After a few requests, I return to blogging again with apologies for my recent absence! I really wanted to write a recap of third year - this transformational year in the life of a doctor - but I kept putting it off while studying for Step 2 and thus missed my window... but now I bring to you my thoughts about fourth year of medical school after approximately 2.5 "sub-internships."
1. Fourth year is great! As I've been told all along, fourth year is the light at the end of med school tunnel vision.
One thing that makes fourth year great is the vacation time. I actually took my first month off to take the USMLE Step 2, which is the second round of sitting in front of a computer for 8 hours straight. This time, I did not even come close to having a panic attack (which is probably my biggest accomplishment so far this year) and happily, I did way better this time around. I think that is a combination of the test being more focused on clinical knowledge than basic science, which is much easier for me to study, and simply having a calmer attitude about the whole thing. Despite the fact that my Step 2 score actually matters as much if not more than my Step 1 score, there was so much pressure surrounding Step 1 that I think my score primarily reflected that stress. Anyway, moving on - vacation! After taking Step 2, I had the amazing opportunity to go to London, Cinque Terre (in Italy), Nice and Paris with my family. When lying on the beach in Nice speaking French with my former host mom, I truly wondered why in the world I had chosen to go to medical school! But in the end, it was a great time to spend with my family and a refreshing reminder that the world is much bigger than the 10 minute walk between my apartment and the hospital! I am going to have a lot more time off this year to spend with my family and friends, and I will also be going to Ethiopia and traveling around Eastern Europe in January and February! This year is going to be great.
Another - much more medically relevant - aspect of fourth year that is awesome is my role in the hospital. I have truly loved my sub-internships (or "sub-Is" as we call them) this year. A sub-I is a month long rotation in the specialty you are going into where you are supposed to act as the intern, aka the first year resident. They serve two main purposes - to prepare you for intern year and to impress the people in your specialty in order to get letters of recommendation. I have loved my sub-Is because I'm finally getting to do what I love - OB/GYN - and I'm actually decently good at it. Gone are the days of feeling completely lost and worrying more about where the stapler is than how your patient is doing. Now I can actually give confident advice to patients about their problems and even give preliminary diagnoses without running it by the attending first. I'm trusted to do more procedures and have more responsibility. I also have more time to connect with patients. Although there is still so much more for me to learn and so many skills for me to perfect, I feel like I actually know how to be someone's doctor. :) It's an amazing feeling. It confirms my hope that I will truly love my job and look forward to going in to work every day for the rest of my life.
2. Fourth year can be kind of frustrating. It is mainly the sort of legal/logistical aspect of it, but essentially, I am no different than I will be at the time (almost exactly 8 months from now) when I will graduate and have an MD behind my name. Unfortunately, I will not be any smarter or much more knowledgeable than I am now. Especially during my inpatient rotation on Labor and Delivery, it was frustrating how I couldn't help more simply because I'm not legally allowed - for instance, I can't sign prescriptions, put in official orders, or write certain notes. In some ways, I'm happy I don't have those responsibilities. I'm glad I did have this time to learn more because that will help me be a better intern eventually. And it's nice to avoid any flack when something goes wrong... :) But it also kind of feels like I can't really learn until I'm fully responsible for something. Which leads me into my next point...
3. Fourth year makes me afraid for intern year.
I think I've gotten a pretty good picture of what it will be like to be an intern, both from doing my labor sub-I and from hanging out with the interns, and it scares the heck out of me. Intern year is this perfect storm of an enormous increase in responsibility, consistent sleep depravation for month after month, and having to adjust to a new city and make new friends. All while working 80+ hours/week. And wanting to be perfect at everything I do right away. And at work I will suddenly be responsible for everything that I was just whining I can't do now - without any more know-how than I currently have. It's truly birth by fire. In many ways I think intern year will be amazing. I'll go from having delivered 8 babies to delivering hundreds. I will finally have the privilege of being the primary surgeon on a case. I will learn an amazing amount about patient management. But these past few months are the first time I really contemplated what interns lives are like and it is truly a fearsome thought.
4. Fourth year is full of fear of the unknown. In addition to fear of the known (I know I will be doing intern year somewhere next year and it will be difficult) fourth year is also a year of unknowns and possibilities.
Tomorrow is the first day I can turn in my residency application. While I am looking forward to flying all over the country and experiencing what different programs are like, this senior year is just like the other two in that I have no idea where this year will take me. Either it hasn't really hit me yet or I have been talking about the Match for so long that the idea doesn't seem crazy to me anymore, but on May 20th I will open a letter in front of an auditorium full of my classmates and find out where I will spend the next four years of my life. At this point, I feel very peaceful about all this and believe that I will end up where God wants me. I think I will be happy with whatever program I match at. I have a feeling, though, that the anxiety and fear will increase as I go along this process, so that's why I included this last point. Also because I like the symmetry of having four points for fourth year.
