Medschool + Sharing

Two years ago I sat with my fellow students in the auditorium like newly minted pennies, fresh, enthusiastic, bright eyed and ready to mount up on our journey into the unknown world of medical school matriculation. Our enthusiasm was our armor against what we all felt, the fear of god raining from the sky smiting us out of medical school with the doomed possibility of failure.  We had all heard of at least a story of the mishaps or misfortune of a poor medical soul lost to the abyss. It was a thought we couldn’t entertain, our enthusiasm alone would will us past our insecurities.

The all mighty validation of medical knowledge affectionately called the mean, ruled whether we were on track to medical success.  Below the mean meant a darker sky, less enthusiasm, more pessimism. By the end of first year we were so good at reading each other, we could split the class in half by disposition alone.

While reflecting on first year, I took the the time to explore medicine outside the semi lit lecture hall. I read case files, sat in on tumor boards, attended grand rounds and visited patients. I saw the lives of residents and innovative leaders share their latest medical research. I saw a collaborative world where patients were put before board scores, publications, edging out peers and politics. They were candid about limitations and honest about missteps in treatment plans. I couldn’t help, but wonder if there was something intangible in medical practice that we all shared that went beyond valid assessment by neatly organized test scores.

Returning to second year the stakes were higher, the work load larger and of course our time more limited. We weren’t shiny matriculated pennies anymore, but our armor was still intact. After all we had survived first year, we could do anything. But as second year took hold, fatigue crept in and boards loomed, our armor began to crack. Enthusiasm wasn’t sustaining us anymore. We became more candid and open about missteps and limitations. We started to share study guides more openly, and compensate for each other’s missteps to save our friendly simulated patients. As our armor continued to break down we had only one thing left in our arsenal, we shared our gifts.

About: Aaron Schenone Third Year Medical Student in St Louis, studying clinical research in oncology.

4 Years In Medical School Is Wasting HealthCare Resources

Ezekiel J. Emanuel MD, PhD and Victor R. Fuchs PhD want to speed up the clock in medical school and residency.

If you think 10 to 15 years of training to become a doctor is nuts but decided to go for it regardless, I have some bad news. According to recently published article in JAMA, you where right, it is nuts! More than that, it may be a place to look for cutting unnecessary costs in healthcare. This article calls to question some of the most basic assumptions central to becoming a physician.

The Death of The All Knowing All Powerful Physician

The picture of the lone physician hero fighting off death and disease may seem inspiring but is really just ignorant and impossible in healthcare today. No matter how many of your internal medicine attendings puff up their chest and say "I don't need to get consults" it does not change the fact that we can no longer effectively practice medicine in a vacuum. Learning to work closely with our colleges is something that competition in medical school has suppressed but it is a skill that future physicians need to develop.

The consequence [of trying to train one all knowing doctor] is a broad training regimen... [it] emphasizes the autonomy of the physician rather than team-based care. The new model recognizes that with increasing clinical and scientific complexity, no physician can be a competent triple threat; that few clinicians will also be investigators; that no single clinician can know everything even in his or her own specialty; and that effective care requires collaborative, multidisciplinary teams.*

Less Time In Medical School and Residency Makes Better Doctors

At first this seems like a paradox, but when you consider the time spent learning outdated and extraneous facts or working hard to efficiently take care of more and more useless paper work, it begins to make sense. What if the right of passage was something besides showing how well one can fill out reams of paper work on patients. I guarantee any intern will tell you this takes up most of there waking moments during the first year of training. The current system has evolved to fit this waste and has little reason to correct course because, "that's what interns and medical students are for". However this drives up education costs for new physicians and increasing educational debit also limits the career options for graduating doctors. We are all inherently practical and when faced with a mountain of debt, grabbing a job with the highest pay and benefits will win. Following your desires to work in an undeserved area or taking a risk on a new business venture is a cost that many will not take.

There is substantial waste in the education and training of US physicians. Years of training have been added without evidence that they enhance clinical skills or the quality of care. This waste adds to the financial burden of young physicians and increases health care costs. The average length of medical training could be reduced by about 30% without compromising physician competence or quality of care.*

Read the full article here: Shortening Medical Training By 30%

*Emanuel EJ, Fuchs VR. Shortening Medical Training by 30%. JAMA. 2012;307(11):1143-1144. doi:10.1001/jama.2012.292.

Endurance Training During Medical Training

9 tips for any medical student thinking about doing a marathon, triathlon, or even Tough Mudder?

A guest post by Brad Harris, a Medical Student and Ultramarathoner currently attending Loma Linda University School of Medicine.

