Forensics

As you may have inferred, if you are a med student or former med student reader (ha ha... I think people read this!), I have been absent from this blog as the stress of studying for Step 1 took its toll. But I have emerged victorious! Or at least, I passed. WHOOO RAH! I think my score is solid, especially since I don't want to be any kind of surgeon or read films all day or spend the rest of my life dealing with people's disgusting skin.

Boy, do I hate skin conditions. Just the word "papule" is upsetting.

And speaking of things I won't spend the rest of my life doing, I am currently on forensics. Pathology as a whole I have not ruled out, but forensics? Absolutely not. Why? Because insects are waiting for you to die, and they will eat you. I cannot unlearn this. It will haunt me till, and especially on, my dying day. Thanks, forensics.

Physical Diagnosis

This semester we are continuing with the physical diagnosis format from last semester. Every student is assigned to a preceptor along with another student or two. We have five assigned afternoons to go into the hospital, find a patient, perform a complete interview and physical, and meet with the other student(s) and preceptor to present this patient. For me, last semester was a disaster. Though my preceptor was friendly, she gave little instruction or feedback, and the overall experience has left me anxious about my lack of knowledge in performing a physical. I think some schools give their students the chance to learn physical diagnosis on standardized patients. We learned to interview with standardized patients, but we were expected to learn the physical exam by practicing on one another. This was not especially helpful. Our school has also recently built a center for simulated exams on dummies, but as of yet my class has not been given the chance to make good use of it. Given the widespread dissatisfaction with this part of our curriculum, I wonder how other med schools have integrated clinical exam skills into the first two years.

My new preceptor seems like he will be expecting more from us, so I am hopeful I will be more prepared for third year by the end of this session. At the very least, I hope to not miss anything this semester as glaringly obvious as I did last--purple hands. Yes, indeed, the patient's hands were purple. But even omitting inspection of the hands was a vast improvement over my first patient of the year, who I was too afraid to touch. He was an actual hospitalized sick person! I could hurt him! I suppose if we can manage to somewhat bungle our way through the physical exam by third year they've accomplished something.

Ayche's 12 Step Program to Gunning - Step 12

Step 12 - Don't Actually Be a Gunner

Every student should do his or her best to learn the material, but actual "gunning" takes the emphasis off of patient care and puts it squarely on the ego of Hot-Shot Med Student. I attend a medical school that has switched to a Pass/Fail system. It seems many schools are switching to a non-grade grading scale to encourage cooperative learning. I do not know how successful these are at other schools, but at my school they still dole out "Honors" for the top 10% and keep GPAs so students can qualify for AOA (the medical honor society). It makes me wonder, what's the point?

We are all in this together, right? While there is nothing wrong with being a good student, it is at least as important to do what you can to help out your classmates. This view is antithetical to true gunning. I have much more respect for a classmate with average grades who sends the class a brief email concerning an important piece of information the professor remembered when asked a question after lecture, compared to a 4.0 student who in the same situation would keep the information to himself. If my class were a venn diagram, the circles of "knows the most" and "shares knowledge" only slightly overlap. Why? Gunning.

Atrial Fibrillation

I heard atrial fibrillation for the first time while doing a physical exam today. I reviewed heart sounds on my own the night before (as we've never been lectured on abnormal heart sounds), but only the murmurs. Now I know that "holy crap, what is going on in there?" means atrial fibrillation. So that's what irregularly irregular sounds like! Ah, the power of learning by experience.

Registering to Vote

I have needed to register in my new precinct for some time. My roommate is very active politically and was horrified to discover I had not yet done this (October 4th deadline!). She printed off the voter registration form for me and heckled me daily until I found both my old registration number and enough stamps to send this off. Some day I will go to the post office and get some 1 cent stamps... and an enormous roll of those Forever stamps, as it would appear I haven't bought regular stamps since high school.