Sorry again for my relative absence (especially following such a morbid post last time) but hopefully I will be able to keep up a lot better now!
Sunday, September 14, 2014
Sunday, April 13, 2014
death and dying
I have debated writing about this subject. The first death I mention actually took place a while ago, and it took me a long time to be able to talk about it at all. I feel like we talk about death in many ways - we talk about people who have passed and what death means to us in our lives. We talk about how it has touched us and how it affects our decision-making. So I guess when I came to medical school, I was expecting to deal with death. I expected to talk to people about it, to express sympathy for people who had experienced it in their family, to learn how to tell people they are going to die or that their loved one is dead.
But what I didn't really think about was what it would be like to experience the act of dying.
The first person I saw die was an eleven year old boy. He was shot in the heart by his mom.
He came to the emergency room and they did what's called a thoracotomy. This is an emergency surgery where you cut open the ribs in order to be able to massage the heart directly. You already know death is coming when you do this - survival from a thoracotomy is about 10%. They opened this little boy up and his heart was shredded. They pronounced him dead.
No one really talked to me about it afterward, besides my preceptor saying "that's fucked up" - which is about the best summary I can think of. It was numbing. The ugliness and brokenness of the world we live in was so vivid to me that day. I turned on the news when I got home that night and heard some personal details about him, but I had to turn it off because I couldn't bear it. I couldn't bear to personalize it. Kids aren't supposed to die. They are resilient. They recover.
They definitely aren't supposed to be shot by someone who loves them.
A few weeks ago I watched an old man be coded and die. They did CPR and pushed epinephrine and intubated him. About half way through the code his wife came back to the room, realized what was happening, and began wailing and saying "it's over" and calling all their children. The team continued to "work on him," but after 20 minutes he still had no pulse. They pronounced him dead.
I didn't know him well. He was one of the patients on my team but not one I was following. I had met him once about a week before. At the time he just kept saying he was thirsty.
While he died, I was just overwhelmed by the ugliness. Death, especially death in a hospital with people fighting to keep you alive, is terrifying to watch. There is no dignity. It is not peaceful or romantic or even sensational like it seems in tv shows. But after he died, all I could think was: at least it could be worse. Nothing seems quite as bad after seeing a little boy die from being shot by his mom.
Death and dying are hard to talk about because we're afraid to be "morbid" or "depressing." I hope, in reading this, that you aren't too depressed or fearful. Because the opposite of death is life. You are living! All we can do is live each day God gives us. I wish I could end with more wisdom, but at this point all I can say is that experiencing dying changes you. I hope it changes me for the better.
But what I didn't really think about was what it would be like to experience the act of dying.
The first person I saw die was an eleven year old boy. He was shot in the heart by his mom.
He came to the emergency room and they did what's called a thoracotomy. This is an emergency surgery where you cut open the ribs in order to be able to massage the heart directly. You already know death is coming when you do this - survival from a thoracotomy is about 10%. They opened this little boy up and his heart was shredded. They pronounced him dead.
No one really talked to me about it afterward, besides my preceptor saying "that's fucked up" - which is about the best summary I can think of. It was numbing. The ugliness and brokenness of the world we live in was so vivid to me that day. I turned on the news when I got home that night and heard some personal details about him, but I had to turn it off because I couldn't bear it. I couldn't bear to personalize it. Kids aren't supposed to die. They are resilient. They recover.
They definitely aren't supposed to be shot by someone who loves them.
A few weeks ago I watched an old man be coded and die. They did CPR and pushed epinephrine and intubated him. About half way through the code his wife came back to the room, realized what was happening, and began wailing and saying "it's over" and calling all their children. The team continued to "work on him," but after 20 minutes he still had no pulse. They pronounced him dead.
I didn't know him well. He was one of the patients on my team but not one I was following. I had met him once about a week before. At the time he just kept saying he was thirsty.
While he died, I was just overwhelmed by the ugliness. Death, especially death in a hospital with people fighting to keep you alive, is terrifying to watch. There is no dignity. It is not peaceful or romantic or even sensational like it seems in tv shows. But after he died, all I could think was: at least it could be worse. Nothing seems quite as bad after seeing a little boy die from being shot by his mom.
