Currently studying the cardiovascular system so thinking about plumbing, pipes, pumps and the failure of these components. For some reason, the physical aspects of hearts and vessels make sense to me in a way that my limited understanding of flow-related physics suggests they should not. Subtle nuances of ECGs are not my cup of tea but electricity was an even worse topic for me in physics. Working on the ambulance has finally come in handy for something though, I know more about ECGs than I thought by virtue of seeing hundreds and listening to folks trying to decode them or teach others to understand them.
Other pumps and pipes in my life are not being so cooperative. After months of struggling with the temperature, I finally found someone to fix the electrical problem at the school house which was causing the upstairs to be unnecessarily hot. Then the downstairs heat at our house seized up. When it was -15. All is repaired now but I don't really want to think anymore about pumps and pipes.
26 January 2011
13 January 2011
I can do that?!
Some days I stop to think about what I am learning in medical school, what people are going to trust me to do when I leave this building soon and I am actually frightened. EMT work was much less disturbing because in general, the people I could kill were already dead and I was not in the chair where the buck stopped. But now, I'm going to be able to prescribe doses of medications that could become toxic before I see you again and some other doctor will be trying to figure out what went wrong. Give drugs which will hopefully help but may irreversibly damage your heart, your kidneys or your liver. Hold your infant when he is still covered with amniotic fluid and needs life-saving medications. Try to stamp out the cancer that is slowly taking over your body by poisoning you with radiation. Of course I'm not going to do all those things, but the possibility is real.
I want to remember the feeling of awe I have right now. I've never really felt like physicians held overwhelming responsibility or a position of great status, but I don't know how I'm going to meet the standards society expects. I know that no physician starts out making all the right decisions, that is why we have such long training periods during which everything is reviewed and nit-picked to the finest detail. As I'm accumulating textbook knowledge and seeing the science as more and more feasible to master, the next uphill battle is looking mighty steep.
I want to remember the feeling of awe I have right now. I've never really felt like physicians held overwhelming responsibility or a position of great status, but I don't know how I'm going to meet the standards society expects. I know that no physician starts out making all the right decisions, that is why we have such long training periods during which everything is reviewed and nit-picked to the finest detail. As I'm accumulating textbook knowledge and seeing the science as more and more feasible to master, the next uphill battle is looking mighty steep.
06 January 2011
Trying to remember to be calm and think
After a bit more than a year break from writing to indulge in general medical school freaking out, a summer research project and the start of second year, I'm thinking about writing again. Brief update: the man and I have adjusted to living mostly apart, we got a second dog and so far I've passed all my courses. I feel like I might have a bit more to think about and say as I am pushing through the pathology of various body systems, approaching Step 1 board exams and clinical rotations.
Exams are heavily on my mind as the current curriculum includes an exam for each body system we cover (including the related pharmacology) and the ever-present specter of Step 1 lurking over my precious free time. Why is Step 1 so stressful? Because residency programs (post-medical school training in a specialty) use it to rank applicants and there is an overwhelming relationship between where you do your residency and what kind of jobs are realistically available to you afterward. My school has contracted with a paid review program to prepare us for Step 1 and yesterday my class took a short practice exam that is supposed to help us figure out our weaknesses and focus our studying - I'm hoping that the biggest suggestion isn't going to be all the systems we haven't covered yet!
As a generally good test-taker, I haven't worried much about standardized exams. I used some study prep materials for the MCAT because I'd been out of school so long, but I didn't really stress about the exam. Step 1 is a whole other beast in my mind, it feels ridiculously important, overwhelmingly difficult and is actually causing me major anxiety. In times of trouble, I always fall back on old habits - including trying to cram hours and hours of studying into my life even when it becomes ineffective. I'm trying to remember perspective and focus.
Thanks for checking in, hope to write more for you soon!
