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Lessons Learned From First Year

April 17, 2009 by 15 Comments

Originally posted on The Differential on September 3, 2008

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I’m sitting here in my room on the island of Kauai. It’s the week before classes resume and my second year begins. Coincidentally, I’ve met two of my classmates on Kauai within two days of arriving on the island.

Being this close to the start of a new school year, I can’t help but remember the feelings I felt before starting first year. I also can’t help but think about what I’ve learned during the first school year.

My cousin, who is now an OB/GYN, told me to just study like I did in college. Unfortunately for me, I hardly studied at all in college. I was in an undergraduate program that was heavily math-based. I used to cram and be alright for tests because all I needed to know were theorems and/or concepts. The rest could be figured out or derived during an exam. Medical school was a big shift for me because now the majority of my studying consists of rote memorization.

So, from the perspective of someone who has had his share of first-year struggles, here are some of the lessons I learned from first year.

1. Figure out your learning style and figure it out fast. This one seems like it’d be common sense. But sometimes students find out that their way of studying isn’t working and instead of changing their approach, they go at it harder. Personally, I felt that going to lectures helped me. But I know many of my classmates hardly ever showed up. If you thrive in a good group study, seek out some classmates and make a group. If not, then don’t be forced into one. However, even lone “study-ers” can benefit from the occasional discussion with classmates.

2. Seek help. Students who make it into medical school are used to being near, if not at, the top of their respective classes. It might be hard to ask for help. If you need help, put aside your pride and ask for it. At my school there are tutors available for the first and second year students. I think that if I had sought out a tutor, I could have had some better scores. Don’t wait until it’s too late to get help.

3. Make time to do other things. It’s really easy to get caught up with studying when the pressure starts piling up. But it’s important to remember to make time to do things outside of schoolwork. Volunteer to tutor high school students. Take up a new hobby. Continue an old hobby. Go to the gym. Or even go and volunteer at a free clinic so you can get patient interaction. Don’t let studying define who you are.

4. Study hard. Push yourself — at least through the first semester. Then, you can decide how much you can afford to pull back while still attaining acceptable (in your eyes) scores. It’s easier to “ease off the throttle” because you’re studying more than you need to, than to “floor the pedal” trying to catch up at the end of the school year.

5. Finally, visualize. Remember the reason you wanted to go into medicine. Don’t forget it. Then, picture yourself done with medical school and residency, and practicing medicine. Aim for that goal. Try not to let the stuff in between — the grueling hours of studying in medical school or running around in residency — get you down. They might be necessary parts of the journey, but they sure aren’t the destinations.

Good luck!

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How Good Do You Want To Be?

April 17, 2009 by Leave a Comment

Originally posted on The Differential on August 25, 2008

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I’ve been obsessed with these Olympics. It’s been so inspiring watching the athletes compete. The last event I saw was the Women’s Beam Final where America, led by Shawn Johnson and Nastia Liukin, won the gold and silver medals. After Shawn Johnson won the Gold Medal, the commentator talked about her background.

Ten years ago she bounced into Chow’s (her coach) gymnasium and began training at the age of six. During those years of training her coach asked her an important question: How good do you want to be?

That is a question every athlete must answer for himself or herself. The top athletes in the world only want to be the best. And they put their whole soul into achieving their goals, putting in hours and hours of training every day. The answer to that question determined what kind of training Shawn Johnson would need; it dictated the course of her childhood, finally culminating in an Olympic Gold Medal.

A couple of weeks ago I asked why we, as medical students, should bother learning something we’ll eventually forget. A number of people commented and left what they felt was the reason for learning such things. And I think they are all very useful answers to this question.

For me, the answer is best phrased in the question I heard while watching the U.S. Women’s Gymnastics competition -– the same question Shawn’s coach asked her: How good do you want to be?

At the end of my first year I spent almost two weeks on the General Surgery service. On the last day I was there I spoke with the chief resident who was less than a week from completing his general surgery residency. He spoke about his training and how he felt it was very well rounded. Because he had to rotate through many services, he felt comfortable speaking to internists, neurosurgeons, orthopedic surgeons, radiologists, etc. Even though those areas were not his specialty, he knew enough to communicate intelligently about a patient. These days, with multiple teams caring for a single patient, effective communication between healthcare providers is crucial.

