming.

3. Insecurity - To be honest, I haven't had this be the case at all, but as this post and this NYTimes article note, it can be one reason why attendings pimp in some cases.

2. Tradition - They got pimped, so they feel "obligated" to pass along the "fun." Thanks. No really, thank you sir, may I have another?

1. Because they can - 'Nuff said.

Hm, I guess I sound more bitter than I really am. For the most part, I haven't had that many bad experiences being pimped, but I guess I just fail to see the point most times and would rather enage in an open discussion and have someone ask questions in a non-"put me on the spot" way and then explain concepts vs. just firing q's at me. Anyone have their own outrageous attending pimping experiences? Let's hear 'em!

Worried about being pimped on the wards? Check out:

Updated 2015-12-07

The Falling-Down Professions

As a recent piece in the NYTimes discussed, medicine is a falling-down profession, which I take to mean a profession that has seen better days. As the article notes:

As of 2006, nearly 60 percent of doctors polled by the American College of Physician Executives said they had considered getting out of medicine because of low morale, and nearly 70 percent knew someone who already had.

In a typical complaint, Dr. Yul Ejnes, 47, a general internist in Cranston, R.I., said he was recently forced by Medicare to fill out requisition forms for a wheelchair-bound patient who needed to replace balding tires. “I’m a doctor,” he said, “not Mr. Goodwrench.”

Sad, but true. As the brand of 'doctor' has been devalued over time, so has the morale within the profession. One thing that the article fails to mention though is the length of time needed to become a practicing MD. Any time people make a decision, especially a purchasing one, they are implicitly consider their 'return on investment,' or ROI. As students, we are purchasers of professional education, be it law or medical or business school. I don't know all the figures, but let's assume for the sake of argument that med school is $40k per year, law school $50k, and business school $60k. Now, to simplify this further, assume that people only consider the ROI as their first 5 years of employment. A lawyer invests $150k over 3 years, and typically will find a job starting around $100k, which translates into a ROI of roughly 233%. The b-school student invests $120k, probably gets about $100k coming out, for a ROI of roughly 316% over 5 years.

The med student? Pays out $160k, earns $40k per year for an avg of 5 years of residency. ROI? 25%.

25%!

Terrible when compared to 233% and 316%, no? Of course, these are averages of numbers I pulled out of the air and have no real application in reality. Still, they illustrate the general point. The morale in medicine will not improve until the ROI improves, no matter how benevolent we imagine ourselves to be.

Teachers Vs. Professors

Med schools should hire actual teachers with actual training in how to teach. For that matter, colleges should too. It makes no sense to simply assume because someone is proficient in their field that they would necessarily be good at conveying that knowledge to other people, especially if they have received no formal training in how to teach. Maybe if professors were required to go through some basic training, they would be okay, but in many instances, I would prefer someone who knew less but was better able to convey that knowledge to me, instead of someone who knows a whole lot, but has no clue on how to communicate those ideas effectively. For more, let's turn check out some point/counterpoint action:

Teachers use instructional aids to guide learning and help students who learn through different modalities.
Professors put together 100+ slide powerpoints with 9-point font that they flip through at warpspeed with the assumption that if it was displayed, it was taught.

Teachers take the time to ensure that students understand key concepts, and explain the underlying mechanism in clear, concise ways.
Professors believe in the "Say it once, show it once, never mention it again til it shows up on 5 questions on the test" view.

Teachers add in interesting tidbits to make the lectures come alive, and also to aid students in remembering key facts.
Professors add in boring tidbits about their pet research projects to keep the class asleep, and also to torture students when these tidbits again show up on the test.

Teachers realize that if students are not understanding a concept, they should reconsider how it is being taught.
Professors believe that if students are not understanding a concept, then the students clearly have not being studying enough, and they should question the students' work ethic (true story).

Am I bitter? Perhaps a little bit. I guess I've just found that while studying at times, I'll come across a concept explained in a concise, easy-to-understand way, and I'll actually feel like a lot of things coming together, which is nice. However, it makes me wonder what I am paying the medical school for exactly, especially during the basic sciences. Perhaps I would have been better off investing in review books and studying those instead of wasting my time in lectures. Grr, stupid powerpoints.