We are two exams into medical school, and I am starting to lose the ability to converse in a socially acceptable manner.

This was already a delicate situation. Since even before postbac I have become increasingly difficult to watch television shows with. I point out medical errors, incorrect logical assumptions and bad scientific methods pretty much as I see them. My parents think it’s cute. Everyone else has taken me off their movie-night guest list.

Now, however, the endless solo study hours are starting to affect my daily interactions. I ran into a fellow med student as I was leaving the library after a ten hour study session the other day and our interaction went something like this:

Her: Hey, how is it going?

Me: I…it…good…think it is. You are doing, how?

Her: ::nervous laugh:: I’m pretty stressed too. Uh…good luck?

Me: I words hard find. Sleep now. Bye.

That was a good day. After a particularly unproductive study session, with the weight of my worries and my backpack weighing me down, the slightest hint of sympathy is downright dangerous. I find myself telling perfect strangers about the genetics paper I haven’t written yet, or that the real problem with studying biochemistry is that all the enzymes have the same names. The guy I buy coffee from every day knows the structure of our exam questions and my roommate has heard several blow-by-blow accounts of classes I’ve found particularly frustrating. In my head I am thinking, this person doesn’t care about the stupid class exercise you did today. This person is a CVS employee who just wished you a nice afternoon. She would probably like to return to her magazine. STOP TALKING.  And yet the poorly syntaxed words spill out.

I always figured that the classic physician stereotype of not being able to talk to their patients came from the general personality type attracted to medicine. We’re folks who like to know how things work, and for the most part the content of our studies is geared toward the technical side of things. But now I’m starting to wonder there isn’t a certain amount of unlearning of basic communication that occurs simultaneously with stuffing one’s head full of facts. I’ve heard statistics on how medical training can dull one’s sense of compassion; perhaps one’s sense of coherency suffers as well.

On the other hand, it might just be me. And it might just improve, given a few more group study sessions and a week off to breathe.

In the meantime, let me know if my writing starts to nosedive into incoherent babbling. And be very sure you want a full answer to your question when inquiring how things are going.

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Amid all the whining about exams and stress and studying, I want to share with you one of my favorite things about medical school. I am sure I’ll come up with a few more in time (I am expecting awesome things from the simulation center, for example), but right now the highlight of every week is our class patient interview.

If you’re not familiar, a tried and true habit of medical schools since ye-olde-days is to get find patients with the disease you are studying and bring them in front of the class to talk about their condition. I suspect that in said ye-olde-days they also demonstrated their ailment or had to deal with some undignified poking and prodding by the presenting physician. In our class, thus far, they have simply sat in the front of the room with a clip-on microphone and answered questions by their physician or, in a few cases, a specialist in the field who may not have met them yet.

I have a few selfish reasons why I love patient interviews. First of all, it isn’t material we’re tested on. Yes, the disease of interest is related to what we are studying, but there is no expectation that we will take notes, and the interview is not recorded, for confidentiality reasons. We’re not even allowed to have our computers open during the interview, which is a big deal in a curriculum where everything is online. The only expectation is that we show up on time, we dress professionally and we wear our white coats. Some people do take hand-written notes, but I am happy enough for the chance just to listen for a change.

Besides the low-stress environment, a patient interview offers so much to learn. First of all is the variation. Lectures strive to teach you typical cases, but seldom do I expect a patient to walk into my practice with every single hallmark sign of a disease. It’s kind of fun to watch the physician try to lead the patient down a particular path (and when did you start to experience X symptom?) only to have the patient go off in an entirely different direction.

We also get the chance to see how a disease affects day-to-day life. Most of the lecture pathologies come with a cause, a list of symptoms, and perhaps a few lines about what the patient might say if they wandered into your office looking for a diagnosis. Patient interviews follow a narrative. They fill in the blanks between doctor’s visits and express frustrations I might not expect.

Also? I love any excuse to wear my white coat. I know it’s terribly dorky of me, and I’m usually uncomfortable in my nice clothes before I even get to school (last time we were all caught in a rainstorm that somewhat (haha) dampened the professional spirit), but dressing up for patient interviews makes me feel like I’m really in medical school. Like I’m actually going to be a doctor someday. That thought still catches me by surprise sometimes.

