Lately I've heard more and more rants about how today's medical students need to "grow up" or that we are "wusses" for not wanting high-stress jobs or for asking what we need to know for the exam, or how today's senior physicians are "washed up and out of touch."
Don't get me wrong, I strongly agree with the fact that medical students should not be recording remains of body donors (as mentioned in here). This does NOT happen at my medical school; along with virtually all of my classmates, I am strongly in support of my faculty's oft-stated policy that bringing cameras into the lab is grounds for dismissal from the program. While you can be upset at the students for doing this, there's also a lot to be said for not giving the students the opportunity.
What I am referring to is the impression of some more senior doctors that today's medical students are wimps, and that medical students today recoil to comments like this by saying that old doctors have no idea what it's like now.
One retired MD in my faculty, extremely well-respected among nearly everyone who knows about him, made the entire first-year class an exception to this during a lecture by making comments to them that he thinks they never would have survived medical school back in his day.
This only generates division between the generations. "How can he say that?" they reply. "HE would never make it through OUR medical school class. There is SO much more known about medicine today... heck, DNA wasn't even INVENTED when he was a medical student!" Despite their exaggerated protests, they have a point. One example: a rheumatologist told us "The things you are learning in this week in your second year of medical school weren't taught to me until my fellowship."
And whereas most people respect him very highly for his accomplishments in the faculty, all the first-years I spoke to on this won't see him for that. In their words, they think he is a "tool."
In fact, that retired doctor is right in one regard - today's medical students wouldn't make it through medical school back in his day... but only because they wouldn't make it in to medical school back then. This goes both ways, though - he and many from his generation (as I've heard many M.D. interviewers from that generation say during interview weekend) would likely not make it past the admissions process to get into medical school if he submitted his application from 1950 to one of today's medical schools.
And that leads me to the point of this post. Admissions procedures, like so many things, are very, very different today from how they used to be. Comparing a medical school class of today to a medical school class of 20, 30 or 40 years ago is virtually impossible.
Some of the differences I can come up with:
1. How medical students are admitted.
---> Class of 1960: Chosen on the basis of GPA.
---> Class of 2000: Chosen for extracurriculars, personality, answer to the ... . These days, many people in medicine know someone with stellar MCAT marks and GPA who are not in medical school. Back in the day, they were the only ones in medical school.
As a result of the admissions, this leads to a difference in:
2. The type of medical students that are admitted.
---> Class of 1960: Students who put medicine first. Everything else second.
---> Class of 2010: Variety of extracurriculars and social supports (family, friends, etc.) Can't get in to medical school without demonstrating this.
The type of students that get in is related to:
3. How the students that get in approach a high volume of information.
---> Class of 1960: Medicine comes first, so I will learn it all.
---> Class of 2010: How much do I need to know to pass the tests, so I can still have time to enjoy time with my family, friends, and extracurriculars?
This impacts:
4. Types of specialties students choose
---> Class of 1960: Specialties that allow them to be doctors 24 hours per day, live at the hospital, and surround their lives around their career
--> Class of 2010: A documented increased interest in "Lifestyle specialties" (a term now recognized and used by the AAMC) such as the "R.O.A.D. to a good lifestyle" - Radiology, Ophthalmology, Anesthesiology, Dermatology. Or, working 4-day work weeks. As medschoolhell puts it, "Honestly, why work 60 hour weeks for $120,000 per year if you can work the same amount of time and pull in $300,000?" This way, they can spend time with their families and doing the things they love, with their career on the side. Apparently that is what makes us wusses.
Put both types of medical students in a high-stress situation, and that leads us to the fifth difference.
5. What happens when these medical students are subjected to extreme stress
---> Class of 1960: Learn the physiology, pathology, and stay awake until you know it all. This is not a problem because its what they did during undergrad, and medicine comes first so sleep is the only thing that needs to be sacrificed.
---> Class of 2010: Learn the physiology, pathology, and stay awake until you know it all. This is a major problem because during undergrad, these students relied on their many extracurriculars to help relieve stress... but now, the volume of information is much too great to have time for anything other than study. So, far too many students have outlets in other ways... drugs to help them get to sleep (both prescription ie. sleeping pills, and non-prescription ie. alcohol), full-on medically diagnosed anxiety attacks, many minor freak-out sessions.