People always ask me how I find time to train for 50 mile races while juggling a full schedule as a medical student? It's not a difficult as it sounds but it does take some work and planning.

Here is what I've learned....

Make it fun.

The most important thing is to incorporate activities you enjoy doing into your workouts. Find something that you just can't wait to get home to do then use that for motivation.  Remember, training doesn't have to be boring. Maybe you have a frozen yogurt craving. Instead of driving, run down to the local FroYo establishment, indulge, and run back home. Just make sure to make it something you look forward to. Enjoying your workouts is a mindset.

Find your pain cave, and crawl inside.

The pain cave is an uncomfortable place to be. It's a mental state that makes you feel fatigued and want to quit. Sometimes medical school pushes you into the pain cave. Find your personal pain cave and get comfortable with feeling uncomfortable. It is through stressing our bodies that we become stronger.

EXPLORE!

Grab a map, be prepared for the conditions, and go see what's around the next corner. Never stop exploring. Where does that trail go that's behind your house? How do you get to the top of that mountain? What's it like to run through the middle of skyscrapers in the big city? During my time in SoCal I've really enjoyed finding new trails in the local mountains, its actually become a hobby of mine. Don't be afraid to wander and explore new places from time to time.

Give each workout a purpose.

I, like most people, get bored simply going out and pounding the pavement for 3 miles every morning in order to check off the exercise box on the to-do list. Build variation into your workouts. Warm up and just run hills one day. Find a running track and do repeats of 2-8 minutes of sprinting with a 2 min recovery after each. Find an elliptical trainer or treadmill at the gym and set it to a random setting while you review notes or flash cards. Seek out new workouts to push yourself and keep it exciting.

Add minutes or even hours to your day.

Wasting time on the internet is something that we all do. By limiting time on the internet with a program like StayFocused, you'll be surprised how much more free time you have for exercising. Plan out your internet usage before getting on your computer and set a time for each task. You will be surprised what you can accomplish with an extra 30 minutes in a day?

Listen to review sessions while exercising.

A few of my classmates would audio record every lecture during the first two years of med school. I know some med schools do it for each class, either way, this is a great way to maximise study time.  Goljan audio review was my running companion for most of 2nd year. This is a great way to avoid feeling guilty about exercising when the pressure is building before exams.

Rest.

Lay low every once in a while. Take mental breaks, both from studying and training periodically. I have found that taking one day off a week from studying (I know they may sound like nonsense to some, especially those with gunnorrhea) did wonders for my focus and provided opportunities to maintain sanity and balance during times of stress. The body also needs rest. Don't be afraid of taking time off from exercise to let your body recuperate.

Plan long workouts on the weekends.

If you are looking to run a 10k, half marathon, or marathon - plan your long runs for the weekends or off days when you'll have more time. If you don't plan them, they won't happen! Also, try to make them an adventure, not just a slog. Proper planning and mindset will both make a huge difference.

Exercise after tests.

Maybe you missed some of the gimme questions that everybody else in the class said were easy on your most recent exam. Getting out and exercising after a stressful test is a great way to clear the mind as well as isolate yourself from frantically looking up every question you think you missed. Exercising will allow you to burn off some frustration and rejuvenate your mind to allow for more efficient studying.

Train with friends.

Some of the best conversations come during long training runs. Invest time forging bonds with new friends and reconnecting with old ones. They will keep you motivated and push you as well. Also having someone that is counting on you to show up for a run is great for accountability.

Hope these tips help! My endurance training has truly made a big difference in my medical school experience and I believe it will make me a better doctor as well. If you have any other great tips for training leave me a comment and let me know.

Do What You Love Guide: Tips On Keeping Dreams Alive During Medical Training

"Reality is merely an illusion, albeit a very persistent one."- Albert Einstein

From the outside looking in, becoming a medical student is not unlike scoring one of Willie Wanka's golden tickets. Most people see you as someone who is on the fast track to living a life of your dreams. They hear you are going to be a doctor and already picture you healthy and happy, with a condo at the beach. Sadly, the burnout rates and frustration amount physicians are on the rise, especially in primary care, and this trend does not seem to be changing any time soon.

Medicine is a culture with very rigid structure. Each type of physician is supposed to fit into a predetermined personality, way of practice, and even work schedule. There is a certain amount of brainwashing that is built into the system and it can be difficult to dream big and chart your own path in this sort of environment.

We are well into the graduation season and this means there will soon be many med students embarking on a new journey as residents, and many college grads preparing to hit the books as medical students. I thought this would be a good time for some tips on Doing What You Love.  For that we turn to someone who has helped many people follow there dreams...