Death and dying are hard to talk about because we're afraid to be "morbid" or "depressing." I hope, in reading this, that you aren't too depressed or fearful. Because the opposite of death is life. You are living! All we can do is live each day God gives us. I wish I could end with more wisdom, but at this point all I can say is that experiencing dying changes you. I hope it changes me for the better.
Wednesday, February 5, 2014
concept: "on call"
This is a concept I had completely wrong before I came to medical school. Considering I'm about to do four weeks of q4 (I'll explain later) call, I thought it would be a good time to explain what being "on call" actually means.
So when I was a young fresh-faced college student applying to medical school, I imagined being "on call" actually had to do with receiving calls - silly me! I imagined being "on call" meant your lightest day - either you stay at home all day and just answer calls about patients, or that you are at home but have to be ready to go in if needed. The strangest thing about this idea was when I heard that medical students did it - considering we know practically nothing compared to the residents and attendings and because our opinions very rarely (read: never) matter.
Turns out this wasn't completely wrong, but what I was imagining is actually specifically called "home call." It's also true that only the senior residents and attendings have home call where during certain periods they are responsible for answering calls and making decisions - but here's the wrench - another, younger resident actually has to be there at the hospital to call and to do the bidding of the more senior resident. And the medical student gets to be there right along with the resident! So my idea of call days being the lightest days was actually the complete opposite of reality - similar to many of the other things I imagined about medical school.
So what being "on call" really means is that you are the person on a particular service responsible for accepting patients. When someone comes to the ER and it's decided that they need to be admitted into the hospital, they are assigned to a medical service related to their problem. Heart attack goes to cardiology, stroke goes to neurology, etc. There has to be someone there from your "team" to accept the patient, take their history, do a physical exam, and start any work-ups and necessary treatments overnight. So the way "call" has classically worked is that you come in the morning for rounds, stay all day and overnight in the hospital, then stay through rounds the next morning to present the new patients to the team. So after approximately 30 hours you go home, hopefully sleep a lot, then come in the next morning.
I would argue that this is a ridiculously stupid system. As scientists who study things like sleep cycles, circadian rhythms, cortisol peaks, and the mental consequences of sleep deprivation, it astounds me how we continue to expect physicians to be these magical people who can go without sleep every fourth night and still function at an exceptional level. Simple shift work at night has been shown to be detrimental to health as compared to day shift work, but at least your body has a chance to adjust. Having an irregular sleep schedule in addition to sleep deprivation seems like a terrible idea to maximize mental acuity of residents, not to mention maximizing their health. So far I have only done two weeks of q4 call when I was on the neurology inpatient service - and I was a complete mess. I actually began this blog post at that time (about 3 months ago)...
At least there is some hope. There are two things that are changing/have changed about this system now.
One is that we are doing call less frequently. When I say "q4" call I mean that I do this overnight, 30 hour work day every fourth night. Older attendings will tell you how residents nowadays "have it easy" because they used to have to work q3 call, but this has essentially gone away with increasing work hour restrictions for residents. While I would agree that their lives clearly sucked and that q3 call sounds terrible, I don't think that means q4 call is a joyful schedule full of free time.
The newest solution to this problem that many residencies are now implementing - the one I personally like the best - is a "night float" person instead (also known as the "mouse" on ob/gyn). Thus instead of working q4 call during your entire residency, you work a couple months out of the year where you are consistently on nights for a whole month. Granted I haven't worked nights yet, this sounds so much better than working q4 call. At least you are able to establish a steady sleep schedule (in addition to purchasing dark blinds).
Obviously someone has to be there at night. Obviously no one wants to be that person. Obviously, as a resident you will be that person. But I still think it would be nice if we used a little scientific reasoning when we come up with the best way to schedule shift work.
So when I was a young fresh-faced college student applying to medical school, I imagined being "on call" actually had to do with receiving calls - silly me! I imagined being "on call" meant your lightest day - either you stay at home all day and just answer calls about patients, or that you are at home but have to be ready to go in if needed. The strangest thing about this idea was when I heard that medical students did it - considering we know practically nothing compared to the residents and attendings and because our opinions very rarely (read: never) matter.
Turns out this wasn't completely wrong, but what I was imagining is actually specifically called "home call." It's also true that only the senior residents and attendings have home call where during certain periods they are responsible for answering calls and making decisions - but here's the wrench - another, younger resident actually has to be there at the hospital to call and to do the bidding of the more senior resident. And the medical student gets to be there right along with the resident! So my idea of call days being the lightest days was actually the complete opposite of reality - similar to many of the other things I imagined about medical school.