Exams are heavily on my mind as the current curriculum includes an exam for each body system we cover (including the related pharmacology) and the ever-present specter of Step 1 lurking over my precious free time. Why is Step 1 so stressful? Because residency programs (post-medical school training in a specialty) use it to rank applicants and there is an overwhelming relationship between where you do your residency and what kind of jobs are realistically available to you afterward. My school has contracted with a paid review program to prepare us for Step 1 and yesterday my class took a short practice exam that is supposed to help us figure out our weaknesses and focus our studying - I'm hoping that the biggest suggestion isn't going to be all the systems we haven't covered yet!
As a generally good test-taker, I haven't worried much about standardized exams. I used some study prep materials for the MCAT because I'd been out of school so long, but I didn't really stress about the exam. Step 1 is a whole other beast in my mind, it feels ridiculously important, overwhelmingly difficult and is actually causing me major anxiety. In times of trouble, I always fall back on old habits - including trying to cram hours and hours of studying into my life even when it becomes ineffective. I'm trying to remember perspective and focus.
Thanks for checking in, hope to write more for you soon!
20 November 2009
More dissection
It isn't surprising to me that the most interesting thing I'm doing in medical school right now is dissection. It also isn't terribly surprising that the memorize/regurgitate portion of anatomy takes some of the fun out of it. I try not to let that interfere with my enthusiasm for discovery and recent weeks have been quite interesting.
My dissection table learned a small amount of patient history at the outset of the course. As we progressed through the dissection, I learned she had several surgeries including some procedure which required her chest to be wired back together and that surgeons are not very careful about making sure free ends of wires are flat under the skin. Every time we begin dissection on a new area, we search for clues about what her body experienced and how it recovered or compensated. Although the first year of medical school is focused on normal anatomy/physiology/etc., we've encountered a fair amount of pathology from examining cadavers with 70-80 years of life experience.
The current section is chest and abdomen, but we've only just begun the chest. I held her lungs in my hands and marveled at the size, the structure and complexity of a lung and what it accomplishes. I wondered how hard it was for her to breathe in her last months with a tumor filling much of her right lung. We tried to guess where the tumor near her trachea had grown from and to before we were permitted to dissect that section. I held her heart in my hands and wondered if the tumor pressing down on it caused her pain, if she could feel the weight of her heart failing.
Interestingly, in conversation with some of the other students, they are questioning themselves because they felt nothing. One woman said she held the heart in her hand and thought, "Okay, what am I taking out next?" She is experiencing some self-doubt and questioning, but I think that is an entirely reasonable response. We've done so much dissection of these bodies that sometimes there really isn't any wonder left in a student by the end of lab. I don't think my reaction is any better or worse than others and I'm glad some folks are honest enough to share.
My dissection table learned a small amount of patient history at the outset of the course. As we progressed through the dissection, I learned she had several surgeries including some procedure which required her chest to be wired back together and that surgeons are not very careful about making sure free ends of wires are flat under the skin. Every time we begin dissection on a new area, we search for clues about what her body experienced and how it recovered or compensated. Although the first year of medical school is focused on normal anatomy/physiology/etc., we've encountered a fair amount of pathology from examining cadavers with 70-80 years of life experience.
The current section is chest and abdomen, but we've only just begun the chest. I held her lungs in my hands and marveled at the size, the structure and complexity of a lung and what it accomplishes. I wondered how hard it was for her to breathe in her last months with a tumor filling much of her right lung. We tried to guess where the tumor near her trachea had grown from and to before we were permitted to dissect that section. I held her heart in my hands and wondered if the tumor pressing down on it caused her pain, if she could feel the weight of her heart failing.
Interestingly, in conversation with some of the other students, they are questioning themselves because they felt nothing. One woman said she held the heart in her hand and thought, "Okay, what am I taking out next?" She is experiencing some self-doubt and questioning, but I think that is an entirely reasonable response. We've done so much dissection of these bodies that sometimes there really isn't any wonder left in a student by the end of lab. I don't think my reaction is any better or worse than others and I'm glad some folks are honest enough to share.