I do, however, wonder what it looks like from the patient’s perspective. I understand the need to dress professionally–how awkward would it be to talk about your health problems in front of 150 kids slouching around in T-shirts and sneakers–but I wonder if the white coats don’t make it a bit more intimidating than it needs to be. A friend of mine who has been the subject of such interviews said that everyone looked like clones. I suppose you have to be a brave soul to agree to the patient interview in the first place. I also wonder if it isn’t a bit pretentious for us first years, who know nothing much of merit, to be sitting around wearing these symbols of knowledge, as though we had something to offer this individual other than gratitude. Regardless, I am glad they are required, because if left to my own devices, I would never quite feel my white coat was an appropriate wardrobe addition.

White coats notwithstanding, I hope the interviewed patients have a positive experience as the subjects of our scrutiny. When the floor is turned over to the students for questions, at least one individual usually voices thanks for the opportunity. I hope the patients know how genuinely it is meant. We future physicians like to pretend that we’re something special, but in the end we are nothing without the trust of the sick. I have not yet earned that trust, and it feels very special that, despite that, there are those out there willing to put themselves out there for our education.

What do you call the dude who comes in last in his medical school class?

Answer: Doctor!

I was told this joke when I was preparing for postbac. It’s funny, right? Because no one wants their doctor to be that guy. We all hope we’re getting treated by a genius who never misses a needle stick and can diagnose you as soon as you walk in the door. We don’t want to think about our doctors missing questions on exams or struggling to understand the basic concepts of disease.

I think that’s part of the reason I get a funny look when I tell people that medical schools are pass/fail for the most part. (The first two years, anyway.) No one wants to think about their doctor as someone who just barely scraped by with a 70; we’d at least like to think of them striving for that A.

source: Yoga Retreats.

There are good reasons for the pass/fail system, though. By and large we medical students are competitive bunch, and that particular quality is only reinforced though extreme curves and weed-out classes in pre-med. That kind of competition has an ugly side. There is a pretty significant difference between a doctor who made it to the top of her class because she is intelligent and hardworking, versus one who made it by being vicious. (Although, I won’t lie, it makes for great television.)

Beyond that, most of the medical schools I seriously considered attending seemed to take the attitude that, by virtue of being accepted into their program, we had proven ourselves. We all had the capacity to become physicians, and there was no need to put us through the wringer just for the sake of establishing our right to be there. Once you’ve made it to medical school, you’re clearly a smart, driven person. Now it’s just a matter of making sure you’re a smart, driven person who knows how to practice medicine.

Of course. there are degrees of excellence, so in case you’re worried that all doctors are considered equal, keep in mind that the second two years of medical school are graded, and students must pass  two numerically graded board exams before they can be considered for residency. There is another board exam after the first year of residency, and regular board certifications throughout a doctor’s career.

And, if I might just add, having just clawed my way through my first real medical school examination, passing medical school is nothing to sneeze at. It isn’t the same thing as passing high school or a college course. These tests are designed to challenge us, we who fought our way to the top of the undergrad heap.

So to the dude who came in last in his medical school class? I will most certainly call you Doctor. I know very well that you earned it.

For your captain obvious insight of the week, I present to you the following information: Medical school is hard.

I’m not saying that I’m surprised by this fact, but I do feel a bit as though someone turned my treadmill up to 11 while I was still in warm-up mode. Or perhaps I should go with the tried and true “drinking from a firehose” metaphor, which I have heard no fewer than five times this past week. (It has become no less accurate with repetition.)

I suppose the real shock to my system is the utter lack of “ramping up” that occurred before between casual-laid-back-if-you-feel-like-it orientation classes and let’s-cover-all-of-cell-biology-in-two-days-and-you-don’t-mind-if-we-slip-two-quizes-and-an-ethics-lecture-in-there-and-oh-by-the-way-here’s-histology. I spent Monday, Tuesday and half of Wednesday in a partial daze wondering if maybe a pass/fail system wasn’t quite fool-proof enough for me.

As I started to get my footing later in the week, though, I also realized that postbac started much the same way. Those first few days of chemistry, I struggled my way through laughably simple equations like a rusty gear struggling to turn. Sitting in a classroom having utterly no comprehension of what is being said with the sinking sensation that the person sitting next to me is hanging on every word is not as new of an experience as it felt. Sometimes the difference between comprehension and confusion is just a few hours sorting through powerpoint slides and online textbooks in the library.