Anatomy on the Beach has written on this as well, and mentions a number of other factors: dashed expectations, professors who could probably do a better job of explaining the relevance of some of the seemingly irrelevant, nitpicky details we're expected to memorize and regurgitate, and the reality and stress of medical school which can dampen the enthusiasm of learning.
Well, this is just my take on the situation - in my opinion, the Class of 1960 and Class of 2010 are too different to be compared to each other and call one group "wusses" in relation to the other. I would be very interested in hearing from people who have been around longer and therefore know about this situation a lot better than I do...or anyone who has thoughts or can think of other differences.
Monday, June 23, 2008
Are today's medical students wusses? Consider what's different now.
Sunday, June 15, 2008
Top 10 List: Ten things I learned in second year med school
Keeping with the tradition, my classmate Jay wrote another list of things he learned. Again, used with permission.
1) Chest pain at rest can also be diagnostic of 3+ cups of coffee before 10am.
2) Being in med school, I achieve a high Woodcock-Johnson every morning.
3) After one week of teaching us about chronic pain, the take-home message is to not call our patients liars.
4) I get all teary-eyed in only 2 situations: watching the ending of the movie Rudy, and being bedside at a live birth.
5) It is possible to almost completely forget what you had known front-to-back the previous week... and do this over and over for 20 straight weeks.
6) Me, and possibly most of my friends, have this condition called Orbitofrontal syndrome.
7) Apparently, the local hospital administration is willing to disrupt/discontinue the medical education of hundreds of 2nd year medical students, because of food and drink inside a lecture hall... and that hundreds of 2nd year med students respond by shrugging and using that forget-what-just-happen-last-week ability.
8) Toxic megacolon is pretty much exactly what it sounds like.
9) Everything you do in med school is the next hardest thing you've ever done.
10) Oh my god... in 2 months, they're going to expect me to make real-life decisions about patient care... wtf, I'm PRETTY SURE that I'm not ready to do that.
If you enjoyed this, check out the top 10 things Jay learned in first year.
Tuesday, May 06, 2008
Cool body tricks: Nystagmus
In class a few weeks back, we learned that if you put hot water in one ear and cold water in another (the "Caloric test"), you can induce nystagmus, a symptom that involves your eyes quivering back and forth.
A guy in my class changed his MSN name today to: "I just did the caloric test to myself... it works."
Med students are a funny breed.
Of course, the coolest tests come with a cool mnemonic: the mnemonic for this one is COWS.
Sunday, December 23, 2007
Words I'd use to describe med school: Honour
There are a number of words I'd use to describe med school. This blog post is the first of a small series I'll devote to expanding upon these words.
I've heard people joke about it before. "You know, you're lucky... as a doctor you're one of the few people who can get someone to to take their pants off for you within minutes of having met them!"
That's not necessarily always a fun thing, considering how unpleasant it is to perform a digital rectal exam on, say, a patient who has lost control of their bodily functions and hasn't showered in weeks.
But that borderline crude statement has a lot more to it than just humor.
Statements like that only scrape the surface of the depth of the honour it is to be able to practice medicine...something that we med students can occasionally tend to lose sight of when we are in the midst of 80-hour work weeks on the wards, or in our tenth 15-hour study day in a row, or when we've just been humiliated by a preceptor in front of both our colleagues and patients.
While I can use this blog to complain about finals or how much stress I'm feeling at times, I probably don't say enough that I do feel honoured to be a part of this profession.
There are so many ways in which this honour is revealed. Here are a few I can name:
- Medicine: a profession to which people are willing to donate their bodies...their most personal possession....after they die. It's an honour to be a part of that.
- Medicine: a profession to which people are willing to give you a huge amount of trust just because you are a part of the profession. Depending on where you look, physicians may not be the #1 most trusted profession, yet around the world, they almost always fall in the top 10 (BBC: Doctors #1; Harris: Doctors #1; Ipsos Reid Canada: Top 5; Reader's Digest Australia: Top 10). It's an honour to be a part of that.
- Medicine: one of the professions in which there are so many sides and approaches to the common goal of health, and in which those various health professionals are starting to work harder to work together to achieve this goal. It's an honour to be a part of that.
- Medicine: one of the few reasons that a driver, though enraged by the thick of traffic, would still be willing to pull over. I've seen people grumble when a cop turns on the siren to whiz through a red light, but never when an ambulance has come through. It's an honour to be a part of that.