Enter Leo Babauta, the founder of ZenHabits.

I wrote the first words of ZenHabits more than five years ago, I had no idea those few keystrokes would change my life.

I thought I was doing nothing more than reflecting on the changes that had been happening in my life, sharing a bit about what I learned with a handful of friends. I thought those tinkling of computer keys would fade into the void, as most of my thoughts had before that.

I never imagined that a year later, I would have 26,000 people reading my blog (and eventually a quarter million subscribers), that I’d finally be out of debt, that I’d have my first book publishing contract, that I’d happily hand in my resignation for my day job. All of that was out of the realm of possibility.

That’s the amazing realization here: that we rule out the possibility of great change, because it doesn’t seem realistic. For nearly two decades I focused on going to college, and working at a day job that I sometimes enjoyed but often dreaded, because that’s what we expect should happen. Starting my own business, pursuing my dreams, doing something I loved? Crazy talk.

Crazy talk is what I’m going to give you today, in hopes that perhaps one of you will expand your possibilities. It is possible — I did it, all while working a full-time job, doing free-lance writing on the side, and having a wife and six kids. I did it, even if I never dared to dream it for the first three decades of my life.

I am not someone who likes to give career advice, or teach people to be entrepreneurs. So I’m not going to do that here. I’ll just tell you this: it’s possible. And I’ll share what I’ve learned, in small snippets of goodness, about doing what you love.

If you don’t think it’s possible, do a small easy test.

Don’t think you can start a big/impossible idea? Start small. Take one small step in the direction of your dream. You don’t even need to tell anyone about it. It costs nothing, risks nothing, takes almost no time. But you will learn you can do that one little thing, and if you pass that test, you now know your theory of impossibility was wrong.

Expand your tests.

If you pass the first test, do another small one. Then another. Keep going and notice your confidence grow. Your skills grow along with the confidence. It’s amazingly simple. Iterate and re-iterate as long as you are having fun.

If you don’t know exactly what you love, don’t worry.

There’s no need to figure that out right away. Try something that someone else is doing, and see if you think it’s fun. The real fun part, btw, comes when you start to get good at it, so perhaps stick with it for awhile and enjoy the learning, then enjoy being good at it. If that first try doesn’t work, try something else. You don’t have to commit to one thing for your entire life. You can do a dozen a year if you want, for a decade. You’ll probably find something by then.

Find inspiration.

Think about what will inspire you 10 years from now. Who else is doing what you love doing? Who is excited about it most? Follow them. Learn about them. See what path they took. Watch closely how they execute, what they do right. Learn from the best.

Reach out to a mentor.

Of the people who inspire you the most, try to make contact with a few of them. If they never respond, try a few more. See if you can buy them lunch or coffee. Don’t pitch them on anything. Just ask for their help, and say you’d love for them to mentor you in a way that won’t take up much of their time. Don’t demand a lot of time, but go to them when you’re having trouble making big decisions.

Choose one passion at random.

Some people have many interests and don’t know where to start. Pick one or two randomly if they’re all about equal, and just get started. Don’t let choice paralyze you. Get started, because in the end it won’t matter if you started with the wrong passion — you’ll learn something valuable no matter what. Read more.

Get good at it.

You get good at something with practice. Allow your friends and family to be your first audience, readers, customers. Then take on a few others at a low cost, or increase your audience slowly. But always have an audience or customers if possible — you’ll get good much faster this way, with feedback and accountability. Read about it. Watch videos. Take a class. Join a group of others learning. Find people to partner with. Before long, you’ll be good at it.

Help others.

One of the best ways to get good at something is to help others learn. Making someone’s life better with your new skill is also an amazing way to get satisfaction out of what you do, to love what you do. Help as many people as you can in any way possible — it will pay off.

Find your voice.

Eventually, as you master your skill, you will learn that you are different than the thousands of others doing it. You will find your uniqueness. It’s not necessarily there at first, because you might not have the technical skills to express yourself. But eventually, find that voice. Find the thing that sets you apart, that helps you to stand out from the crowd. Then emphasize that. Read more.

It’s the doing and loving that matters.

Many people focus on growing, or hitting goals, or making money, but they forget what matters. What matters most is loving what you do. If you love it, and you’re doing it, you’ve already succeeded. Don’t worry so much about achieving certain levels of success — people push themselves so hard to reach those things that they forget to enjoy what they’re doing, and in the process they lose the reason they’re doing it in the first place.

Dream bigger.

