My Medical Transformation

Doctors Make 3 Cents Less Than Teachers

noreply@blogger.com (Justin) — Fri, 05 Dec 2014 01:30:00 +0000

I'm now in week 6 of 8 in the Internal Medicine clerkship - and I'm absolutely LOVING IT. While it's one of the less time-demanding clerkships so far (6 weeks of between 9.5hr days, 2 weeks of 12-hour nights at the hospital, averaging 3-6 hours of work per night at home, only two weekends scheduled with an average of 12 hours studying at home on off weekends), 70-100hr weeks are no small thing.

Friends and family regularly comment on the number of hours that we, even as lowly med students, ~~pay to be at~~ "work" in the hospital, then ~~go home to be with our loved ones~~ study. These comments are often followed by some paraphrasing of "Well, at least someday you'll be pulling in the big bucks." Here's something that, while it does not take into account certain nuances of tax law, various debt repayment infrastructures, variable interest rates and debt consolidation, it DOES do a fairly good job of drawing an eye-opening, relatively accurate comparison between something with which most people aren't familiar (physician hours and compensation) and something they might understand a little better (teacher hours and compensation).

What do you think? Don't forget to check the references at the bottom.

Image credit: http://www.bestmedicaldegrees.com/salary-of-doctors/

Surprise for Wife!

noreply@blogger.com (Justin) — Thu, 30 Oct 2014 15:14:00 +0000

So, this happened today:

I'm home on my day off while on third shift, so I've been studying most of the night.

I hear the door open downstairs.

Wife is home from work, also on third shift.

She yells from downstairs, "Honey! HONEY!"

I have an idea of what's going on, since I'd set some traps during the night...

Wife had found a surprise!

Third Shift

noreply@blogger.com (Justin) — Thu, 30 Oct 2014 07:10:00 +0000

This week, I started my Internal Medicine rotation. While not the first where we've been on night shift (ObGyn and Peds each had at least one week of nights), it's the first where we have a total of two weeks with a 3-on-1-off schedule, with a smattering of day-time lectures thrown into the mix. This means occasionally getting home at 8am after a 12-hour shift, sleeping till 11:30am or so, attending lecture from 1:00pm to 3pm, sleeping from 3pm to 6pm, then working from 7pm to 7:30am again.

Today, I am on my "day" off. Day is bracketed by those nifty quotes because I've spent most of it trying to actually convince myself it really is daytime (it's currently 2:53AM). I leave more lights on in the house, and do my best to ignore the "AM" to the right of the time on my computer and phone. With only one day off in between sets of shifts, it's not really possible to switch back to first shift without really putting your circadian rhythm through the ringer.

And so, I study. I go on Facebook. And I study. And I realize all the things you can't do when you're awake on 3rd shift on your day off, like:

- Call / text your friends. Nobody's awake to answer, and if they did it would probably be pretty grumpy.
- Go anywhere. If it's not a grocery store, it's closed. (The one exception to this is The Grand Coney, one of my favorite places anywhere. Diner down the street. May go there to experience it in a bit, actually...)
- Check Facebook more than once. All the statuses are old.
- Go for a nice walk outside. It's very dark. And cold.
- Read on the porch. Again, dark and cold.

On third shift, certain things happen. For example, the other day I was doing a full neurological exam on a patient at some ridiculous hour between 2 and 5am. For those that don't know, a full Neuro exam requires that you assess orientation to person, place, and time. The patient knew their name and where we were, but couldn't tell me the date (day, date, or year). After several moments of pondering, the patient said, "You know, I just can't think of it. What IS the date?" And I realized I didn't know. No clue. I knew the year and month, but had no idea which twenty-something we were in of October. It took some ~~awkward~~ skillful deflection before I skirted the issue and continued the exam. As soon as I got out of the room I checked my phone for the date, have myself a shake with a couple mental *slaps* to the face, and continued on with my night.

3rd shift is definitely a very different way to live life.

M3 - Pediatrics and Med-Peds

noreply@blogger.com (Justin) — Sat, 25 Oct 2014 21:51:00 +0000

I ~~loved~~ love Pediatrics.

After 8 weeks in Pediatrics (4 inpatient at the children's hospital, 4 in specialty/outpatient settings), I can safely say that I love pediatrics. Kids are awesome to take care of; they are (for the most part) really resilient, and are tons of fun to interact with when you can distract them from the reason they're at the visit / in the hospital. I love teaching, and (as I've said a million times when explaining to people the myriad reasons why I like Peds) nobody wants to know more details about a medical condition than the patient's parents. So far, I've found that (with very few exceptions) as long as you communicate well and efficiently, most parents are awesome to interact with. Sure, most parents have done everything they can to educate themselves, and sometimes this results in preconceptions that aren't entirely on base, for the most part the parents are incredibly appreciative of the fact that you are there to help their child.

I liked both inpatient (ie admitted to the hospital) and outpatient (pediatric clinic) settings. It seems really cool to be able to establish relationships with kids right from the time they're 2 days old and 8lbs heavy all the way to their 18th birthday. It's also awesome to see a kid come in to the hospital as sick as he's ever been, then see him walk home with his parents four days later because of the care he received from your team. Plus, I get to help a team of people solve problems! Sometimes they're more complex than other times, and thus sometimes easy, sometimes hard. Regardless, it's interesting; no two patients are the same, regardless how easy or hard their management is. You need to use different communication styles, different familial considerations, etc.

I wasn't expecting Peds to wow me like it did. I was expecting to enjoy it, but that's simply because I hadn't had any experience in Peds before. I wasn't expecting to love it because I didn't really know what Peds was. After 8 weeks, I don't really know how I could pursue a career that doesn't involve taking care of kids. Not to mention the fact that it would be cool to always know what's going on with my own, future kids... That would be cool too.

The thing is, I can tell that a lot of what I've enjoyed about Peds (longitudinal relationships, seeing a sick patient go home healthy, educating people about medical conditions, changing my communication and interaction to fit the needs of each patient situation) will translate to Internal Medicine (IM), which is my next rotation. Over the next 8 weeks, I will be assessing whether or not I enjoy IM as much as I've enjoyed Peds. I will need to decide whether or not I will need to take care of adults as well as kids in my future career. If I can't part with either...

Enter Med-Peds. According to the joking comments of a few Peds and IM residents I've talked to, it's the specialty for "people who couldn't make their mind up, so decided to do everything." Normally, IM and Peds residencies are a total of 3 years. With Med-Peds (a relatively new specialty), you have a 4-year residency in which you have two years each of Pediatrics and Internal Medicine. You rotate through alternating 3-month segments of Internal Medicine and Pediatrics so that at the end of 4 years, half your time was in Peds and half was in IM. This means that you essentially have 1 less year in each specialty to learn what you'll need to know to practice. You also get double-board certified at the end, sitting for the licensing exams for both Internal Medicine and Pediatrics. Despite the decreased time, you learn both IM and Peds in-depth. As one resident put it, they're the people you go to "if you want to know anything." The thing is, I love learning the details; it helps things stick in my head if I know the "why" behind the "what." I was always the person in second year as we began truly learning about pathophysiology who was constantly wondering, "Yeah, but what's the mechanism?" then going home, looking it up, and learning it to help me remember the particular condition or association at hand. That type of mentality is fostered in Med-Peds.