- Medicine: one of the few professions legally allowed to self-regulate by the Canadian government. It's an honour to be a part of that.
- Medicine: the reason why people will open up to me their deepest secrets, the greatest extremes of their emotions, their first and last moments on this earth...all because of my field of study. It's an honour to be a part of that.
- Medicine: one of the areas of study that thousands of the most intelligent university graduates fight for the chance to be able to enter every year. It's an honour to be a part of that.
- Medicine: one of the professions where you are able to call some of the most brilliant, accomplished, fascinating and devoted people your colleagues. It's an honour to be a part of that.
- Medicine: one of the professions with a longstanding legacy throughout centuries, and is continually looking back into its history and deep into its future to better itself for the good of the patient. It's an honour to be a part of that.
===
Even if I could think of all the reasons why it's an honour to be studying medicine, I don't think all of them could be put into words.
That being said, I know I've missed some... if anyone is reading this and can think of some I've missed, I'd love to hear your thoughts in the comments!
Thursday, December 20, 2007
When the dust settles
It was just as if a hurricane had passed.
The merciless pounding stopped,
and everyone began to come out of their makeshift shelters,
wandering bleary-eyed into the streets,
looking at the destruction around them,
assessing what little they had left of their friends, and social lives, and dignity.
And they began to talk to each other,
wondering aloud,
putting into words the thoughts they were all thinking...
"Did that really happen?"
"I can't believe I made it. There were times when I didn't think I would."
"Can it actually get worse?"
"I'm not sure anybody would understand what this was like if they didn't see it with their own eyes."
Yep... finals for the term are now done... and another semester is over.
Time to enjoy the precious few weeks of recovery before it all starts again in January.
Saturday, December 15, 2007
You know you're consumed by studying when...
I found this list in a friend's Facebook notes... and with her permission, am reproducing it here for your reading pleasure. I won't pretend that I'm coherent enough to be this creative at this point right before finals... this many 15-hour study days in a row is enough to shut down most basic cognitive functioning.
You know you're consumed by studying when...
10. You think osteoclasts are cute (white furry balls!)
9. It seems like you're studying more than breathing
8. Things that secrete mucus are mucous-secreting
(clarification for those not in our class: incorrect spelling = incorrect answer = no marks. because we don't have enough stress!)
7. Breaks consist of eating
6. You don't sleep, you nap
5. You look forward to sleeping
4. Taking a shower is a relaxing activity
3. A change of scene involves studying a different block
2. Hearing "6 days til the holidays" provokes fear, not excitedness
1. You think personal hygiene is an option, not a necessity
Okay... back to work!
Sunday, December 09, 2007
Final are depressing. No, really - I can prove it.
School in itself is a challenge for most of my classmates and myself, especially with finals study time in full swing. Apparently they want doctors to know a lot of things.
I looked at a post I wrote about this time last year and it's very similar to how I feel right now.
One of the differences this year, though, is I know my classmates a lot better, and so I'm much more aware this time around that many of us have a lot of additional stress outside of class. There are a number of students that I am genuinely worried about - I honestly don't know how they have the strength or stamina to get out of bed every morning, considering what they have going on in their lives.
This year in clinic I learned about a questionnaire called the PHQ-9, which the physicians gave to some patients as part of a comprehensive assessment for depression.
As I got to know the questions better, I began to realize that if you took a survey of my class right now - in the middle of finals season - based on this questionnaire I wouldn't be surprised if the vast majority of them would register as "severely depressed."
In fact, to prove it to you, I'll go through it right now:
Over the last 2 weeks, have you been bothered by any of the following problems?