Once you’ve overcome the initial fear and started to become good at something you love, dream bigger. The first stage is small steps, but don’t stop there. You can change lives. You can change the world. Doing so will change you.

The Battlefield Mentality Of Medicine

 The Physician Casualties of Medical Tragedies

A Guest Post by Dike Drummond, a family doctor who specializes in physician burnout prevention and treatment at his website, The Happy MD.

The mother of the dead baby sat in her husband's arms and simply asked "why?" over and over through the Vietnamese interpreter. I had no way to answer the question. I didn't know why. There was nothing to point to. No defect in the child or mother or the actions taken in L&D.

All I could do was say "I am so sorry" ... for your baby, for you ... for everyone involved.

It was a nightmare, losing a baby during childbirth in my family practice residency. It was THE thing each of us dreaded the most. What happened afterwards was even more devastating in the long run. What happened was ... nothing.

It had been a normal evening on call. The family practice residents ran our community hospital. I would end up delivering over 250 babies in my two years here. It was just before midnight, three women in labor, I had just changed out of my clothes into green scrubs and the typical long white jacket.

As I walked past the first labor room on the left I heard an obvious deceleration on the external monitor. HR dropped from 140 to less than 60 for almost a full minute with what looked like a late pattern. The mother was a Hmong woman who did not speak English. This was her third child. No previous problems in childbirth.

She was doing just fine. Dad was standing by the bed in the half light of the labor room. Everything was quiet - that’s how I had heard the deceleration. The night shift had just come on. A calm scene really, except for the yellow light of my nerves jangling from the deceleration.

Exam showed her to be 7 cm dilated, head well applied, normal contraction pattern. The decelerations continued. Protocol called me to rupture the membranes and apply a scalp electrode. I opened the amnion hook, had the nurse stabilize the external monitor puck and apply some fundal pressure. The father held the mother’s hand as they spoke quietly to each other in a language I couldn’t understand.

I ruptured the membranes but only a small amount of clear fluid came out. The heart rate dropped immediately to zero as if it had tipped off the edge of a table and fallen to the floor. 140 - 60 - 20 - nothing. Vaginal exam showed no prolapsed cord, no bleeding or any other abnormality. I was the only doctor in the hospital. The OB attending was 15 minutes away. This baby needed to be out right now.

With much shouting to push, my fingers completing the dilation of the cervix and good cooperation from the mom ... we had the baby out within three contractions.

No nuchal cord, no abruption, no blood anywhere ... the child was normal ... except it had been without a heartbeat for almost 5 minutes at this point. Full resuscitation. Epi down the tube. Chest compressions. Nothing. [Heart breaking. Are we getting anywhere? I do not want to call the code and give up.] Suddenly, five minutes of chest compressions and two doses of Epi in ... we have a heartbeat at 160. [Hallelujah] Stop the chest compressions. Let's tape the tube and call the NICU in the big city down south.

As the nurse and I begin to breathe again ... I feel a gentle tap on my shoulder. The father is standing next to me and points at my left hand. I notice that this whole time - as I stabilize the ET tube and the child’s head - the tip of my left pinky has been touching the baby's open eye. I thank the father, change my grip and close the upper lid. I begin to realize this heartbreak of the last 20 minutes is only the beginning.

We got the call three days later. The child showed no signs of brain activity and the ventilator had been turned off. I released the breath I had been holding since that night in this moment of final recognition. The baby was dead. That is NOT supposed to happen to anyone ... ever. Not to the baby, not to the family and not to any Resident.

The director of the residency program and the OB staff held a case review. No "fault" was found. Procedure had been followed. The baby's post mortem was normal. All actions were deemed "appropriate". I was not to blame. That was very little consolation. The baby was dead. My mind ran over and over the events like a gerbil on a wheel.

A little piece of me died that day. Deliveries were never the same joyful wonder they had been before ... they were bullets to be dodged. For years and another 300 deliveries I would occasionally be jolted awake at night by a vision of an amnion hook with a trigger on it.

In the days and weeks afterwards ... it gradually dawned on me that something I had always taken for granted ... was NOT happening. We were a small residency ... only 8 of us running our community hospital. It felt like a family. I had always assumed any tragedy would be met by a rallying around the unfortunate resident.

Here was our collective worst nightmare ... and ... nothing happened. Nothing except the case review and my meeting with the family - both agonizing experiences where I was by myself. I felt tainted, like a failure, an outcast in the wilderness.

I don't blame anyone. I am certain the first reaction among my colleagues was ... "OMG it happened". Followed by, "thank GOD it didn't happen to ME."