19 November 2009
Demotivational tool
Sometimes, feedback is not really what I need. Today I performed a physical exam (history, review of systems and the hands-on examination) of a "simulated patient". Simulated patients are people who are trained and paid by the university, come in and pretend to be patients all afternoon, complete with story lines and complaints, for the medical students to practice on. It is great to try being a doctor with the few skills I've actually gained and to try and shift my perception of myself from student to physician. It is nice to hear from my simulated patient what she thought of my performance and what I can improve upon.
The part that is not nice is, today, I sucked. I couldn't keep my mind straight on all the things I was supposed to ask, so there were some long awkward pauses. I have some expectations for myself given that I have patient care experience, but today I wouldn't have believed that I have ever been in the same room with another human, much less a patient. Even worse than just being bad is that it is recorded to DVD. I have to watch it and comment. I have to bring it to one of our small group sessions for everyone to watch and comment. I do not want to do that. I know my performance was not good. I know there was no sort of rhythm or flow and that I seemed nervous and awkward. I felt it at the time and my patient reinforced it, I don't need to have 11 other medical students tell me that too and I don't need to watch it. Just another wonderful thing to look forward to, I guess.
The part that is not nice is, today, I sucked. I couldn't keep my mind straight on all the things I was supposed to ask, so there were some long awkward pauses. I have some expectations for myself given that I have patient care experience, but today I wouldn't have believed that I have ever been in the same room with another human, much less a patient. Even worse than just being bad is that it is recorded to DVD. I have to watch it and comment. I have to bring it to one of our small group sessions for everyone to watch and comment. I do not want to do that. I know my performance was not good. I know there was no sort of rhythm or flow and that I seemed nervous and awkward. I felt it at the time and my patient reinforced it, I don't need to have 11 other medical students tell me that too and I don't need to watch it. Just another wonderful thing to look forward to, I guess.
15 November 2009
Reciprocal education
One of the courses I'm currently taking involves a VERY non-traditional process for in-class activities and learning structure. This class is traditionally one of the more difficult, even when taught in a traditional manner. The educational method for this class involves two phases. Phase 1 is assigned readings to be completed before class, an in-class quiz, group discussion and a group quiz over the same questions without access to course materials to discern the correct responses, and a brief instructor-led review of topics which frequently consists of diagrams from the text with little additional explanation. Phase 2 consists of readings or brief case descriptions involving a patient presentation of the related concepts from phase 1 (graded), a group activity to connect concepts and case presentation, a group quiz with questions from the case presentation, an entire class response time where we use "clickers" to record our group decision and receive group grades and sometimes a brief instructor-led discussion. Inherent in the grading is also peer-evaluation where the group members rate performance and contribution. There is also a contribution of the traditional written exam grades which is about equal to everything else listed above.
This course has caused much wailing and gnashing of teeth among students who feel that the instructors have completely abdicated teaching and evaluation duties and are not enhancing student understanding of this traditionally difficult material. I can honestly tell you that I retained zero information from the first several rounds of this process and spent a disproportionate amount of time trying to be prepared then separately trying to learn the information required for the written exam. A group of concerned students met with the faculty to attempt to understand how we were being graded, what the goals of the process were, how we could enhance our learning and what type of help they were willing to provide. This has been interesting because it resulted in additional information on what the intended goals were as well as persuading the instructors to provide us with additional information in the form of on-line lectures and the topics we need to connect between the case presentations and related concepts.
Today was the first time I felt like I've learned anything from this process. I read material before the quizzes last week, I listened to the online lectures and worked through my incorrect quiz responses from phase 1. I read the case presentation, found and worked through the concept connections and feel like I might actually understand how the material relates to the case. We'll see if that holds up tomorrow during phase 2 but I feel more optimistic about the process than at any point during the first 13 weeks of class.