So what being "on call" really means is that you are the person on a particular service responsible for accepting patients. When someone comes to the ER and it's decided that they need to be admitted into the hospital, they are assigned to a medical service related to their problem. Heart attack goes to cardiology, stroke goes to neurology, etc. There has to be someone there from your "team" to accept the patient, take their history, do a physical exam, and start any work-ups and necessary treatments overnight. So the way "call" has classically worked is that you come in the morning for rounds, stay all day and overnight in the hospital, then stay through rounds the next morning to present the new patients to the team. So after approximately 30 hours you go home, hopefully sleep a lot, then come in the next morning.
 |
| A visual illustration. (Not my actual schedule for next week, just in case anyone wanted to stalk me.) |
I would argue that this is a ridiculously stupid system. As scientists who study things like sleep cycles, circadian rhythms, cortisol peaks, and the mental consequences of sleep deprivation, it astounds me how we continue to expect physicians to be these magical people who can go without sleep every fourth night and still function at an exceptional level. Simple shift work at night has been shown to be detrimental to health as compared to day shift work, but at least your body has a chance to adjust. Having an irregular sleep schedule in addition to sleep deprivation seems like a terrible idea to maximize mental acuity of residents, not to mention maximizing their health. So far I have only done two weeks of q4 call when I was on the neurology inpatient service - and I was a complete mess. I actually began this blog post at that time (about 3 months ago)...
At least there is some hope. There are two things that are changing/have changed about this system now.
One is that we are doing call less frequently. When I say "q4" call I mean that I do this overnight, 30 hour work day every fourth night. Older attendings will tell you how residents nowadays "have it easy" because they used to have to work q3 call, but this has essentially gone away with increasing work hour restrictions for residents. While I would agree that their lives clearly sucked and that q3 call sounds terrible, I don't think that means q4 call is a joyful schedule full of free time.
The newest solution to this problem that many residencies are now implementing - the one I personally like the best - is a "night float" person instead (also known as the "mouse" on ob/gyn). Thus instead of working q4 call during your entire residency, you work a couple months out of the year where you are consistently on nights for a whole month. Granted I haven't worked nights yet, this sounds so much better than working q4 call. At least you are able to establish a steady sleep schedule (in addition to purchasing dark blinds).
Obviously someone has to be there at night. Obviously no one wants to be that person. Obviously, as a resident you will be that person. But I still think it would be nice if we used a little scientific reasoning when we come up with the best way to schedule shift work.
Tuesday, February 4, 2014
advice for the OB/GYN shelf exam
This is an atypical post for me because I usually tend toward the narrative - and write for a non-medical audience. However, the only medical blogs I look at myself are ones that give advice on how to study for the NBME shelf exams or USMLE step exams. Until this point, I really didn't feel like I did well enough on anything to be worthy of giving advice, but considering on how often I look at this blog post about third year shelf exams, I wanted to put in my two cents about how to do well on the ob/gyn shelf exam - because for once this year, I did do well on a shelf exam!
Here are the resources I used:
1. Blueprints Obstetrics and Gynecology - This book is great for the people who prefer to read text, and I believe this edition is considered to be the best in this series. I think the obstetrics chapters are more helpful/detailed than the gynecology ones. What I found really useful about reading this book is that I read the chapters in coordination with the 10 APGO questions on that topic. This is my favorite learning format (think back to ExamKrackers for the MCAT) so I liked doing it this way, although I think it might have been more time-consuming than necessary.
2. Case Files: Obstetrics and Gynecology - I was really glad I forced myself to finish this book during the last week of my rotation. It was more updated than Blueprints and I thought it explained certain differentials with more clarity. I wondered whether I should have read through Case Files during the first two weeks of my rotation (but I was on Gyn Onc, so this is really useless wondering). It did seem nice to have fresh in my brain right before the shelf, but I really think reading this first, then reading Blueprints (if you have time), is probably the better way to go.
3. APGO U Wise Question Bank - This is the indispensable resource in my mind. Unfortunately, I've read that not all schools pay for this question bank, but it was definitely the best resource I used. It contains ~580 questions grouped into 10 question quizzes by topic, as well as 50-question and 100-question comprehensive tests. A nice piece of trivia to know is that the 50 question tests are actually just randomly generated from the question bank. This means that you will recognize questions if you were able to go through the whole bank, but it also means that if you are studying at the last minute, just doing the 50 question test over a few times would expose you to a smattering of topics. I'm unsure whether or not the 100 question comprehensive test contains questions from the bank. Some of them seemed familiar to me, but by the time I was taking this my brain started to feel a little numb, so I'm not sure. Still worth taking to see how ready you are for the shelf.