Check. Even things I used to like doing, like learning about medicine. Too much of a good thing, you know? Like a dump truck full of ice cream.
b. Feeling down, depressed, or hopeless
Check. Despite the overwhelming statistical precedence that 99% of us will pass, everyone I talk to thinks they will be the one person who will fail.
c. Trouble falling asleep, staying asleep, or sleeping too much
Some of my classmates are so revved up that they are self-medicating just so they can sleep at night.
d. Feeling tired or having little energy
Try exhausted. And I don't think it's African Sleeping Sickness.
e. Poor appetite or overeating
One classmate told me that her theory is that "everyone in our class either gains or loses weight during finals."
f. Feeling bad about yourself, feeling that you are a failure, or feeling that you have let yourself or your family down
Wow, I swear the writers of this questionnaire talked to my classmates
g. Trouble concentrating on things such as reading the newspaper or watching television
Haven't had time to do either of those. But trouble concentrating while studying...check.
h. Moving or speaking so slowly that other people could have noticed. Or being so fidgety or restless that you have been moving around a lot more than usual
Absolutely. Mini-anxiety attacks will do that to ya.
i. Thinking that you would be better off dead or that you want to hurt yourself in some way
Not me in particular, but there are some in my class who might...I've heard comments like "I want to crawl in a hole and die," "Maybe I should just drown myself in the bath," and "If only I had a gun." Which ones should I be taking seriously?
Major Depressive Syndrome is suggested if:
• Of the 9 items, 5 or more are checked as at least "More than half the days."
Proven. Voilà.
In fact, if I could find a checklist for "Cabin Fever," given the number of students cooped up in a study room for the last few weeks I can guarantee we'd score pretty high on that one too.
At least our faculty isn't like some other ones I know of, which, in response to student comments that the curriculum is stressful, recommend that the students a) seek counselling - kind of not an option given the limited free time during finals study time - and b) take anxiolytics, ie. medicate the stress away. Thanks for your support.
Gonna get back at it. Wish me luck.
(Again, this is not a place for you to be getting medical advice, but if any of the above apply to you - and things won't return to normal on a set date ie. you aren't in the midst of finals - please book an appointment with a professional!)
Thursday, September 27, 2007
It had to happen eventually: "That sounds like something I read on a blog once."
When I'm hanging out with med friends, as much as we may try to avoid it, every conversation turns to school somehow... some gross thing we saw, some cool clinic case, or general hatred or love for certain professors. (The professor who approached me and told me he reads my blog fits into the latter category, of course).
The other day I was at a classmate's house having some incredible steak, and for some unknown reason, the conversation turned to our cadavers.
We were talking about the nature of our cadavers and how some of the ones with high BMIs are really hard to dissect... some of them you're cutting through the skin and you cut and there's fat, so you go deeper and there's more fat, and you go really deep and you're in the muscle, and so you go back and realize that there isn't any distinction really between the fat and the muscle like there is on the really nice cadavers; instead, on the more fatty ones it's more of a gradient and the fat and muscle is all mixed together, making learning the muscles of the thigh and buttock a much different experience than if you had a different cadaver.
Anyway, a girl who's also in my class piped up that on some of the cadavers, at room temperature the fat is mostly liquid, and this requires suction to get rid of the extra liquid.
"Mine's a lot like that," I said. "It seems like every lab I'm suctioning the fluid... the dead human body fluid... mine had so much I ended up with it dripping all over my leg once."
At this point, my buddy's brother, piped up. He's not in medical school but is interested in going; otherwise he probably wouldn't be able to stand hanging out with med students and listening to their med chatter. He was apparently interested - not grossed out - by my story. "How did that happen?" he asked me.
I explained the story that I've written here before under the heading of Great Moments in Anatomy Lab, where I had proceeded upon a course of actions that resulted in DHBF (Dead Human Body Fluid) dripping down my leg.
This is where things started getting weird. Not dead body weird, but, well, read on.
After I told him the story of how I ended up with DHBF dripping down my scrubs pants, he looked at me and said, "That's funny, there's this medical blog I read, some medical student somewhere in the Carribean - the exact same thing happened to him."
I knew right away where this conversation was going to end up.
"Vitum writes a blog," said his brother. "Maybe you read it there."
"No," he replied, "this one I read was from a student in the Carribean, I think. The exact same thing happened to him - he ended up with DHBF all over his leg."
Either somebody is plagiarizing my blog, I thought, or he's referring to my story. "Yeah, I think that's my blog," I said.
"No, no," he insisted, "I really think this was some medical student in the Carribean that wrote the story."
I loaded up my blog on my mobile phone's web browser and said, "Read this."
Before he read it, he said, "Okay, okay, the story I read on this blog ended up saying the guy was upset that he had cadaver juice running down his leg, but the worst part was that this was the second time it had happened."
Which is exactly the premise of my story.
I handed him my mobile phone and stood back, watching it sink in.