And so, that's the update for my current thoughts on a future career. There's still a lot of figuring out to do, but it's much more defined than back when I thought I wanted to do Emergency Medicine. Third year is definitely serving its purpose for me. I think I could be happy doing many different jobs in healthcare, but I've been learning that happiness is not all there is to the equation. It's also about what I and my individual skills can bring to the team - how I can best serve my patients - as well as how well the specialty fits you and you fit the specialty. Personal satisfaction plays a huge role in this decision-making process (how can I best help my patient if I'm not engaged enough to be sufficiently up on their care?), but personal "fit" plays a huge part as well.

All right, it's currently my Saturday off (took the Peds shelf exam yesterday), and half-time is now over for the Michigan State University vs. University of Michigan football game. So, time to go.

Wish me luck over the next several weeks in Internal Med!

M3 - Perspectives and Lessons

noreply@blogger.com (Justin) — Wed, 08 Oct 2014 00:13:00 +0000

The title says it all, which is a good thing because this won't be a long post.

I used to think I wanted to go into Emergency Medicine. I still think I could do EM, help a lot of people, and feel rewarded doing so. However, one thing that I've learned about myself so far during third year is that I could be happy doing a LOT of things. That proves definitively that 1.) medicine is the right field for me (as if there was any question), and 2.) it's not all about what makes you happy. I've learned that it's also about where you fit and what your strengths can do for the team in which you're working.

I have really loved working with the teams on my Pediatric rotation. I loved every minute of working in the hospital during my inpatient weeks. I felt like I fit. Communicating with the patients' parents about their treatment plans and diagnoses, being somewhat goofy and helping the kids feel comfortable even while they're feeling super sick, and then brainstorming with the residents and attendings about what could be going on as well as how to treat it - everything was SO COOL. It was really fun to be able to use my Spanish skills in a clinical setting again - haven't done that much since I was a medical interpreter way back in the day, which I actually don't think I've ever mentioned on here before. I used to be an interpreter at an Obstetrician / Gynecology office before I ever realized that I could go back to school to become a doctor... It was good experience, but only part-time, and I left it after a while to pursue a job that could better pay the bills. It's hard to be a full-time interpreter if you don't work at a hospital, and at the time the local hospital where I lived wasn't hiring.

Anyway, I definitely did not expect to feel so great about Peds. I expected to like it (kids are awesome, after all), but I didn't expect to really love it. It was a pleasant surprise... Let's just say that subsequent rotations have a lot to stack up against. I'm currently doing my outpatient weeks, and the excitement is not fading, merely changing.

All right, UWorld Step 2 practice questions are calling to me. Adieu.

The MD Countdown

noreply@blogger.com (Justin) — Fri, 19 Sep 2014 01:06:00 +0000

I've had a countdown going on my iPad for a while now. I figure I'll share a screenshot now and then.

Here's the first:

The exact date is an estimate based on previous graduations, but it gets the point across.

In 2016, I will be a doctor.

Time to keep studying...

Time, Med School, and Life

noreply@blogger.com (Justin) — Sat, 13 Sep 2014 16:51:00 +0000

Yesterday as I walked through the hallways of the hospital, I had a few moments of profound contemplation. Specifically, I pondered the volume of time my classmates and I are devoting to future careers as doctors.

Most of the time these past couple of years of med school, I have just ridden the waves of exams, studying, simulated patient encounters, exams, and real clinical experiences. I don't often think about how much time this is taking. Our lives are finite, but it's easy to stop paying attention to that fact, getting distracted by everything that's going on. When that happens, it's easy for the significance of each day to slip by unnoticed. I don't like that so much.

I'm now 29 years old. I started this blog when I was 25, a year after I got married, then went back to school to become a doctor. People mention all the time how long it takes to become a doctor, but most people don't really know what that means. It's a statement of commiseration, but it usually stops there. It's okay, because it's really hard to truly get it without living it.

For me, the time involved will be a little longer than most because I had to go back part-time after graduating college to get the credits needed for med school. So for me it's been:

- 4 years of undergrad the first time around (2003 - 2007)
- 3 years of school part-time, then the application year (2009 - 2012)
- 2.3 years of med school so far (2012 - 2014)

So, I'm 9.3 years in at the moment, with about 1.7 years left or so before the total of 11 years of post-high school education before I get my MD and start residency. With my most recent specialty choices in mind (more on that at another time - I'm loving Peds right now, even more than ObGyn, so everything's still way up in the air), I'll have another 3 or 4 years in residency.

That will make a total of 14 or 15 years of undergrad+graduate education by the time I can start working autonomously as a doctor. If you think that the average male my age these days will live to about 90 years, that's about 1/6th of my lifetime spent in school after high school.

That seems like a lot. Maybe it's not. But sometimes it really feels like a ton - especially when I'm surrounded by family and friends who are busy doing so much more with their lives during their 20s. Having or adopting kids, building careers, establishing themselves in communities, settling into houses, planning for their futures - all things we continue to put off until "after med school." Sigh.

All right, enough self reflection. I've been feeling behind in my book-learning for Peds recently, so today will largely be spent doing practice questions, reading, and maybe reviewing some drugs.

Enjoy your day today! If you're in Grand Rapids, enjoy the street fair in Eastown for me. It looked pretty cool as I drove past it to buy Hobbes more dog food this morning.

Obstetrics and Gynecology - A Review

noreply@blogger.com (Justin) — Thu, 28 Aug 2014 22:11:00 +0000

Original image from: http://www.theamericansurgecenter.com/wp-content/themes/asurge/images/Gynecology-2.jpg

I need a break from studying for my ObGyn NBME Shelf exam (it's tomorrow morning), so I'm going to give a recap of the ObGyn clerkship. You might be surprised by what I have to say (or, if you're an Obstetrician, Gynecologist, or one of my classmates who just completed ObGyn with me, you might not), but to sum it up - it was awesome. Really cool stuff.

I wasn't expecting to like it nearly as much as I did. No, I haven't decided to go into ObGyn. Yes, I'm still pretty undecided on what I want to do with my life (Emergency? IM? Family? ObGyn? Surgery?). Luckily, experiences shall abound in the remainder of my third year of med school.

Okay. So ObGyn was an amazing experience - especially in comparison to M1 and M2. I mean, sitting still and learning in lectures, then sitting still and studying from books/notes/coursepacks is fun and all (I mean it - I actually enjoyed didactic learning!), but nothing really beats getting to be immersed in a real patient care environment. Especially when stuff's happing - and stuff HAPPENS in ObGyn. Most of the time. There were a few lulls (mostly on nights when half the people are trying to sleep thanks to their epidurals), but there was almost always something to talk about, something to see, or at the very least something you had just talked about or seen that you had to then go read more about.

One thing I learned was that vaginal lacerations give me the heeby-jeebies. What's the technical term for that? Oh yeah - The WILLIES. Everyone knows they happen more often than not, especially the first couple of times a woman delivers. It's not necessarily the reality of them - once they happen, they're just something to repair, no problem *dusts off hands as though he's the one doing the repair instead of the resident or attending*. Rather, it's the waiting, when you're not sure how extensive the laceration is going to be. The baby's head is crowning, straining the perineum, the bridge of the nose just barely peeking into the world... It's that moment, right before everything releases. That's the moment that causes the most tension within my chest, and it really takes some getting used to.

Suffice it to say that I really don't blame the mothers when they decline the offer of a mirror.