4. UWorld Question Bank - I made the plunge and paid for this question bank for the whole year, and I always do the topical questions before each shelf. There are about 200 questions for ob/gyn. I did them all on tutor mode over the last couple days before my shelf. I would recommend going through them, although I did find that some were more nit-picky than I found the shelf and APGO questions to be. A usual recommendation is to then go through your incorrects, but I didn't have time to do this.
Summary:
I was definitely glad I was thorough with my studying because the exam was harder than I expected. I had heard it was one of the easier exams to prepare for because it actually stays on-topic (unlike surgery, psych, neuro, oh yeah... all shelf exams), which was true, but I thought the questions were more complex than the questions in APGO and UWorld. So although the question banks were great prep, I was glad I read something in addition. Also, just a reminder that I really want to go into OB/GYN, so I was highly motivated to do well, and otherwise I definitely wouldn't have come home and studied two hours every night while working 80-hour weeks on L&D. I think you could still do pretty well with simply doing the APGO questions.
Hope this helps and good luck!
Here are the resources I used:
1. Blueprints Obstetrics and Gynecology - This book is great for the people who prefer to read text, and I believe this edition is considered to be the best in this series. I think the obstetrics chapters are more helpful/detailed than the gynecology ones. What I found really useful about reading this book is that I read the chapters in coordination with the 10 APGO questions on that topic. This is my favorite learning format (think back to ExamKrackers for the MCAT) so I liked doing it this way, although I think it might have been more time-consuming than necessary.
2. Case Files: Obstetrics and Gynecology - I was really glad I forced myself to finish this book during the last week of my rotation. It was more updated than Blueprints and I thought it explained certain differentials with more clarity. I wondered whether I should have read through Case Files during the first two weeks of my rotation (but I was on Gyn Onc, so this is really useless wondering). It did seem nice to have fresh in my brain right before the shelf, but I really think reading this first, then reading Blueprints (if you have time), is probably the better way to go.
3. APGO U Wise Question Bank - This is the indispensable resource in my mind. Unfortunately, I've read that not all schools pay for this question bank, but it was definitely the best resource I used. It contains ~580 questions grouped into 10 question quizzes by topic, as well as 50-question and 100-question comprehensive tests. A nice piece of trivia to know is that the 50 question tests are actually just randomly generated from the question bank. This means that you will recognize questions if you were able to go through the whole bank, but it also means that if you are studying at the last minute, just doing the 50 question test over a few times would expose you to a smattering of topics. I'm unsure whether or not the 100 question comprehensive test contains questions from the bank. Some of them seemed familiar to me, but by the time I was taking this my brain started to feel a little numb, so I'm not sure. Still worth taking to see how ready you are for the shelf.
4. UWorld Question Bank - I made the plunge and paid for this question bank for the whole year, and I always do the topical questions before each shelf. There are about 200 questions for ob/gyn. I did them all on tutor mode over the last couple days before my shelf. I would recommend going through them, although I did find that some were more nit-picky than I found the shelf and APGO questions to be. A usual recommendation is to then go through your incorrects, but I didn't have time to do this.
Summary:
I was definitely glad I was thorough with my studying because the exam was harder than I expected. I had heard it was one of the easier exams to prepare for because it actually stays on-topic (unlike surgery, psych, neuro, oh yeah... all shelf exams), which was true, but I thought the questions were more complex than the questions in APGO and UWorld. So although the question banks were great prep, I was glad I read something in addition. Also, just a reminder that I really want to go into OB/GYN, so I was highly motivated to do well, and otherwise I definitely wouldn't have come home and studied two hours every night while working 80-hour weeks on L&D. I think you could still do pretty well with simply doing the APGO questions.
Hope this helps and good luck!
Tuesday, January 28, 2014
Saturday, January 25, 2014
a surprise maybe-not-so-surprising announcement
There are some people who come into medical school set on an idea (most typically it's a jock-looking guy interested in orthopedic surgery) and are shocked when they love pediatrics and completely change their career path. There's actually a statistic that 75% of medical students end up going into a different specialty than what they planned when starting medical school.
Then there are others, like me, who insist they are open minded. I insisted on my awareness of this statistic and how I would change my mind anyway, so I didn't even want to tell people my favorite specialty. But while I remained purposefully vague, the people around me seemed all too certain. When I look back, I think about my weird obsession as a preteen with watching "The Baby Story" on TLC (which literally just consists of interviewing couples and then watching the birth in a 30 minute episode). I think about how of all my high school science classes, AP Biology and Anatomy were my favorites. I think about how I took Women and Gender studies classes in college just because I was interested - when they didn't count towards either of my two majors. I think about how my college roommates and I would have too many discussions about how "it's your uterus and not your vagina shedding during a period" or how does surrogacy really work? I think about how first year of med school I got really mad when a professor said that sperm penetrate the egg - which, by the way, is a lie which you can read about in this fascinating article - and then a med school friend said "if you don't become an OB/GYN I will eat my shoe."