This course has caused much wailing and gnashing of teeth among students who feel that the instructors have completely abdicated teaching and evaluation duties and are not enhancing student understanding of this traditionally difficult material. I can honestly tell you that I retained zero information from the first several rounds of this process and spent a disproportionate amount of time trying to be prepared then separately trying to learn the information required for the written exam. A group of concerned students met with the faculty to attempt to understand how we were being graded, what the goals of the process were, how we could enhance our learning and what type of help they were willing to provide. This has been interesting because it resulted in additional information on what the intended goals were as well as persuading the instructors to provide us with additional information in the form of on-line lectures and the topics we need to connect between the case presentations and related concepts.
Today was the first time I felt like I've learned anything from this process. I read material before the quizzes last week, I listened to the online lectures and worked through my incorrect quiz responses from phase 1. I read the case presentation, found and worked through the concept connections and feel like I might actually understand how the material relates to the case. We'll see if that holds up tomorrow during phase 2 but I feel more optimistic about the process than at any point during the first 13 weeks of class.
29 October 2009
Pause for a moment of dissection
I had my first "Wow" moment of anatomy dissection this week. Not to say that other things haven't been interesting or informative, but what I saw this week was really amazing. Part of lab is the expectation that you will complete dissection on the cadaver at your table and learn from the variation present in other cadavers throughout the lab to make the most of the unique experience afforded by our generous donors and to give students a chance to learn about natural variation.
Most joints have nice smooth surfaces, you can see a glossy shine to the cartilage on the bone ends. My table dissected the hip joint and we noticed some degenerative changes at the head of the femur, but nothing which really made me stop and take note. As I circled the lab to see the other hips, knees and ankles which had been opened, I stopped and could not believe my eyes. This knee was matte, dull and had grooves on the back of the patella and the front of the femur. I don't mean little changes of less shiny or grooves you could play back on a record player. I mean you set a cheap ballpoint pen into the groove and it would almost disappear. And there were 4-5 grooves that deep. Amazing, this woman was walking around on a knee (or maybe knees) that was so worn. You'd have to ask an orthopedic doc, but I'd guess that didn't feel very good. As I examined the joint with other students at the table, we tried to find the medial meniscus (your main cushion for all the pounding of your femur onto your tibia) and only a thin rim of it remained at the inside and the back. The only word for the entire joint was wow.
Most joints have nice smooth surfaces, you can see a glossy shine to the cartilage on the bone ends. My table dissected the hip joint and we noticed some degenerative changes at the head of the femur, but nothing which really made me stop and take note. As I circled the lab to see the other hips, knees and ankles which had been opened, I stopped and could not believe my eyes. This knee was matte, dull and had grooves on the back of the patella and the front of the femur. I don't mean little changes of less shiny or grooves you could play back on a record player. I mean you set a cheap ballpoint pen into the groove and it would almost disappear. And there were 4-5 grooves that deep. Amazing, this woman was walking around on a knee (or maybe knees) that was so worn. You'd have to ask an orthopedic doc, but I'd guess that didn't feel very good. As I examined the joint with other students at the table, we tried to find the medial meniscus (your main cushion for all the pounding of your femur onto your tibia) and only a thin rim of it remained at the inside and the back. The only word for the entire joint was wow.
05 October 2009
Hermit crab lifestyle
Carrying your home on your back can be hard work. Students of many levels experience this phenomenon, but I think grad students living off campus take it to an extreme. In the age of electronic everything, a number of my textbooks are available on-line which allows me to live out of a backpack and lunchbox. I generally refuse to stay on campus for dinner and try not to return to campus in the evening since I study well at home. Others in my class travel with multiple bags for exercise clothing, other books, breakfast and lunch and dinner, and the variety of other junk people carry around when they don't know when it might be feasible to leave the building. If we really could invent some sort of portable shell which would allow us to curl up and nap securely on campus, I don't think some of my class would even bother to rent an apartment.