Keep in mind, I'm not a squeamish guy. My mom had to hold me back so I wouldn't get in the way when they were setting my younger brother's arm after he broke it when we were kids. When I was younger and got shots, they always had to ask me to keep my head back so they could see what they were doing. I was that enthralled. Anyway, I'm not squeamish, but I never thought I would enjoy the operating room as much as I did. For those that don't know, Gynecology is pretty much a surgical subspecialty. They do A LOT of surgery. Hysterectomies, oophorectomies, tubal ligations, exploratory laparoscopies for endometriosis, vaginal vault suspensions, urethral slings, dilatation and curettage, etc.

So yeah. I'm not 100% sold on ObGyn, but General Surgery might be on the table now - I liked the OR that much. Just not so sure right now about the lifestyle. We'll have to see how my surgery rotation goes in January. Wife really doesn't want me to pick ObGyn or Surgery because of the demanding lifestyle. In her words: "Just please don't. If you do, I'll support you. But please don't."

But back to my recap. I delivered 14 babies and participated in 12 Cesarean sections! I also assisted in 18 major and minor surgical procedures. I got to see robots being used in surgery. I practiced my knot tying and learned to close bellybuttons and low transverse abdominal incisions (skin only). I learned a lot from people, experiences, and books. And practice questions. I've done about 450 questions w/explanations (about 150 of which I've done a second time), and I have about 50 more to do tonight before I'm done. Just took a practice exam and passed, so I'm optimistic about tomorrow morning.

So what do I NOT want to forget? Here's a short list:

How it felt to hand the first baby I had ever delivered to his/her parents, and to then see the looks of joy on their faces. How that look was repeated with every set of parents in every delivery.
How hard the residents work! For everyone that thinks med school seems hard, just check back in two years. Then, if I'm anything like the amazing residents that I've been learning from the past two months, you'll see something truly impressive.
The moral considerations I wrestled with surrounding the management of the most complicated cases, and the conclusions that each physician must come to for him/herself.
Wondering in my head about which fathers will cry, get woozy, or do really well - and almost always being wrong.
Seeing the doctors and everyone else work as an amazing, fluid machine when managing an emergency. I have so much respect for everyone in healthcare and what they do together for their patients.
How much I enjoyed everything (minus waiting for vaginal lacerations to happen).
The huge awe I now have for my mom and all the other moms out there, having glimpsed what they go through. And thus, the never-ending respect and gratitude I will one day have for Wife if she gives birth to any of my future gangly-limbed kids. Those will be some mad props.

That is all. Back to the practice questions. Wish me luck tomorrow!

Third Year = Awesome - An Update

noreply@blogger.com (Justin) — Wed, 30 Jul 2014 22:17:00 +0000

An image of almost exactly the same setup as on my first day of ObGyn.
Original image from: http://www.lourdes.com/media/157961/daVinci_OR2.jpg

Yeah, yeah, I'm behind in posting. I have good reasons:

1. Exhaustion
2. Lack of free time
3. Exhaustion

I'm currently just over three weeks into my Obstetrics and Gynecology (ObGyn) rotation, and it's AWESOME. Crazy, crazy, exhausting hours, but very cool stuff. To help you understand the hours, I'll put it this way: I just finished day 3 of a 20-day stretch where I am scheduled at least 12 per day, every day. No weekends. No breaks. Let me break it down a bit more for you:

This week, I'm on from 5:30am - 6:00pm every day in Labor and Delivery (L&D). Yesterday I didn't get home till about 6:45pm because a patient started pushing right at the end of my shift. It was great though, because I GOT TO DELIVER HER CHILD. I'm keeping a running tally of deliveries - more about that once this clerkship is over. Anyway, this Friday I start at 5:30am and don't get home till Saturday morning at 7:30am. That's 26 hours straight, so I don't go back in until Sunday morning, when I work 7am-7pm (12 hours). Then Monday through Friday next week it's 5:30am - 5:30pm in Gynecologic Oncologic Surgery. That Saturday I'm back in L&D from 7am Saturday morning until 7am Sunday morning. After that, I'm on 5:30am - 5:30pm Monday - Friday in Maternal Fetal Medicine - all high risk patients. Then, I get a two-day weekend before a week of 14-hour night shifts from 5pm - 7am.

I want to reiterate - this is exhausting, but TONS of fun. I didn't expect to enjoy the ObGyn rotation half as much as I am. The moments when a couple's new baby is born is indescribable. It's awesome to see tough guys cry the first time they lay their eyes on a new son, or the look on a mom's face the first time she sees her baby. So fun to be part of all of that.

I've assisted on more than 20 different surgeries in the past weeks, even getting to throw My First Stitch. Who knew that ObGyn was half surgery?!? Definitely not me. My first day of the rotation, I was able to be in the room during a da Vinci robot surgery (see above image). While I wasn't operating (students don't operate), I was able to observe as the resident and attending worked. It was really cool how much they could do through just one small port through the umbilicus (bellybutton).

In most of the other surgeries, I've been able to actively assist the resident and attending. At this point, I think C-Sections might be my favorite, but I'm not sure. My week of ObGyn (lots of surgery) is still coming up, so we'll see if that changes. It's just really cool to have surgery start off nice and normal and then all of a sudden BOOM a BABY is coming out of the surgical site.

I have been almost constantly in awe of what modern medicine is capable of these past three weeks. It's insane what we are able to do with the aid of anesthesiology. A patient can be awake and talking to you one second, and then two minutes later surgery is underway and you're inside them, working to make them better... Many times throughout each day, I take a few seconds to pause and think about what I and the other doctors, nurses, and techs are doing, and I'm humbled. We are so privileged to have the abilities and education that we have, but we are so much more privileged to have such profound trust as that which is placed in us by our patients.

I still don't know what I want to do. I just know that I made the right choice in pursuing a career in medicine. Yes, there are often frustrating, embarrassing, uncomfortable, and really exhausting periods of time, but the good outweighs the bad, no question about it. I love taking care of people, and even though (as a med student) I'm not the focal point of the patient's care quite yet, I'm finally learning how to move into that role. Yes, I might be constantly on the verge of nodding off whenever I move to a quite room with some white noise. No, I don't get to play with Hobbes as much as I'd like. And extra-big YES, I might be missing Wife more than ever these days, with both of us working 12+ hours most days. But in the end, third year is leaps and bounds different from the first two years, and I'm love it. Granted, that might be because I haven't had to take an exam yet (and won't have to for another four weeks), but there you have it.

Third year is off to a great start.

My First Stitch

noreply@blogger.com (Justin) — Thu, 10 Jul 2014 23:39:00 +0000

Today, I put my first stitch into the skin of a human being. It may or may not have looked very like or unlike the above umbilicus. Sure, the attending may have quipped good-naturedly as I started the first knot, "Boy, I could have gone on Christmas vacation already" before laughing then just saying, "Hahaha - just kidding. I love med students." When I finished the knot he asked when I had learned to suture, and I said mostly last week, but that this was the first time I'd ever been able to assist in closing on a person, he said, "Oh really! Well, good job then."

My resident made me feel even better when she said, "And his first closing was deep in a bellybutton, not some straight, superficial incision like my first time."

Yes, third year is a lot of work. We moved from one surgery to another for eight hours straight with no room for a meal, and only time for one bathroom break toward the end of the day. I'm not sure if that is normal or not, but I am enjoying it nonetheless. I did let my blood sugar and hydration levels get too low today, though. Had a sharp, cracking headache all day that slowly built into a blinding, pounding migraine by the end of the day.

Now, I'm settling down to some nice, passive lectures to finish out the day. On the back burner is the case report that is due next Wednesday, along with the many chapters of reading that I haven't quite gotten to...

Ah well. There's always the weekend!