Then came third year when everything I loved pointed to the same thing. On surgery, I liked the breast cancer patients the best. I loved being in the OR and doing surgery much more than I expected, and one of the things people forget about OB/GYNs is that they don't just look at vaginas and deliver babies, they also perform various surgeries. On radiology, I liked ultrasound the best.
So I went into my OB/GYN rotation hopeful that I would just have this feeling. That everything about it would be perfect. Truthfully, not everything about it is perfect. I am not ignorant of the negatives. I'm not terribly thrilled about going into a specialty that has 90% female residents. I have already experienced how terrible it is when a baby is born and can't breathe on its own. But there is a lot of happy to counter the sad. And dealing with the tragic parts of life is a burden anyone going into medicine is choosing to carry.
But there were two things about OB/GYN that made me sure it was the right fit - 1) I just liked the people better. When I look back at my blog post about surgery, that was a major thing that made me feel unsure about choosing it as a career - I just didn't like the people. I didn't think "I want to be the kind of doctor you are" - but on OB/GYN, I thought this so many times. Not only did I want the attendings to be my friends, I also wanted to be as good with patients and as interested in what I do as they are. 2) I loved delivering babies. I know this is cheesy, and there are certain things that all medical students love to do - and delivering babies is definitely one of them. But delivering babies made me emotional in this deep and wonderful sense. And even though I said there were only two reasons, if you reference above, clearly 3) is destiny. Ha I love how freaking cheesy that is.
I am going into Obstetrics and Gynecology! (surprise!)
I am so excited. Not just because I love the relief of finally having decided and getting to focus on the next steps, but because I feel like I've found something that really fits me. The first time I delivered a baby, afterwards the attending said "I've never had to help a medical student so little! You just knew what to do!"
I am also so happy to be choosing a specialty that is so varied in what I can do with my life - I can be a generalist and do surgery, see people in the office, and deliver babies; I can be a cancer surgeon and operate and follow women during chemotherapy; I can specialize in endocrine and infertility and work on medical problems as well as do procedures to help people get pregnant; or I could specialize in high risk OB and deal with sick pregnant women and the interesting and intense complications surrounding high risk pregnancy. So many choices! I can't imagine I will ever be bored for too long. I get to combine surgery and procedures with primary care and advocacy.
I am really excited and I just want to thank my family and friends for supporting me along the way! Can't wait to see what adventures the future holds.
So I went into my OB/GYN rotation hopeful that I would just have this feeling. That everything about it would be perfect. Truthfully, not everything about it is perfect. I am not ignorant of the negatives. I'm not terribly thrilled about going into a specialty that has 90% female residents. I have already experienced how terrible it is when a baby is born and can't breathe on its own. But there is a lot of happy to counter the sad. And dealing with the tragic parts of life is a burden anyone going into medicine is choosing to carry.
But there were two things about OB/GYN that made me sure it was the right fit - 1) I just liked the people better. When I look back at my blog post about surgery, that was a major thing that made me feel unsure about choosing it as a career - I just didn't like the people. I didn't think "I want to be the kind of doctor you are" - but on OB/GYN, I thought this so many times. Not only did I want the attendings to be my friends, I also wanted to be as good with patients and as interested in what I do as they are. 2) I loved delivering babies. I know this is cheesy, and there are certain things that all medical students love to do - and delivering babies is definitely one of them. But delivering babies made me emotional in this deep and wonderful sense. And even though I said there were only two reasons, if you reference above, clearly 3) is destiny. Ha I love how freaking cheesy that is.
I am going into Obstetrics and Gynecology! (surprise!)
 |
| Chosen for its complete creepiness |
I am also so happy to be choosing a specialty that is so varied in what I can do with my life - I can be a generalist and do surgery, see people in the office, and deliver babies; I can be a cancer surgeon and operate and follow women during chemotherapy; I can specialize in endocrine and infertility and work on medical problems as well as do procedures to help people get pregnant; or I could specialize in high risk OB and deal with sick pregnant women and the interesting and intense complications surrounding high risk pregnancy. So many choices! I can't imagine I will ever be bored for too long. I get to combine surgery and procedures with primary care and advocacy.