Someone commented that a doctor with a broad base of medical knowledge is a well-rounded doctor.

A well rounded doctor means better care for patients. And it’s all about the patients, right?

So… How good do you want to be?

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Uncertain About Uncertainty

March 20, 2009 by 2 Comments

I spoke with the one of the deans in charge of the School of Medicine’s graduate programs. We spoke about the program and I asked about the PhD and MS in physiology.

She said there are positives and negatives to science and a job as a scientist. One big positive is the feeling one gets when making a big discovery. There is nothing like it. Unfortunately, those times are rare and one must cherish and hold on to those special moments.

Then she asked me how I deal with uncertainty because, in her mind, there is quite a bit of uncertainty when doing research.

I told her that I wasn’t quite sure. “I guess I’m uncertain about uncertainty,” I answered with a chuckle.

By the look on her face, I don’t think she was too amused…

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Picture Perfect

March 20, 2009 by Leave a Comment

Originally posted on The differential on August 17, 2008.

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Like many Americans and non-Americans alike, I have been following the 2008 Summer Olympics. It’s been fun watching Michael Phelps grab a record 8 gold medals, Misty May-Treanor and Kerri Walsh dominate on the sand, and the “Redeem Team” (I’m not sure who came up with that nickname) led by Kobe Bryant and Lebron James handle business in the early preliminary rounds.

But it’s also been amusing to read the news about how Beijing has focused on putting on the perfect show. First there was news that some of the fireworks outside of the Olympic stadium were faked using the wonders of modern technology. Then I read that the cute little singing girl dressed in red was, well, just cute and little. She wasn’t actually singing. The real singer wasn’t “cute enough” and so the red-dressed girl was told to lip-synch.

It looks like China has been doing a whole lot to convince the world that all is well and perfect in their country behind that bamboo curtain. And maybe it is. But most likely it isn’t. Of course, I have yet to find any place on earth that is perfect.

The whole idea of projecting perfection, though, reminded me of some of the things we discussed in class. One professor noted that doctors have this strong desire to stick together. They want to give a colleague the benefit of the doubt. As a result most doctors are very slow to offer any criticism, often exercising their right to remain silent because they weren’t present during the procedure.

I think that giving the benefit of the doubt is great. False accusations can lead to devastating consequences. But there have been instances when certain doctors no longer deserved the benefit of the doubt. An extreme situation is described in the book Blind Eye by James Stewart. In that book, Stewart writes about a doctor that got away with murder.

Would transparency in the medical field be beneficial to both doctors and patients? I’d like to think so. But sadly, with our current litigious environment, complete transparency would be a nightmare.

And so, doctors may very well have to continue painting that picture perfect image of medicine.

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You Look Familiar!

February 27, 2009 by 2 Comments

This week during clinic I walked into an exam room behind my attending. She introduced herself and then she introduced me as a medical student. The fifth grader in the room exclaimed, “You look familiar!”

I just laughed and asked, “Oh?”

“You look like that guy on MythBusters,” the kid told me.

I just laughed again. The guy on Mythbusters? I assume he was referring to the Asian guy named Grant Imahara and not the girl or one of the white guys (because I am an Asian male, if that wasn’t already obvious)…

Oh and a few minutes later the kid asked me if I did anything extreme… like blowing things up (like the guys on mythbusters.) I think he was disappointed when I told him the most extreme thing I’ve been involved in is medical school…

Patients make me laugh…

And what am I supposed to say to this? Thanks?

*****

I was also put on the spot this week in clinic. A patient came in with a complaint of a bump on her hand. The attending looked at it, then looked to me and asked for my “spot diagnosis.”

Tentatively I replied, “Uh… wart?”

Fortunately I was correct. But my satisfaction with myself lasted only until we saw our next patient who had Otitis Media.

The attending decided to quiz me. “What’s the most common causes of Otitis Media?”

She told me number one was Streptococcus Pneumonia and waited for me to give causes two and three.

Brain went totally blank there. She finally told me two and three are Haemophilus Influenzae and Moraxella, respectively.

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Why Bother Learning Something We’ll Lose?

February 14, 2009 by 5 Comments

Originally posted on The Differential on July 30, 2008

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During high school I took three years of Spanish. I thoroughly enjoyed it and really wanted to spend a year abroad to become fluent with the language. Unfortunately, when I got to college, I desperately wanted to finish in four years. My year abroad ended being sacrificed. In my final year, I did take Spanish 101 and 102, more for the fact I knew they would be easy A’s.