Step 1 - CHECK

noreply@blogger.com (Justin) — Thu, 10 Jul 2014 01:52:00 +0000

These are the balloons that I would blow up and use to have a party if I had more time and didn't need to go to bed right now because

I have officially passed the first United States Medical Licensing Examination - Step 1!!!

While I won't be sharing my score, I will say that I'm very happy with it. Want the back story? Click here for My Step 1 Experience.

And now, I move on with 3rd year, which is turning out to be quite a bit more work than I expected.

This Is The Part Where I Save The Day

noreply@blogger.com (Justin) — Sat, 05 Jul 2014 22:06:00 +0000

When Wife and I were in Asheville on vacation, we stopped at a pretty cool bookstore called Malaprops. In this bookstore were some very cool shirts. Wife decided I should have two of them. The other (my favorite) I will share at a later date, I'm sure, but the below shirt is still pretty cool:

I haven't yet figured out Wife meant it as a joke or not. There's the obvious bookstore nerd theme of comic books and superheroes. Then there's the aspirational theme of me on my way to becoming a physician. I think it's safe to say that a lot of med students dream of using the skills that we're acquiring to one day save someone's life.

The thing is, today I may have done just that. Not really probably, but maybe a little bit possibly. Perhaps. Probably not.

I was out walking Hobbes for the second time today. On our walk, I'd tried out my new hospital Med Student badge on the parking structure at the hospital to see if it would work. It's ridiculous, but when the entrance gate swung up to admit the car I wasn't driving, I was thrilled.

So Hobbes and I are walking down the sidewalk back toward home, past some houses in the neighborhood, and I see this woman in her thirties walking with a little girl. The woman had a kite in her hand, and I thought maybe they were going to a nearby park to fly it.

Suddenly, the woman starts jogging and letting the kite rise behind her. She lets it go up about 15 to 20 feet, right next to the elevated cable and telephone lines. Where we live, the lines go: cable (lowest) then telephone (middle) then electric (highest). The kite was getting higher as she got closer to me and picked up speed, and I could tell she was trying to get it as high as possible. It was making me nervous, thinking about the kit hitting the higher lines, so I casually said "Um, it might not be the best idea to fly that near the power lines. You could maybe get electrocuted?"

She quickly slowed, letting the kite drop to the ground behind her. Her expression slowly changed into this dawning look of horror, and she said, "Oh. It probably wouldn't be the best to hit those would it?" I said, "Nope. Not the best idea." and just kept walking.

I don't know what would've happened if she'd hit the power lines. Best case scenario, the string would've been a sufficient insulator to not let her be zapped and she'd've just lost the kite to the tangle of string. I don't like to think of the worst case, but at least now we won't find out.

MS3 - Orientation - Day 4

noreply@blogger.com (Justin) — Sat, 05 Jul 2014 18:07:00 +0000

Behold, the glory of my suturing technique (haha).

Special thanks to all the pork chops out there that used to ambulate on the above foot.

Your sacrifice did not go unnoticed.

Orientation week is a bit of a blur. We went on hospital tours, learned shorthand for writing prescriptions (after learning that we will likely be writing prescription and procedure orders for REAL patients, which will then be approved by a resident or attending before actually being carried out), and met our clerkship directors. We learned about ~~the consequences of making mistakes and how to minimize them~~ risk management, how to wash our hands (fourth time through that video? fifth?), and how to gown and glove using aseptic technique.

We learned about the software used to manage patients' Electronic Health Records (EHRs), how to get involved with research as well as our mandatory research projects this year, and how to fully utilize the university libraries in taking care of our patients.

We also once again learned about HIPAA (Health Insurance Portability and Accountability Act) - specifically how I will almost never be able to write about specific patients or their conditions on here. Even if I say nothing about their name, age, gender, etc., merely mentioning their condition may count as "identifying information." Particularly because I'm not *really* anonymous on here. I mean, my first name is in my comments, and my picture is all over the blog. It wouldn't be the hardest thing to identify me if you were a patient I'd seen. It's only one step further to realize that the patient I'm writing about is actually YOU. Nope, not a good idea. My patients' privacy is too important to me to compromise it just because the experience happens to be really interesting.

This in NO WAY means my blog will stagnate into a boring quagmire of mediocrity like the above paragraphs about orientation. No! I will still be able to write about things that I learn, procedures I see, and much of the other awesome stuff that goes into the transformation of a bookish MS2 into a slightly less bookish, more worldly MS3. You will probably just never see anything patient-related on here. Sorry.

Anyway, orientation week culminated in learning to tie specific knots used in surgery, then practicing those knots along with standard suturing technique on some dead pig feet. You see, pig skin is pretty much the closest thing to human skin - though it's still quite a bit tougher.

My first rotation in the hospitals will be Obstetrics and Gynecology (ObGyn), and I start the week off with Gynecology. I expected this to mostly be Pelvic Inflammatory Disease (PID) cases, pelvic exams, and various pelvic pathologies. I didn't think it would be very much surgery, but according to the rumor mill from the MS4s, that's not so much the case. Apparently I can expect a lot of time in surgery this first week, as there are a lot of hysterectomies seen in the Gyn side of the rotation.

I'm pretty interested in seeing anything and everything at this point. While the prospect of getting up each morning at 4:30am to begin rounding at 5:30am and not get home until 5:30pm is a bit daunting, the past couple weeks of vacation have left me feeling refreshed and rejuvenated.

I'm still trying to not think about getting my Step 1 score back on Wednesday, as thinking about that seems to magically slow down time, but hopefully the business of the next few days will minimize that effect.

And so. I have today and tomorrow before clerkship-specific orientation on Monday, then full-swing rotations begin on Tuesday morning. I'm making the most of today - slept in (and I mean SLEPT IN - 10am yo!), made a killer bacon & egg breakfast, bought new shoes, grazed in the Apple store, walked Hobbes, transferred some photos, and now wrote this post. Now I may do some video editing from the NC Vacation, or I may chill on the porch and read. Who knows.

Anyway, wish me luck this week - especially on Step 1 Wednesday...

MS3 - Orientation - Day 1

noreply@blogger.com (Justin) — Tue, 01 Jul 2014 03:38:00 +0000

Today saw the official beginning of Third Year. I'm (un)officially a third-year med student. Why the (un)? Because we don't actually get our Step 1 scores back until ~10 days from now, and we're not technically allowed to be MS3s until we pass that bugger.

However, barring disaster, I'm an MS3, as evidenced by the new (de-identified) hospital badge and pager. That's right folks - we still use pagers.

Granted, the practical rationale for pagers is pretty strong: cell signal = unreliable in big hospitals but pager function = good .: we use pagers. Pretty sure Wife already hates the idea of a pager. One more way in which med school trumps regular life. Case in point - the phrase "Your time is no longer your own" was used several times during today's orientation...