It’s the same thought process as a soldier in battle when his best friend goes down as they storm the beach. I don’t know if I would have thought the same things if it had happened to another resident. I don’t know if that fear would have stopped me from reaching out to them. Here’s what I do know...

Most of the physicians I have worked with have their own version of this story; something bad that happened followed by complete isolation. It has hurt us all. Let’s vow to end this compounding of the natural tragedies that occur in our profession. Losing a baby is bad enough. Coming away from the experience feeling that no one really cares and we are all on our own in the end ... is a wound on a wound. This does not have to continue. We do not have to let our own fear stop us from supporting our colleagues in their hour of greatest need.

If you are still reading this article, I want you to know something with crystal clarity. Your Physician Colleague who suffers a bad outcome wants you to come and talk with them. Sit and have coffee, put a hand on their shoulder. Make them a “hot dish” so they don’t have to cook for a couple days. (I am from the upper Midwest ... that’s just what we do) Do it again and again until they say, "enough already".

There are some stories even our significant other and parents can never understand ... only another doctor can fathom the feelings. The next time tragedy strikes in your medical community, reach out to your sisters and brothers. PLEASE don't run from them because of your own discomfort. They are not contagious, nothing is going to rub off on you.

Don't let the natural "battlefield mentality" win out. Notice it and act in spite of it. It will make a huge difference to your friend. I promise.

This is the time when you can step up and pay it forward. Just be there ... when it counts the most. You never know when you will desperately want them to do the same.

-Dike Drummon M.D. The Happy MD

The 5 Top Inventions That Will Make Being A Medical Student Or Resident A Breeze

The Future Of Medical School and Residency

1.Never Miss Another Pimp Question With Google's Project Glass

Google is working on a pair of glasses complete with a heads up display inside the lens. Soon you'll have an Android Operating System right in front of your eyes. If the attending asks you for 15 differentials for a patient with dizziness you can give her 20. Also sweating through another operating room anatomy pimp session will be a thing of the past. Just pull up the Netters app on your glasses and tell the surgeon to bring it! The glasses are slated to hit the market by the end 2012 at a cost of between $250 and $600. So start saving your student loan money now.

2. Never Forget the Definition of Any Medical Term With Touch-Hear

This idea is from National University of Singapore's Design Incubation Centre. Essentially, by touching a word or phrase in a particular piece of reading material, the user can listen to its related information such as pronunciation and/or meaning. Those obscure medical terms that are always on the tip of your tongue but you just can't remember will not be a problem. If a question says, the patient has astasia-abasia, asomatognsia, abulia, and anosognosia and you are lost? No problem, you now have the answer at the tip of your finger.

  

3. Holding Retractors in a 20 Hour Surgery? No Problem With a Powered ExoSkeleton

Currently being developed by the United States Army for application in combat. The powered exoskeleton gives a person super human strength. Current models increase your strength 10 fold and will never fatigue. Imagine how much easier holding that butt cheek retractor will be once you can slip on an exoskelton.

4. Long Lectures Become Fun With Flexible/Foldable TV Screens

Soon those gruelling all day medical school lectures will turn into a wonderful experience. Just bring a stack of notes or text book and slide your TV screen into the pages. Instead of keeping up with the professor's boring lecture you could be Keeping Up with the Kardashians. Just remember to move your highlighter around from time to time so they don't suspect something is up.

5. Take the 80 Hour Work Rule And Laugh In It's Face With Turbo Snort

The product is called Turbo Snort, I really don't think much more needs to be said. One bottle boasts 400 hours of energy. With Turbo Snort you will be able to huff your way to success in medical school and beyond. Just slip on a pair of google glasses, an exoskelton, and take a shot of Turbo Snort and you will become the Medical School Gunner version of Iron Man.

Medical Student By Day, Indie Author By Night

Brian Justin Shier is a 3rd year Medical Student at the University of Califonia Irvine School of Medicine. He plans to pursue a career in Hematology and Oncology.

As B. Justin Shier he is also the Author of the Zero Sight Series. The first two books in the series have been well recieved with loads of 5 start reviews on Amazon. As well as this high praise.

Top 5 in Kindle Contemporary Fantasy Ratings
--Based on Amazon reader reviews (September, 2011)

Top 10 in Hot New Contemporary Fantasy Releases for the Kindle
--Amazon (June, 2011)

I had the pleasure of chatting with Brian about medical school, writing, publishing, and finding time to make it all happen. He maintains an eclectic online journal at www.bjustinshier.com where many topics are discussed, including future releases of his book series.

Listen to our conversation below, right click to download an mp3 file.

Uncommon Student MD talks with Brian Shier