It’s the first weekend of medical school and I’m still standing, albeit listing slightly. I spent six hours in the library on a Saturday and I have a sneaking suspicious I should have been there longer. I’ve got my game face on and I’m pretty sure this is exactly where I’m supposed to be right now.

I feel like I have started medical school three times already. First there was social orientation, which began with a trip to visit a local historical site. Everyone was nervous and excited and in full-fledged getting-to-know-you mode. Then, of course, there was the first day we had to show up to class and the subsequent four days of academic orientation. More nervousness. Slightly less getting-to-know-you. A small amount of information was conveyed over a long period of time, which was likely a good thing given that all of us were adjusting our schedules to waking up for a morning class. 

Then today, still yawning and surprised to find ourselves awake at 8AM, we had our first actual class. There was a real lecture, a patient interview, a small group session and homework.

We’re not done starting things though. This first class is only three days long, as it turns out, and entirely ungraded. (I’m sure there is a consequence for skipping it entirely, but the pass/fail system hasn’t officially kicked in yet.) Monday we begin biochemistry, when the real chips are down.

All of these overlapping beginnings have left me a bit off-kilter. I feel spread out and unfocused. We’ve been in class all day each day, with dinners and social events in our free time, and only a moment here and there to do the smattering of assigned work. I’ve yet to form a routine, to get a feel for the pattern of day to day life as a medical student. We’re being offered opportunities–clubs, student governments, volunteer work–but I am reluctant to sign up for anything until I know what my time and energy is going to be in the coming months.

I feel like I’m listening to a discordant piece of music. I know there’s a melody in there somewhere, but my brain is stuttering over predicting the next note. Our lecture today abruptly threw a smattering of biochemistry into the discussion and I found myself panicking over my inability to take good notes. I couldn’t piece together what was relevant or important. I forgot to click in a quiz question because I was distracted trying to figure out where we were in the lecture. I have not bought a single book. I am assured that is okay, but I’m apprehensive about reading most of the medical literature on my computer.

Amidst all of this I keep checking in with myself and asking, “Do I feel like a medical student yet? Have I really started medical school yet?” Thus far the answer has been, “Um…sort of?”

Two days from now is our white coat ceremony. Perhaps once I have my official doctoral vestments I will feel like this all is really happening. After all, seeing “Medical Student” on my ID badge filled me excitement, perhaps seeing my name embroidered across a pristine white coat will do the trick.

Maybe I should bring my stethoscope too…just in case.

Well, folks, the time has arrived. Social orientation for medical school is already underway, and the academic orientation is breathing down our necks. So we begin. (Please imagine some dramatic music to go along with this opening.)

Orientation, by nature, is one of my least favorite activities. Social or academic, I always wish I could just download the relevant information and skip to the part where we’re all settled. Instead, I’ll be spending countless hours, often sweating at outdoor events, going over the standard med student intake questions and desperately trying to think of something to say to spark a real conversation with strangers.

Source: Tory Shulman

Ninety percent of the conversations go like this:

Step one: Introduce yourself. For extra points, actually manage to remember the other person’s name.

Step two: Establish where the other person is originally from. Extra points if you know a detail about that location. More extra points if you’ve lived there yourself and can discuss local inside jokes. Minus points if you note that another first year is from the same place.

Step three: Establish where they went to undergrad. Minus points if you’ve never heard of the school.

Step four A: How long have they been in town? For me, this involves a short derailing of the conversation to explain that I have been in town for two years because I did a postbac.

Step four B: Having been shifted into a conversation about postbac, we fill in the missing years between undergrad and now. I politely correct their use of the word masseuse. I ask how they are liking the town and fill in my own favorite details.

Step four C: Where are they living in town? Bonus points if you almost lived there or looked at it on your apartment hunt.

Step five: At this point the conversation has probably gone on long enough that someone else has shown up and everyone has started over at step one. Ideally this is also where the conversation can begin to drift into new territory, but also runs a high risk of trailing off into silence if no one can think of a good segue.

The extra awkward part? Unless you have an eidetic memory, there is a decent chance you will run through this conversation more than once with the same person. Neither of you may realize it. I’ve taken to giving my apologies up front. “I’m sorry, you might have already told me this but….”