Speaking of which - Today's Orientation Schedule:

7:30am - Check-in and Continental Breakfast
7:45am-8:45am - Welcome and introduction to staff
8:45am - 9:00am - Intro to the building and operations by Security
9:00am - 10:00am - Professionalism. Apparently stuff gets REAL in Block III.
10:00am - 12:00pm - Fitting for respiratory suit masks for when we interact with quarantined patients.
12:00pm - 1:00pm - Full Hour LUNCH! PROVIDED = Yesssss.
1:00pm - 1:20pm - Pre-recorded Camtasia video by the Dean about being a virtuous physician. People be respectin' and we gotta be worthy of it, yo.
1:30pm - 3:30pm - Orientation Part 1, wherein we learned all the intricacies of the grading system and how important it is to never miss a day of clinical rotations. Suspension = My Eternal Fear.
3:30pm - 4:30pm - How To Properly Present The Patient You Just Evaluated.
4:30pm - 7:00pm - Block III BBQ and Surprisingly Fun Games with Prizes

In summary (because I just spent WAY too long on the North Carolina Vacation post, as was necessary to do it even half-justice), assuming all the material we covered was 100% necessary, it was an incredibly well-done day or orientation. We've got three more packed days planned for this week, wherein I will learn from the wisdom of the students 1 year ahead of me, meet my first clerkship director (Obstetrics & Gynecology!), tour some killer (figurative, people) hospitals, learn about "risk management" (which instantly makes me think of this clip of Ted from Scrubs - skip to 0:21), how to control infections (WASH YOUR HANDS), use new computer programs, suture people, and much, much more.

I'm going to try to put up a quick post each day about orientation, but I might just decide not to. We'll see how these next few days stack up against today.

Photos - Smoky Mountains Vacation - Asheville, North Carolina

noreply@blogger.com (Justin) — Tue, 01 Jul 2014 03:13:00 +0000

Here's a super-quick, photo-heavy recap of our recent vacation to the Smoky Mountains in Asheville, North Carolina. I wish I could go into more detail, but I just got done with my first day of orientation for my 3rd year here at MSU CHM, and I'd like to write out a post about that tonight as well.

Here's how the vacation went following Step 1:

Monday, June 16th:
- Step 1 from 7:30am - 5:30pm (click here to read My Step 1 Experience)

Tuesday, June 17th: Driving
- Drive to Asheville, North Carolina (12hr trip took 13.5hrs d/t traffic jams)

Wednesday, June 18th - Free Day #1
- We hung around the Hummingbird Cabin, which was pretty much all ours in the middle of ~70+ acres of small mountains, streams, and trails. Went out to eat at 12 Bones Smokehouse - AMAZING. They're so good, they didn't even blink an eye when I jokingly told them we'd driven from Michigan just to eat there. They only laughed once Wife told them I was kidding. Afterward, we soaked in our hot tub and generally recovered from Step 1 and the drive.

Thursday, June 19th: Breakfast & The Biltmore
- Ate books and read breakfast - oh wait... Nevermind - at the Early Girl Eatery. Highly recommended; awesome ~~books~~ food.
- Visited the Biltmore Estate. Summed up in one phrase: The American Downton Abbey. Very literally. Couldn't take pictures or videos inside, but below you'll find some outdoor pictures, several of which are pretty cool panoramas.
- Went hiking on the trails with Wife and Hobbes.

Friday, June 20th - Sliding Rock and Waterfalls
- Explored the beautiful Pisgah National Forest
- Visited (and slid down) Sliding Rock. Tons of (cold) fun - luckily weather was hot that day. A video will eventually (once I get the time to make it) get posted, including lots of fun GoPro shots of us sliding down it.
- Visited Looking Glass Falls - very cool. Sort of wish we'd had time to go swimming here.
- Returned home to hike around with Hobbes, grill out, nap and enjoy the cabin.

Saturday, June 21st - Blue Ridge Parkway & Mt. Mitchell
- Got lost finding the Blue Ridge Parkway. Met some interesting mountain people who were having a yard sale by the roadside when I stopped to ask directions. Before I could get out more than "Hi, I was wondering if you could-" all seven of them pointed in the same direction and in unison said, "That way." Apparently there was nothing in the other direction.
- Found (after speaking with the communally-dubbed "Map Man" (and then getting lost again)) and drove around the Blue Ridge Parkway
- Drove to the top of Mount Mitchell, the highest point East of the Mississippi River.

To explain the above photo, after walking the trail at this "scenic outlook" there were no Glassmine Falls currently falling. Hence the joking frowns.

Sunday, June 22nd - Free Day #2
- Slept in, enjoyed reading around the cabin, cooked the best bacon I've ever eaten. Of course, I can't remember what kind it was...
- Ate an absolutely FABULOUS late lunch at Tupelo Honey Cafe in downtown Asheville.
- Walked around downtown, spent too much money on books at a local bookstore
- Went back to the cabin and enjoyed relaxing one last evening before packing up. Below are some shots of the cabin itself, since I neglected to take them at the beginning of the trip:

Monday, June 23rd - Driving

All in all, it was the perfect post-Step-1 vacation. Many, many thanks to Wife for organizing and planning EVERYTHING while I was in the throes of Step 1 prep. She even worked three 12-hour shifts back-to-back the three days before we left on the trip. I'm still kind of confused as to how everything worked out, but never before has a vacation gone so smoothly. Well done, Wife.

Well done.

Hobbes is a Therapy Dog w/Bonus GoPro Video!

noreply@blogger.com (Justin) — Thu, 26 Jun 2014 22:30:00 +0000

Sooo, guess who passed his Therapy Dog test?

THIS GUY:

That's right, today Hobbes officially passed his Therapy Dog Training Exam. He now has a provisional license, and after three simple shadowing experiences he will be a fully practicing therapy dog. If I did half as well on Step 1 as he did today, I'll be singing a very happy song indeed.

In celebration, I give you a GoPro video of three golden retrievers - Hobbes and his half-siblings - playing at the lake:

Intensive Study Period - A Video

noreply@blogger.com (Justin) — Wed, 25 Jun 2014 19:04:00 +0000

Most med students take several weeks for an Intensive Study Period, ~~maliciously~~ affectionately known as the ISP. Mine consisted of exactly 299 hours and 33 minutes of studying & practice questions spread out over 5 weeks. For the last 10 days of my ISP, I programmed my GoPro to record a video clip every 30 minutes. I turned the recording LEDs off and dimmed the display on the camera so I wouldn't know when it was recording. In the end, I cut some clips to keep it shorter.

Now that I've finished ISP, taken Step 1, and gone on vacation, I've finally gotten around to editing and uploading the video. It's probably as entertaining as a video of someone studying can be.

Interpret that how you will.

My Step 1 Experience

noreply@blogger.com (Justin) — Sun, 22 Jun 2014 03:33:00 +0000

I wake up bleary-eyed at 6:00am. My test is scheduled for 8:30am, but I can't sleep anymore. I try for another 20 minutes, then just as Wife walks in to kiss me goodbye as she's leaving for work, I hop out of bed.

Coffee was made the night before, and sooner than expected it's 6:45am and I'm ready to go. I go for a walk with Hobbes for a while to calm my nerves, then hit the road by 7:10am. Construction re-routes me a few times on the way to the testing center, different even from how it was when I drove the route the day before, but that's why I left early. I still arrive at 7:30am, a half-hour before the center opens and an hour before my test time.

A lot of students from my school are there. We basically pack the small testing facility. Doors open at 8am and we file in. I check in with everyone else, then sit around as they bring each of us individually into the room to start our test, one by one.

My test time arrives. Wait 20 long minutes. They call my name; I go to the window. Nope, another person with my name. Wait 20 minutes. They call my name again, and again I go to the window. Yet another person with my name. Wait another 20 minutes, paying close attention to the alphabetical order of the last names being called, and once I'm sure I'm the next name to be called, they go straight to the end of the alphabet. Go figure.

I didn't get in until an hour after my official start time, two hours after I'd arrived to take the test. My mood was not dampened, and I was successfully calming my nerves. I put my lunch and other stuff in a locker, showed them my driver's license, and signed officially in the book. Then I'm fingerprinted, turn my pockets inside out, and lift my pant legs above my ankles to show nothing's hiding in my shoes. Then, they scan me with a hand-held metal detector up and down my front, spin me 180 degrees, and scan me up and down the back.