Two years removed from graduation, I’m sad to say that I feel I wasted all that time studying Spanish. I haven’t used it at all. Sure, I might remember some words and phrases here and there. I can probably still conjugate the present tense of most regular verbs. But I can’t remember the vocabulary. I turn on Spanish television and I get nothing. Well, the actors are pretty dramatic, so I suppose I can get something.

The other day I was standing in line at the Argentinean Consulate when the lady behind me started talking to me in Spanish. I looked at her, puzzled. She repeated her question. I tried to piece together what she was saying but the only thing I got was “Koreano.” I assumed she was asking if I was Korean. Well, I finally apologized and told her I couldn’t speak Spanish after which the conversation ensued in English. But I couldn’t help feeling frustrated that I couldn’t even understand a simple question after more than 3 years of Spanish classes.

Language is just one of the things that you have to use, or else you lose it. And this got me thinking about medical training. This year, as with most first year medical students across this country, I took General Anatomy. As far as I know, I won’t have any anatomy classes during second year. But Step 1 of the USMLE exam will cover General Anatomy. It worries me that I will go through an entire year without ever having an Anatomy lecture. I guess I am going to have to continually review myself whenever I find myself with that elusive “free time.”

I also thought about the practice of medicine. This year, I heard a talk by a cardiology resident. He said that while he was tempted to go into surgery, he found the clinical skills of surgeons to be lacking. Most wouldn’t be able to properly auscultate a patient. He had chosen cardiology because the cardiologists he had witnessed all impressed him with their clinical abilities.

One could debate the merits of having surgeons equally competent in wielding a stethoscope as they are with scalpels. It is probably not really important for surgeons to retain this skill. After all, they are called in to do their specific job — to cut open a patient and fix an immediate problem. If a patient requires auscultation, then his or her internist should be able to do this or refer the patient to a cardiologist.

But doesn’t it seem like a waste of time, money, and — well — medical training to just let a skill atrophy? Would time in medical school be better spent training students in the specific specialties they are interested in? Why bother teaching a student proper auscultation skills if the student is heading into Ophthalmology? I wonder, is there a better way to train our doctors of tomorrow?

In his book, Complications: A Surgeon’s Notes on an Imperfect Science, Dr. Atul Gawande writes of Shouldice Hospital in Ontario, Canada. The surgeons there are experts at hernia repairs. That is all they do. Day in and day out, the doctors do nothing else but repair hernias. What may be surprising to most American medical students is the backgrounds of those who operate at this clinic. A few of them have never even completed a surgical residency. But they have trained extensively at repairing hernias. This clinic, Dr. Gawande writes, has a far higher success rate for their operations than any other place in the world. Why? Because they only do one thing, and they do it amazingly. Can this be applied to medical school to cut down on the massive amounts of information that medical students are force-fed each day?

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Time Flies

February 13, 2009 by 4 Comments

Today as I was walking through campus I noticed a banner hanging on a wall announcing that it was Parent Day for the School of Medicine. This is a day that the Freshman medical students get to bring their parents to class and basically show off. I wrote about my Family Day experience here.

As I walked by I felt like I just had my Family Day. I almost wish that I could go back in time and be a first year again. At least I know (now) that I could do it. I’m struggling right now. Going through one of the lows of medical school. And I can’t help but think about doing something else.

There are times when I wonder whether or not it’s all worth it. I hear it all the time. But most of the time it’s from people who have no idea (i.e. they’ve never attended medical school nor do they have any desire to do so).

I wrote a post about it for The Differential. It’s a post about the taboo we seem to have — admitting doubts about ourselves. (Here’s the link.) It’s on the new Differential platform so you will need a Medscape account if you don’t have one already. If you don’t care to sign up for it, I’ll probably repost it here in about six months (minimum time before I can post it elsewhere).

This morning I also heard a classmate say, “If this doesn’t work out, at least I can go to law school.”

I have no idea what context that was in. But I couldn’t help but wonder about law school myself…

Ok, well I realize this is a somewhat scattered post — even for me. But oh well. My brain is scattered. I just got home from the last test of the week and I think I averaged only a couple hours of sleep a night. I don’t like giving excuses.. so call this an explanation.

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