I am really excited and I just want to thank my family and friends for supporting me along the way! Can't wait to see what adventures the future holds.
Monday, January 6, 2014
snow day: a contemplation of expectations and evaluations
What does a medical student need to arrange in order to get the day off work? Just a foot of snow and a wind chill of -30 degrees. No big deal.
I would apologize for my lack of posting, but when I realized my last post was about burnout, so I thought - how appropriate for me to illustrate my own point!
As I sit curled up on my couch with snow drifts on my windowsills and an espresso in my hand, I'm thinking, what do I have to say about being a medical student lately? I want to talk about expectations and evaluations. Because I am sick of both of those things.
Expectations. Here are some things I am expected to know how to do, magically without ever learning. Granted, some resident will show me how to do these things, however they will make it clear how very nice and patient they are being because the idiot med student can't figure it out:
1. How to use a fax machine. This, ladies and gentlemen, is a complicated task. I thought the pathophysiology of glycolysis and gluconeogenesis was complicated, but figuring out how to send a fax to a long distance number is more complicated. Speaking of long distance numbers...
2. The long distance code. Sounds simple, right? A long distance code. I didn't even know these existed. That's what cell phones are for, right? Ok, so the hospital has a system, right? Every single rotation I have been told a different story about this magical code. On the psych floor, the social worker has it. On the neuro floor, every resident has their own code. On ob/gyn, it's on the board (duh! how could I not know that). I've been told on medicine everyone uses the same code, so you just have to memorize it. I've also been told by every secretary I've ever asked that I should have my own code. I don't. On surgery, I never called a long distance number. Ha.
3. Where the stapler is. Probably a common office problem, just never thought it would be a problem I'm often working on solving. Where is the stapler???
4. How to write notes in the fashion of each specialty:
a. Copy it out on this lined paper.
b. Print out this form and "skeletonize" it for us.
c. Print out this form, fill it out, sign it, then copy it with four pages per sheet and put the real one in the chart.
d. Don't write a note, just have it memorized.
e. None of the above, SNOW DAY!
The point is, no matter the environment, and perhaps especially in the uptight medical environment, it is difficult to figure out how the seemingly simple things work. It takes time. I don't magically know how to be the best secretary ever and a brilliant budding doctor. And that leads us to...
Evaluations. Here is the range:
5 = Honors (greatly exceeds expectations)
3 = the average 3rd year medical student (is this strange to you too? shouldn't we all be 3s?)
1 = probably never selected because they would have already pulled you aside and failed you
You are judged weekly, if not daily, on your performance. And whatever small amount of time you spend with a physician, halfway through you should ask for "mid-rotation" feedback. This week I'm going to ask a doctor for mid-rotation feedback after spending two afternoons with her. It's really insane. I think the point of it is supposed to be that we receive feedback "in time" for us to use that feedback to improve our performance and hopefully get the grade we want, but the feedback is usually either "you're doing fine" or "I haven't spent very much time with you." Very formative.
I guess I'm just getting tired of being evaluated constantly. Imagine for this whole year if every day were an interview and you received feedback at the end of each week on your performance. That's kind of what being a third year medical student feels like.
But here's the thing. If you're not somehow already magically performing like a fourth year or intern after one week, you're probably not going to get higher than a High Pass (the equivalent of a B). Now I say this with the caveat that everyone has a different view of how many students deserve Honors (the equivalent of an A) and what constitutes honors-level work. So naturally your grade not only depends on your performance, but on your grader's opinion of what grades mean and how they should work.
So basically Honors is the enigma of the third year medical student. What does it mean, really? What is the formula to achieve it? It seems that the usual medical student recipe - hard work, studying all the time, knowing everything - doesn't really work. It also seems that my method - hard work, being really helpful, people skills :), and trying to convince myself to study sometimes - also doesn't really work. It's not that I really need Honors in everything. It's just kind of hard to work 60 hours a week, to try your hardest at something that kind of scares you, and then to be told that you "seemed like a genuinely nice person" (literal direct quote) but you get HIGH PASS. Buzz. Next.
Needless to say the excitement of third year has worn off a little bit, in addition to the fact that I'm still tested around once a month (the results of which are always discouraging), thus I am already close to ready for third year to be over with.