And then I'm in.

They lead me to a computer, and I go straight in. I waste no time with the tutorial, preferring to have that time added to the 45 minutes of break time I get for the day. For those that don't know, the USMLE Step 1 exam consists of seven 1-hour blocks, with 46 questions in each block. Fast math says that gives you ~78 seconds per question on average. Some questions take only 10 seconds to answer - the stimulus is short, it's a basic recall question, and you either memorized that fact or you didn't. Other questions have long paragraphs of lead-in information and tables, figured, or lab data that often makes a difference to how you'll answer the question. You really have to balance how you spend your time, working through the small questions quickly by admitting to yourself when you don't know an answer, saving your time for the questions that require more careful thought. Anyway, back to the story:

I'm confident and careful, working meticulously but quickly, and before I know it I've finished the first block with 14 minutes remaining to go back and review my answers. I catch an error I'd made and change one answer, leaving the rest untouched.

I stick to my plan of burning through the first few blocks while my steam is up. I don't take a break after the first block and dive right in to the second (after a few deep breaths to call up some serious focus). Still feeling good, I make great time - until halfway through the second block.

I feel a tap on my shoulder, and my concentration shatters halfway through a long question. I turn around, and the testing center employee is right behind me.

She points to my wrist, saying "You are not allowed to wear a watch in here. I need you to come with me right now."

My mind blanks, my throat clenches, and I begin to freak out. Then a dam in my mind breaks and my mind surges, thoughts rushing through faster than I've ever experienced. It's mechanical, not electronic, so according to the website I'm fine. Why didn't they mention this before I came in? They fingerprinted me, checked my ID, turned my pockets inside out, and checked my ankles - why didn't they check my wrists? Why didn't the metal detector pick it up when they scanned me - it's a stainless steel watch!! How can she be asking me to leave? I can't believe this is happening. Why did she come out right now? Is this going to nullify my exam? She wants me to leave the room with her? I can't pause the test. Even if I lock the screen, the timer will still keep ticking down. Why do I have to go with her? Can't she just take the watch? I haven't even looked at it, and I wasn't even planning on using it; I just wore it in as a backup! All that and more rushed through my head in the time it takes to blink.

Me: "Can't you just take it?" I begin to take my watch off, and she shakes her head.

Employee: "No, I'm sorry, you'll have to lock your exam and come with me."

My mind still in blitz mode, I lock my computer and quickly leave the room. As soon as we are outside, I hand her the watch, and she asks me questions. I answer respectfully, apologizing profusely, attempting to explain that the testing center's website had said that digital watches weren't allowed - nothing that can have an alarm, make a beeping noise, or perform calculations - but that analogue watches were fine. She said that some tests have restrictions that are different from the testing center's restrictions, and that my test fell into that category. She also apologized, saying that they should have caught it during the check-in procedure. She photographed my watch and had me put it in my locker before typing up my report. As she handed it back to me, I asked the big question that was still surging around and around in my mind:

Me: "Is this going to nullify my exam?"

Employee: "I don't know. I am going to make it clear in my report that there was no malfeasance here, just an honest mistake, but I cannot comment on how it will be handled by your examining organization."

That scared me. All these months studying, so intensively for the past six weeks that I'd completely cut myself off from life to prepare appropriately for this test, and it could all be flushed because of a stupid watch that I hadn't even looked at. Rationally, looking back now, the chances of that happening are minimal, but at the time I was terrified. Scenario after scenario ran through my mind and filled me with fear and doubt. My hands were shaking so bad when trying to insert the key into my locker, it took me four tries to get it open.

I had no clue how many minutes I had been away from my exam by the time she let me go back in. To log back in and unlock the computer, I had to enter in a long code that I had been assigned at the beginning of the exam. It took me two tries to type it correctly, as I couldn't see what I was typing. It was like a password field, all *********. When I finally got in, I forced myself to ignore the time on the clock, just blitzing through the questions as fast as I could make my mind go.

Unfortunately, I kept getting hung up. My concentration was shot. I'd catch myself rereading the first sentence of a question, the words making no sense, even though I knew I should know what they meant. Several times, I had to start over and read the question again once I got to the end, having forgotten the beginning because I began to think about what had just happened, wondering if all of my efforts in the test that day would be wasted if they decided to nullify my exam.

I finished the last question in that block with 40 seconds left in the allotted hour. Zero time to go back and review the questions that I was less sure about. I can't really do a good job describing on here how deep of a sinking feeling that was. I could make comparisons about my stomach dropping out from beneath me, a "sinking" feeling in my gut, cold hands gripping my spine, but none of it comes close. I had a brief vision of me standing up, screaming at the top of my lungs, then calmly walking out the door, getting in my car, and calmly driving away. It was really vivid.

I took five minutes to compose myself. I breathed deeply. I prayed, asking for strength and calmness of mind. I gathered the shattered pieces of my concentration and slowly melded them back together, like bits of Play-Doh being molded into one smooth sphere. I thought of the awesome notes that Wife had left for me to find around the house that morning as I went about my pre-exam routine. Small, encouraging phrases. I had to force my mind away from more difficult thoughts - particularly one nagging fear: If you do poorly on this exam, you won't be competitive to residencies, and you'll have to move after med school, which will make Wife lose her amazing, specialized, perfect-for-her career. If you do poorly on this exam, you might ruin a huge part of her life.

I don't know quite how, but eventually I pulled it together and started the third block. I'm sweating from nerves as I write all this out. It was hands-down the most stressed I've ever been. So yeah, I started the third block, feeling hot and cold and tingly all at the same time, knowing that I still had five hours of examination ahead of me, having no idea if any of it would do any good. I finished that block with 2 minutes to spare. Not really any time to review any specific questions, but I was being more careful and focusing longer on the questions, so I don't think I would have changed anything anyway.

I took a longer break between the third and fourth blocks, going to the bathroom, splashing some water on my face, and talking to the testing center employee a bit more. In hindsight, I wish I had done that after the second block ended. It simply hadn't occurred to me. I tackled the third block with somewhat renewed vigor, but nothing like the confidence I had starting off. I ended the fourth block with 4 minutes to spare, reviewing and changing a few answers, confirming a few more that I had been unsure of at first.

After the fourth block, I took about 20 minutes for break. I had bought a BLT sub from Subway the day before, hoping to enjoy it as a sort of reward for making it through the halfway mark. I was still so nervous, I only ended up eating a quarter of it. I couldn't help imagining that with all the adrenaline running through my system, my digestive system wasn't peristalsing like it should, and the food would just stay in my stomach until I got sick. I stopped eating, took some more deep breaths, and returned to the test.

I finished the fifth, sixth, and seventh blocks with between 5 and 8 minutes to spare for review on each one. Nowhere near my normal of 14-18 minutes in the practice exams, but whatever. Different circumstances.

After the exam, I wasn't the most optimistic. It wasn't until after talking with some friends and realizing that EVERYONE feels like they guessed way more than they thought they'd have to that I started to feel a little better. As a student from UofM's med school said as we exited the testing facility, "Looks like I studied the wrong stuff for the past six weeks." I thought back through a bunch of the questions, and convinced myself that I got more right than it felt like while actually taking the test.

Five days later, I'm still clinging to that hope. Wife and I have been on vacation for these five days, and I've done my best to minimize thinking about Step 1. Scores won't be released until the first or second week of July, well after we start our clinical rotations.