He finished reading and looked up. "Weird... so that's you... well, I've read a fair bit of your blog. I had no idea."
I thought it was funny but he seemed a bit weirded out. Ten minutes later he was still talking about how weird it was that he'd been reading my blog all along, and he knew me, yet didn't know I was the author.
I did warn him I'd be writing about this. Still, I hope that reading about himself here won't be too weird.
Friday, June 15, 2007
Top 10 List: Ten things I learned in first year med school
Guest-written by my classmate Jay...used with permission, of course. I don't just steal things off my friends' Facebook profiles without asking!
1) I now get annoyed when conversations, even daily conversations I have with family and friends, aren’t quick and to the point, and last longer than 8-10 minutes.
2) The only treatment for a muscle injury is nothing.
3) A patient will not fully disclose the information you inquire about until after you’ve asked, re-phrased, asked again, re-phrased again, and then asked while cocking your head slightly to the side in a conscious gesture of interest... I call it the power-cock.
4) Prednisolone is Snoop Dogg’s prednisone.
5) On a scale of 1 to 10, 5 is not firm enough to penetrate.
6) Even for $14,000 per student, a well-thought-out curriculum and well-taught lectures aren’t guaranteed.
7) Foosball is a cunning game of skill, agility, dexterity, and mental steeliness.
8) Short white coats do two things: they instantly identify you as a clueless rookie… and, they make kids cry.
9) The one time you fake it and say you can hear a bruit or murmur, the clinical instructor will say that there isn’t one.
10) Med school is nothing more than just really hard school.
Update: Jay wrote another list at the end of second year.
Friday, June 01, 2007
Eaglestar's Dilemma: Study for finals, or see his child?
With this whole studying for finals thing going on, especially now that classes are over and I am leaving my study books at school because all I do at home is sleep (and I wonder why I go all the way home just to do that - why not sleep on the clinical skills practise beds!), I feel like I've been fairly disconnected from my family, my friends outside of med school, and heck, even a large number of my med school classmates that choose to hole up in a study room other than my own.
Turns out I'm not the only one that feels this way.
In a rare study break opportunity, when my attention-deficit was getting the better of me, I turned to a friend in my class that I was studying with... we'll call him Eaglestar (hey, again, as is my policy with classmate aliases - he chose his own), and asked him about his son, who was just born a couple months ago.
"Hey, Eaglestar, how's your son doing?"
He lifted his shoulders in the air.
"Who knows!"
We all had a good laugh about it, but we probably should have been crying. In fact, I've decided that anybody in my class that I see smiling is simply neurotic...there is no joy right now!
Yep, guess I'm not the only one who feels disconnected from anything not med school.
Thursday, January 25, 2007
"Oh, you can come in for this, it's not a breast exam."
It turned into a breast exam pretty quickly.
I was at a family physician's office for my mandatory Family Practice class. I'll be going 14 times this semester. Typically its the one time each week we 1/8th doctors can actually put on our humbling little short white coats (white enough to look doctor-ish but not long enough to look cool - especially for guys), fling our hardly-used stethoscopes around our necks, walk proudly into actual clinical exam rooms, and see real, live, sick people. Maybe ask them a few questions. And hope not to get sworn at by patients (speaking from experience here).
It would be anything but a typical day. I was told that my clinic partner, being of the female gender, would be interviewing the next patient. 'This patient is here for a breast exam,' said the doctor, "so Vitum, maybe you can sit this one out." I didn't mind. I was entirely used to - and comfortable with - not observing something like this until I have been well-trained in the process.
My clinic partner interviewed the patient briefly, then came out of the room and described the patient's complaint as a lump below her left breast. The doctor told me: 'Oh, Vitum, I suppose you can come in for this, then; it's not a breast exam.' He checked if it was OK with the patient and it was. In I came.
It turned into a breast exam pretty quickly.
I'll admit that a while ago I was a little nervous about how I'd end up doing my first 'intimate' or 'gender-specific' examinations - nervous enough to do a bit of research on the subject. After doing Google searches using creative combinations of the search terms "medical student," "breast," "exam," "vaginal," and "how the hell do male students not show signs of awkwardness or even arousal when being taught to perform professional medical exams on patients," I censored my search results and carefully chose a link and hoped to find something telling me something of the process.