I am currently in the middle of my Obstetrics and Gynecology rotation, which I really am enjoying (despite the difficulties inherent in third year mentioned above). My goal is mainly to study really hard so I hopefully get a better grade on this test than any of the others, then I basically feel like I can stop worrying and just settle on getting High Passes for my remaining rotations. Hopefully then I will have Honors in the two things I am thinking of going into, and that seems good enough to me! I am hopeful that I'll write another post summarizing OB/GYN in the next three weeks.
 |
| This is actually from the snow Sunday before my snow day, when I should have been doing work, but instead I was doing arabesques in the snow! |
As I sit curled up on my couch with snow drifts on my windowsills and an espresso in my hand, I'm thinking, what do I have to say about being a medical student lately? I want to talk about expectations and evaluations. Because I am sick of both of those things.
Expectations. Here are some things I am expected to know how to do, magically without ever learning. Granted, some resident will show me how to do these things, however they will make it clear how very nice and patient they are being because the idiot med student can't figure it out:
1. How to use a fax machine. This, ladies and gentlemen, is a complicated task. I thought the pathophysiology of glycolysis and gluconeogenesis was complicated, but figuring out how to send a fax to a long distance number is more complicated. Speaking of long distance numbers...
2. The long distance code. Sounds simple, right? A long distance code. I didn't even know these existed. That's what cell phones are for, right? Ok, so the hospital has a system, right? Every single rotation I have been told a different story about this magical code. On the psych floor, the social worker has it. On the neuro floor, every resident has their own code. On ob/gyn, it's on the board (duh! how could I not know that). I've been told on medicine everyone uses the same code, so you just have to memorize it. I've also been told by every secretary I've ever asked that I should have my own code. I don't. On surgery, I never called a long distance number. Ha.
3. Where the stapler is. Probably a common office problem, just never thought it would be a problem I'm often working on solving. Where is the stapler???
4. How to write notes in the fashion of each specialty:
a. Copy it out on this lined paper.
b. Print out this form and "skeletonize" it for us.
c. Print out this form, fill it out, sign it, then copy it with four pages per sheet and put the real one in the chart.
d. Don't write a note, just have it memorized.
e. None of the above, SNOW DAY!
The point is, no matter the environment, and perhaps especially in the uptight medical environment, it is difficult to figure out how the seemingly simple things work. It takes time. I don't magically know how to be the best secretary ever and a brilliant budding doctor. And that leads us to...
Evaluations. Here is the range:
5 = Honors (greatly exceeds expectations)
3 = the average 3rd year medical student (is this strange to you too? shouldn't we all be 3s?)
1 = probably never selected because they would have already pulled you aside and failed you
You are judged weekly, if not daily, on your performance. And whatever small amount of time you spend with a physician, halfway through you should ask for "mid-rotation" feedback. This week I'm going to ask a doctor for mid-rotation feedback after spending two afternoons with her. It's really insane. I think the point of it is supposed to be that we receive feedback "in time" for us to use that feedback to improve our performance and hopefully get the grade we want, but the feedback is usually either "you're doing fine" or "I haven't spent very much time with you." Very formative.
I guess I'm just getting tired of being evaluated constantly. Imagine for this whole year if every day were an interview and you received feedback at the end of each week on your performance. That's kind of what being a third year medical student feels like.
But here's the thing. If you're not somehow already magically performing like a fourth year or intern after one week, you're probably not going to get higher than a High Pass (the equivalent of a B). Now I say this with the caveat that everyone has a different view of how many students deserve Honors (the equivalent of an A) and what constitutes honors-level work. So naturally your grade not only depends on your performance, but on your grader's opinion of what grades mean and how they should work.
So basically Honors is the enigma of the third year medical student. What does it mean, really? What is the formula to achieve it? It seems that the usual medical student recipe - hard work, studying all the time, knowing everything - doesn't really work. It also seems that my method - hard work, being really helpful, people skills :), and trying to convince myself to study sometimes - also doesn't really work. It's not that I really need Honors in everything. It's just kind of hard to work 60 hours a week, to try your hardest at something that kind of scares you, and then to be told that you "seemed like a genuinely nice person" (literal direct quote) but you get HIGH PASS. Buzz. Next.
Needless to say the excitement of third year has worn off a little bit, in addition to the fact that I'm still tested around once a month (the results of which are always discouraging), thus I am already close to ready for third year to be over with.
I am currently in the middle of my Obstetrics and Gynecology rotation, which I really am enjoying (despite the difficulties inherent in third year mentioned above). My goal is mainly to study really hard so I hopefully get a better grade on this test than any of the others, then I basically feel like I can stop worrying and just settle on getting High Passes for my remaining rotations. Hopefully then I will have Honors in the two things I am thinking of going into, and that seems good enough to me! I am hopeful that I'll write another post summarizing OB/GYN in the next three weeks.
Subscribe to:
Posts (Atom)