To sum up, I have no clue how I did. The only thing I truly know is that I would probably have felt better during and after Step 1 if that mishap with my watch hadn't occurred. There's no way to know whether or not it had an impact on my final score. Who knows - maybe wrecking my concentration and making me go slower through the questions made it so I changed fewer correct answers to incorrect ones. Whatever.

The key is, I took Step 1 on Monday, and I learned an important lesson: NEVER WEAR A WATCH TO A STANDARDIZED LICENSING EXAM, EVEN IF THE WEBSITE SAYS YOU'RE ALLOWED TO. DON'T DO IT. EVER.

Expect a blitz of posts in the next week as I attempt to update on everything, including the awesome vacation we're currently taking. Speaking of which, I've gotta get back to relaxing. Later.

Five Days Till Step 1

noreply@blogger.com (Justin) — Tue, 10 Jun 2014 23:03:00 +0000

Photo credit: https://williambacky.com

Just finished studying for today. I think. I might do some more. Don't know.

Trying to figure out what to study once I finish the Qbank for the second time tomorrow.

Can't make this long. Brain done.

Here's how the next few days will go for me.

Wednesday, Thursday, Friday, Saturday - study till brain explodes, gather brain pieces, manually stuff with more info.

Sunday - morning = church. Afternoon = drive white-knuckled to testing center. Evening = solo drug recital at desk / wander aimlessly around until bedtime.

Attempt to sleep.

Wake up 800+ times.

Wake up the 800-nth time, at 6:00am.

Turn off alarm.

Turn off 3 fail-safe alarms.

Breakfast.

Coffee.

Get to testing center an hour early.

Start test.

Go home ~8 hours later.

Pack for vacation.

Go to sleep.

Wake up and drive with Wife 12 hours to the mountains.

Vacation.

Aside from mental fatigue, feeling okay things. Not too nervous.

How nervous?

Appropriately.

5-year Anniversary & ISP Update - NBME #15

noreply@blogger.com (Justin) — Sat, 31 May 2014 01:01:00 +0000

Click to embiggen.

Five years ago today, this is where Wife and I were - gettin' hitched. Now, she's an RN and I just finished my second year of medical school. Time is flying, and today was packed.

This morning, I took another NBME practice exam - more on that below - while Wife took Hobbes to the Dog Beach in Muskegon. When she came home, I took the afternoon off. It also included a scavenger hunt, complete with poem clues and hidden gifts. It was a ton of fun. We do the "traditional" anniversary gifts - a different material for each year. This year was the wood year, and it was the first year we actually made each other cry a bit with the meaning and emotion inherent in our gifts. I got her a carved figurine that has special meaning, and she got me a handmade/carved wooden bowl from the Holland Bowl Mill. I can't explain why it meant so much to me - it's just awesome. She personalized it with the wood-burned verse Ruth 1:16 around the edge - "Where you go I will go, and where you stay I will stay." on the top and "Happy 5 years!! Love, [Wife]" on the bottom. She gets me. It is good.

For the less fun news, brevity is best:

Took my 3rd 4-hour practice Step 1 exam today.

Score has gone up quite a bit, yet not enough quite yet.

I sort of wish I had a better idea of what my expectations should be during all this.

Sharing scores feels awfully... personal. So I'm not doing it.

At least not until it feels like Step 1 doesn't matter anymore. Then I might share.

I will say this: I want my score to go up.

And so.

I study.

ISP Blur

noreply@blogger.com (Justin) — Sun, 25 May 2014 01:27:00 +0000

I hardly ever know what day it is.

Officially 2.14 weeks into my Intensive Study Period (ISP). Took a $60 practice (4-hour-long) Step 1 exam yesterday. Score went gone up 27 points from the diagnostic one I took at the beginning of my ISP. Hoping that's a good increase. Hoping to increase a bit more over the next 3 weeks. Hoping to not burn out...

Currently doing 100-120 practice questions/day with Pharm flashcards and the equivalent of 150-200 pages of reading between First Aid and question explanations. 8-12 hours/day of at-the-desk, distractionless (phone off, deactivated Facebook, email closed) time spent studying, not including breaks, six days per week.

This is the most rigorous / mentally straining period of study I've ever experienced.

Every night my brain feels full.

Three. More. Weeks.

M2 = Done; On to ISP

noreply@blogger.com (Justin) — Wed, 07 May 2014 22:23:00 +0000

Previous post: http://bit.ly/1kZ3sVI
Ahh, nostalgia for freedom...

This is a very quick post to announce that I've officially completed the first half of medical school!

On Monday, I passed the Digestive (Gastrointestinal) Domain. The next thing on my plate is the infamous Step 1, which will (for me) be in mid-June. That leaves me 5 weeks and change to prepare effectively. I spent the past two days relaxing and coming up with a study plan, which basically consists of doing as many practice questions as possible while also reading as much as I can of First Aid for the USMLE Step 1 2014.

During this Intensive Study Period (ISP) as it has been dubbed, I will be foregoing all forms of social media. That means no Facebook and most likely no blogging. What little spare time I allow myself will be spent on 1.) Family and 2.) De-stressing by way of running, playing with my dog, reading, eating, and sleeping. I'm currently planning an average of 8-10 hours of active studying, 6 days per week, taking Sundays completely off for church and family.

This means I will most likely not be posting on here for the next five weeks. That could very possibly change, don't be surprised at the silence if it doesn't. I'm still here, just with my face buried in computer screens, books, and pillows...

After the test, Wife (who is now officially a Neonatal Intensive Care Unit (NICU) Nurse, by the way! Whoop Whoop!) and I will be escaping for a week to the illustrious Smoky Mountains in North Carolina for a bit of R&R. I doubt I'll be posting much that week, but you can probably expect a blur of photos once we get back.

Till then... Over and out.

Wrapping Up M2 - MSU CHM

noreply@blogger.com (Justin) — Wed, 30 Apr 2014 13:33:00 +0000

Yesterday, I attended the last two lectures of my second year of med school - possibly the last *traditional* lectures of med school as a whole; I don't know how much lecturing we get in third year and beyond. I also took a 1-hour clinical skills written exam in the morning, followed by a four-hour practice NBME exam in the afternoon. After which, I and the rest of my class were pretty fried, and thus took most of the evening off.

Today will be a slow day - started off with my last full PBL session ever, and now I'm in the Nerd Nest writing a blog post before doing some more UWorld questions. I've got 33% of my question bank left, which means that I've completed 1478 of 2211 questions so far. I hope to be down to about 15-20% by the time I really kick my ISP (Intensive Study Period) into gear in about a week or so. We'll see if I can pull that off...

Tomorrow night, Hobbes will graduate from Therapy Dog training, finally getting his license. On Sunday, Wife will officially walk in her graduation from Nursing School, receiving her B.S.N. (she technically finished everything in December, but now it'll be OFFICIAL official...). On Monday, I'll take the Gastrointestinal Domain exam, and then it's off to the nerd races for me. Goodbye, World. The intersection of Erkel and Samson, a period of life wherein we force ourselves into a mold whether we fit or not. The mold of the academic, the student with the work ethic that makes most other people shake their heads. We med students will be sequestering ourselves from the world for several weeks to fill every crevice in our brains with all the "knowledge" that the NBME claims is important. Necessary for the real world or not, we've gotta know it.

And that's where I am right now. Getting ready for the biggest test I've ever taken. Mentally and emotionally conditioning myself. Deep breaths. In the next seven weeks, I hope to read a couple thousand pages of information and complete ~4,000 more practice questions. Will it be worth it?