Ayche's 12 Step Program to Gunning - Steps 4-11

Step 4 - Skipping Class

I hate class.  I always have.  Not only am I not an auditory learner, I remain unconvinced that anyone can really focus on professors droning over powerpoint slides for FOUR HOURS.  I have become a highly selective class attender, and my grades second semester rose as a result.  If class isn't helpful, it is an enormous time sink.  This probably isn't for everyone.  The more general message is to not be afraid of learning the way that works best for you, even if it means giving up something that classmates may swear by or taking on something they have sworn off.*

Step 5 - Creating the Perfect Study Environment

I have a new, non-ghetto apartment.  It comes complete with a living room large enough for my desk and bookshelves, so I can move these items out of the bedroom.  If I learned anything in Doctoring last year, it is that studying near or on your bed is poor sleep hygiene.  Though I am usually in the library, it is good to have backup study spaces for when the library is overcrowded and for when you reach that special point during exam week that makes you deeply ponder stripping down and running through the library in your undies, clucking like a chicken, just to change things up a bit.

Step 6 - Embracing my Inner Homebody

I am not going to go out if I would honest-to-God rather be studying on a Saturday night.  While it is going to be important to take time to relax, it is also important to be able to stand up and proudly say, "I'm a dork and I am staying in."  Sometimes I find it more relaxing to read over some new material than to do something else and worry about the fact that I am not studying.

Step 7 - Textbook Selection

I am fed up with professors requiring books that they wrote, or that they have used for the past 20 years.  I'm not buying them.  They are in the library, and all my friends will have copies sitting in their carrels as well.  I am only buying books that I think will make good learning/reference aids based off of reviews from other students and online.  There are excellent textbooks out there.  Purchasing lousy ones kills me a little on the inside.

Step 8 - Remembering Step 2

I will lapse in my exercise program.  It is written in the stars.  No matter how busy I get, I am simply going to have to tell myself over and over to make the time.  Most likely, I am going to need to start getting up in the morning and exercising first thing every day to make myself keep a set schedule.  I cringe to think of it now.

Step 9 - It Is Never Too Early to Think About Boards

From everything I have read, it is helpful to have board review subject books that you use while taking the classes.  It is an extra resource while preparing for med school exams, and when board review time does come around you can study from books you are already familiar with.  I have heard some med schools actually get their students to read First Aid over the summer between 1st and 2nd year.  I have not done that, but it gives me something to think about.

Step 10  - Maintaining Mental Health

I was treated for depression during my first year.  I don't think this is uncommon.  Medical school is hard.  People get low grades.  People get stressed, so much so that marriages can fall apart.  I didn't have those particular problems, but people who get into medical school are the driven, tightly-wound types who are prone to be harsh self-critics.  As it turns out, self-worth is not determined by academic achievement, and a robust acknowledgment of this can do wonders for your mood.

Step 11 - Clinging to an Extracurricular

I sing in a chorus.  And don't you know?  Every performance we have seems to fall on an exam week.  But I will keep singing till I am blue in the face, because I need something that is completely unrelated to medicine that I do with an entirely different group of people than my classmates.  It is a healthy break.

*Eating the syllabus is not an effective study method.

Ayche's 12 Step Program to Gunning - Step 3

Step 3 - Cooking

Preparing your own food allows you to take control of eating habits. It is all too easy as a med student to spend every waking hour in class or at the library, and settle into the routine of eating solely at the hospital cafeteria and restaurants near campus. Eating out, especially on the student's budget, is usually not the healthiest option. And, diet aside, the hospital cafeteria can carry a certain "you are going to be eating an insipid dish with mushy vegetables and jello for every meal for the rest of your life" gloom. So cook! Cook up a meal you like that keeps well, and pack yourself meals to take with you when you study on campus in the evenings. You can also prepare your own snacks. If you are well stocked on food going onto campus, you are much less likely to end up hungry and hitting the vending machines. Eating right while studying helps keep you energized and focused, not to mention keeping you from backsliding when you are logging all those hard hours at the gym! (I had to break a pretty bad gummy fruit habit, myself. If the vending machines in the library ever get Dr. Pepper, I'll still be done for.)