I got lucky. I ended up reading a well-written article by Jules Lipoff, a second-year medical student at the Albert Einstein College of Medicine entitled "Dr. Strangeglove, or, How I Learned to Stop Worrying and do Breast and Pelvic Exams." That article appeased some of my misconceptions about training in these areas. While I had initially pictured being herded into a patient room at a hospital with 7 other medical students following a resident or attending physician and being instructed to 'check out' a patient, one after the other, I was relieved to see that the article addressed
a) thoughts...of ...and during ...the experience,
b) the fact that medical schools work hard to increase professionalism and minimize awkwardness by using trained clinical educators, from whom medical students gain both insight and practical experience, and
c) the fact that students have fair warning about when their first exam of this nature will be (the students in the article were given a month's notice).
I didn't get a month's notice. "We might as well do a breast exam since it's been a while since we've done one with you." The patient consented a little too readily.
When something happens in front of a patient that's a little shocking, as a medical student with common sense you know it's not right to make it obvious that you're going through mild forms of shock. So I hid my surprise at the fact that I was not expecting to watch a breast exam, and yet now, here was one being performed, right in front of me. "Use this part of your finger and go in little circles," said the doctor. "They say to spend five minutes on each breast when doing an exam, but I never have time for that in my practice." I didn't catch much else. My mind was busy reeling from the situation.
Fortunately, the patient didn't add any awkwardness; she was totally fine with the whole situation and was chattering away happily about the history of her originally "A-cup" breasts, her choice to acquire implants, the rupture of said implants, the removal of said ruptured implants, and subsequent natural growth of a well-endowed pair after said removal of said ruptured implants.
My mind continued reeling. In fact, I was still getting over what I was watching when the doctor turned to me and said, "Vitum, your turn."
Damn.
I'm not sure how well I hid the shock that was pretty much taking me over at that time. It was enough to watch this. Now I was expected to monkey see, monkey do. What was I going to do, say 'no'?!
So, somehow confidently, I stepped forward, and reached out, and put my hand down on the breast of a woman whom I'd never met before, a woman that was old enough to be my mother. I still have to get used to how much nakedness doctors see. I began moving my hand around in circles, like I'd been shown. I also began thinking to myself, "Think professional thoughts."
Looking back, I don't think I did that for more that about six seconds before I stepped back to let my clinic partner have a go at it. "No lumps?" said the doctor. My mouth made some sort of a sound, and the doctor replied, "Good!"
So that was my first breast exam. Yay for me for reading up what my first clinical breast exam would probably be like, and yay for it being absolutely nothing like that.
You never forget your first time, do you... especially if it's as unexpected as that.
Thursday, January 11, 2007
My faculty's Admissons Committee has great taste
Other than a few exceptions, I'm really encouraged by the exceptionally good taste that my Faculty of Medicine has displayed in choosing our class. (And by exceptions, I'm not referring to myself. I'm one of the good-taste choices. Obviously.)
There are some incredibly fascinating people in my program. Students who have competed in the Olympics, played various sports at a high level, been politicians, media pundits, entrepreneurs and businessmen, matriculated from the world's top universities, or defended our country as soldiers or fighter helicopter pilots... there are so many people in my class whom I admire that I had to write a whole other post about it.
Beyond the incredible accomplishments of individual students, it's neat getting a group of medical students together and taking a look at them all. While there are differences between us, we're all so similar in many ways. A lot of us are really motivated, driven, and clearly know what we want to do with our lives (and in some cases that has come after trying several different things). We all care a lot for other people, and we are generally quite outgoing and love to chat (though this results in our class sometimes being overly chatty and not shutting up when it's time for class to start).
The thing that has fascinated me the most, however, is this: while everyone in my class brings a huge skill set to the table and our class is generally very intelligent, there are hardly any nerds; most people are really well-rounded and involved in a lot of different things. It's really interesting meeting people who are really outgoing and seem like your average cool guy or girl, but then you see them in a small group or talking about something we're covering in class and you suddenly see a brilliant side of them you haven't really seen before, watching them talk about the voltage-gated potassium transmembrane ion channels that play a role in the regulation of the insulin release from beta cells of the pancreatic islet, or something like that.
We've got a class full of really quality people, and it's been a blast getting to know everyone. I'll be proud to refer my patients to almost any one of my classmates someday, and I'd be willing to put my life in their hands.