I'll let you know when I find out.

The Gateway Exam - MSU CHM

noreply@blogger.com (Justin) — Fri, 25 Apr 2014 03:24:00 +0000

Image modified by me from the original at vitalsigns.bangordailynews.com

I have (un)officially completed the Gateway Examination, which is basically a 4-hour experience wherein we, as second-year med students, show that we've learned enough of the physical examination and patient interviewing skills to be trusted with real patients on the wards in the coming clinical years. I haven't gotten my score back yet, but I think I passed. More importantly:

What IS the gateway exam?

I'll tell you, but first -

Imagine this:

You're a medical student, and you're almost done with your second year of med school. You've completed at least 4 years of undergraduate work, studied for and did well on the MCAT exam, and spent a year applying to medical schools and going on interviews. You most likely took out loans to be here, and at this point (if you're a financially average student) are probably more than $100,000 in debt. You've completed so many classes in med school, it's hard to remember all of their names, let alone their content. Biochemistry, Physiology, Gross Anatomy, Neuroscience, Pathology and more from M1, and now almost all of the Systems/Domains of M2. Last week one of your classmates messaged your class group on Facebook that you've completed your 1,000th hour of med school lecture. That seems like a lot, but you know it pales terribly in comparison to the number of hours that you've spent studying outside of lecture.

Anyway, you are riding the elevator up to the fifth floor (unless you're in East Lansing, in which case I have no clue where you are) to complete the Gateway Exam. You've practiced all five sections: Cardio Exam, Neurological Exam, Acute Abdominal Exam, Newborn Exam, and you've gone over in your head what you need to do when meeting with a patient with an undiagnosed condition.

You meet up with several other students, all of you nervously exchanging halfhearted jokes designed to lower the tension, while everyone knows that the tension can't really be lowered. You know you shouldn't feel nervous, but you can't help it. Nobody wants to fail. Nobody wants to do less than perfectly, and so everyone's nervous.

Each student is assigned a room number, and after a 15-minute spiel on what to expect, we file out of the room to walk across the hall to the simulation suite. The sim suite is basically a big grid of fake doctor office exam rooms, each one complete with examination table, physical exam equipment on the walls, and video cameras mounted to the walls with microphones dangling from the ceiling - all the better for the silent evaluators and recording devices to see/hear you with.

You stop at the room to which you've been assigned. Mounted to the door is a white plastic box with a sliding panel on the front with bold black letters that state, "Do not move this panel until instructed to do so" or something along those lines. Behind the door you know there is a simulated patient and possibly (depending on which experience lies behind that door) a silent physician preceptor with a clipboard, ready and waiting to grade your performance.

You wait. And wait. And wait - until one of the preceptors standing guard in the hallway raises her walkie-talkie to her mouth and says, "Students in North Hallway ready." You hear a crackly voice echo down the hallway from her receiver, "Students in West Hallway ready." Apparently they're only running two hallways at once today, as the next sound is a "Bing BING bing BING" from the speaker in the ceiling above your head, followed by a calm-sounding male voice that says, "Students, you may now access the patient information on the door. When you are ready, you may knock and enter."

Stomach flipping a bit, you slide that white plastic door aside and quickly scan the printed information:

"Mrs. Eleanor Falloway. 55 years old. Chief complaint (from nurse): Abdominal pain."

Until this moment, you didn't know which experience you would be completing after walking through this door. In a couple seconds, you mentally reorder your expectations for what lies on the other side of the door. You're going to be doing an interview with a patient, trying to lightly tease out the underlying etiology of their disease while also addressing their concerns in a caring, supportive manner. Then, you're going to switch to doctor mode, getting all the pertinent positives and negatives, making sure to note all of the important symptom dimensions and risk factors for diseases X, Y, and Z. Throughout the interview, you're doing your best to take detailed notes because you know you're going to need it all when you write your SOAP Note later on. Within a few questions, you're formulating your differential diagnosis, and it never even crosses your mind that even one year ago, what you're doing would have seemed impossible. You've learned a lot.

After the patient-centered and doctor-centered interviews, you transition to the physical exam, specifically tailored to assess the acute abdomen:

1. Inspect the abdomen.

2. Auscultate for bowel sounds. (Patient hands you a card telling you what abnormal bowel sounds their pathologic belly emitted into your stethoscope.)

3. You ask the patient to cough, and she makes a big deal about how much it hurt her right lower abdomen.

4. You make a point to be sensitive of that as you palpate, lightly then deeply, each of the four quadrants of her abdomen.

5. You go on to assess for Rovsing's Sign (+), Rebound Tenderness (+), Obturator Sign (+), Psoas Sign (+), Murphy Sign (-), and you're done. Classic appendicitis. Ain't no thang.

You wrap things up and leave, already formulating the SOAP Note that you'll need to write once you finish up with all of the other examinations. You take the extra time before your next station (you got out FAST! Did you forget something? Did you mess something up?? No, no, you just did a good job. You keep telling yourself that...) to jot down a few more notes before Ding DING Ding DING - on to the next station.

Again, preceptors exchange flat-toned commentary on hallway-specific student readiness, and Calm-Man-Voice tells you that you can access the information behind the secret sliding plastic panel. It's the Neuro exam. Okay - get that vision card ready, you're going to need it. There'll be a preceptor and standardized patient behind this door...

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And on and on you go. It would take far longer to type everything out than it takes to actually do it, so I'll just leave you with the steps for each part of the Gateway Exam, in case you're interested. Hats off to all of the upperclassmen who read my blog out of some sort of deranged nostalgia for their preclinical years when "all we had to do was learn!"

A much bigger hats off to all my fellow classmates who completed this milestone with me this week. We're one sizeable step closer to Step 1 this summer, and to the hospital rotations after that.

Well done.

And now, without further ado,

click to embiggen any of the below images:

The Cardiac Exam:

The Neurological Exam:

The Newborn Exam:

The Unknown Problem Visit:

For this one, we were evaluated by:

1. The patient we interviewed based on how they felt we did.

2. A miniature 10-15 question quiz we took immediately after the interview, asking us about various features of their presentation to determine to what degree we elicited the most important details.

The Acute Abdominal Interview & Exam:

For this one, the simulated patient evaluated our interview (not shown) separately, then evaluated the physical exam:

The SOAP Note:

So yup. Today was a blur. Four hours of lecture, lunch, the Gateway Experience, a run with Hobbes, then two hours of Therapy Dog Training during which he had his first patient visits in the hospital! Today was just a day full of clinical skills for us budding healthcare workers, hahaha. After several hours, a hefty plate of Wife's Taco Casserole, and a blog post of epic proportions, I'm ready for bed. Today was a complete wash in terms of Step 1 Studying, but I'll remedy that tomorrow afternoon - and this weekend, and every day of the domain afterward...

Later.

Mnemonic for Nutrient Absorption - Iron, Folate, B12

noreply@blogger.com (Justin) — Wed, 16 Apr 2014 03:36:00 +0000

Image found on a random site, unknown source.

So, I came up with this mnemonic last year, and this seems like as good a time as any (now that we're on the Gastrointestinal Domain) to share it with the world:

That is to say, iron is absorbed in the duodenum, folate is absorbed in the jejunum, and Vitamin B12 (Cobalamin) is absorbed in the Ileum. I imagine a stereotypical "bro" commenting on his friend, who happens to be deficient in one of these metabolites.

Yeah, that's all this post is about.