I should add that everyone I have met thus far has been lovely. Which is kind of a problem, because, with everyone on their best getting-to-know-you behavior, it’s hard to get a sense of anyone’s personality. Who is going to get my sarcastic humor? With whom can I unashamedly discuss my favorite geeky hobbies? Who is not going to stand for my long-winded explanations? Or will be offended by my work for Planned Parenthood?

In a few months I’ll have a much better idea. In the meantime, I keep doing the orientation dance and hope I can keep my foot out of my mouth long enough to come out the other side with a few friends to my name.

…it’s resting until school starts in August. Stay tuned for our triumphant return.

via seton.com

I don’t know that there are terribly many prospective medical students who read this blog, and I imagine those that do have plenty of advisors to guide them along the path toward getting into medical school. But on the off chance someone might gain some aid from what insight I’ve gained over the past year, here are a few tips for applying to medical school.

Submit your primary application ASAP

I talked about primary and secondary applications in a previous post. The AMCAS application is the one that gets sent out to your schools. It includes all the basics; classes, personal statement, work history, letters of rec. You send your official transcripts to AMCAS once and they verify all your grades and classes before the schools even know you’re applying to them. This process can take up to six weeks (or so the organization says.)

It’s a first come, first serve business though. If you have everything in to them by the first date you can submit your application (June 1 I believe) then the turnaround on verification is about a day. If you wait even a week after that, suddenly that six weeks is pushed to the max. We weren’t even taking the MCAT until mid June, and scores didn’t come out until July, but some folks were still waiting on their AMCAS verification well after everything else was ready to go. It made a much bigger difference in interview invites than I think any of us could have guessed.

And by the way, it takes time to get transcripts sent, not to mention a personal statement and the fact that the application requires you to type in by hand every class you have EVER taken post secondary school (including AP courses.) Plus you’ll have to write a short paragraph about your three most important extracurricular activities, which was pretty excruciating. This is not an application you can run off the night before it’s due.

Apply to a wide range of schools

I have no idea what algorithm they use for deciding to invite people for interviews. All told I had interview invites to a few reach schools, a few right-in-my-grasp schools and two safety school. I was flat out turned down by several schools that had significantly lower average GPAs and MCAT scores than my average, as well as a slew where I felt right on the mean. Why? I haven’t the foggiest. Meanwhile several reach schools not only interviewed me but interviewed me early.

I was always going to apply to the in-state public schools (your chances of getting into an in-state school are wildly better than getting into an out-of-state public school and mildly better than a private school) but aside from that, there was a great deal of arbitrary decision making that went into selecting which schools were on my list. I can’t help thinking that if I had been pickier, I might have had a far emptier dance card come application time.

Of course there was a mild correlation with how quickly I returned by secondary applications which is why….

Turn your secondary applications in ASAP, but don’t skimp on them either

Secondary applications are obnoxious, I won’t lie. You’re asked the same, stinking questions over and over again in slightly different ways so that you have to write out a brand new essay (or tweak the hell out of an old one) each time. By the tenth time I had to come up with a creative way of explaining how I was a diverse student or come up with a reason why I wanted to attend that specific school, I was starting to question how much I really wanted this school to like me after all. We were told to send in our secondaries within 48 hours of receiving them, but it was weeks before I even looked at many of them.

In the end, though, the first four secondaries I turned in were the first four schools to invite me for interviews. In one interview I was told that my essay had been one of the best they had read and afterward they felt they had to talk to me. Meanwhile the schools that I dragged my heels on or that I lazily submitted reworked versions of previous essays didn’t give me the time of day. Secondaries count. Don’t forget it.

Apply to in-state public schools; be wary of out-of-state public schools

All of the in-state schools I applied to invited me for interviews and invited me early.

Meanwhile, an out-of-state public school from the state I had lived in before the postbac, a medical school whose hospital I had volunteered at and whose campus I had lived literally across the street from, was the first school to reject me. (And no, score-wise it wasn’t a reach.) The only other out-of-state public school I applied to not only declined to interview me, but apparently forgot they had even sent me a secondary application. Ouch.

The trends I noticed applying to medical school were based on my own experience and a few close friends. Hopefully it can help give someone the jump on the whole application process as the cycle begins again. Most of all, if you are applying, remember to cast a wide net. Luck plays a bigger role in who makes it to medical school than most of us would like to admit.

A few weeks ago I wrote about the pain and confusion of attempting to cover the cost of education through student loans. There is, of course, an easy answer to avoiding all of this nonsense, so I want to talk a bit about why I chose not to go into the military or apply for the National Service Health Corps.

If it weren’t for the military scholarship, I would likely not be starting medical school in a few months. The seed that was planted in my mind three years ago (by a bygone acquaintance), was that I would apply to the Uniformed Services University of Health Sciences (USUHS) in Bethesda, Maryland. Anyone who promises time to the military after medical school (three to seven years depending on your situation) gets their tuition paid for outright, a small stipend to live on while in school, and a $20,000 signing bonus. (In addition, it was one of the few schools that might have accepted a slew of community college credits as prerequisites. Before I knew I was doing an official postbac, or even what a post-baccalaureate pre-medical program was, this was an important piece.)

Let me tell you, even I know it’s tempting.

The thing about the military is that you can attend medical school anywhere you want to, but afterward your options become extremely limited. The military needs certain kinds of doctors and they need them in specific places.

Everyone who finishes medical school will eventually match into a residency program. This is done by a computer: you list your top programs, the program lists its favorite applicant, and the computer figures out the lowest common denominator. The military has the same approach to residency, but it’s separate from the civilian match program. This means residencies for specialties the military needs–general surgery, general medicine, trauma–are going to far outnumber the ones they have less demand for. Sure, even the military needs pediatricians and plastic surgeons, but those positions are much more competitive. (I looked up neurology and, in my brief research, it looked like there was only a single residency program in the country.)

Beyond the limitations in specialties, there is something about the military that I don’t think would fit me very well. First of all, I’m a wimp and the prospect of boot camp is enough to give me pause. More importantly I do not, as my mother says, suffer fools gladly. I’m not known for keeping my mouth shut when I disagree with someone. I’ve heard that doesn’t always go over well in the military hierarchy.

The other pay-your-way-through-med-school option is the National Health Service Corps. This is a program you apply for (they are very selective) and if you are accepted, they will pay your entire tuition up front. In exchange you agree to do your residency in general medicine (internal medicine, pediatrics, family medicine all count) and work for a number of years in an area that is low on physicians.

Even if you aren’t accepted outright, the program will reimburse you for some of your tuition if you end up working in one of these areas after residency. Many schools also have smaller versions of the program that will give you a break on tuition if you agree to practice in a rural area for some time.

Leaving aside the fact that my heart leans toward neurology as a specialty, there is a reason why the government would be willing to pay for an entire medical education to get you to live and work in one of these locations. It’s not a happening place to be. Many of them are extremely rural, and a number are located on Native American reservations way off the beaten path. Rural areas are rated by how hard up they are for medical care. For the full package, the required level is pretty high. There is only one qualified area in the state I’m living in now, and it’s a men’s prison.

For both the military and the National Health Service Corps, you sacrifice a certain level of freedom in exchange for not having to play the same debt game as the rest of us. The question, of course, is, “Is it worth it?”

If you already wanted to go into the military or if you were planning on rural primary care for your specialty, the answer is, “Definitely.”  But if you’re like me, and would never even consider these options except that the prospect of debt sends shivers up your spine, that question is a little harder to answer.

In the end I decided this: the choice to go to medical school was a choice to live out a dream. There are always practical limitations on our dreams, but there is also value in giving them room to expand and change. Right now I want to be a neurologist. That might change and I might decide that more than anything I want to go into a specialty that would be perfect for the military or the National Health Service Corps.

I spent a lot of time and effort doing things that were not quite on the path I eventually ended up on. I was blessed to have the means and support to change my goals and to not be forced to regret my initial choices. I don’t want to look back six years down the line and think, “I came justhisclose to my dream, but missed it because of money.” Money, even a whole bunch of it, isn’t worth the rest of your life.

That said, I think these programs are wonderful. If you are a prospective medical student considering either of these, please listen to many voices before making your choice. My best advice would be this: if you want the future these programs ask of you, go for it and never look back. But don’t do it just for the money. Do it because at the end of it all you’re going to have lived the life you want to live and the scholarship helped you get there.

 

PS. If you are prospective student looking into any of these programs, I highly recommend talking to people who have made the commitment and are a) still in school or b) well beyond it to see what they have to say. Also, both programs offer versions of their scholarships you can sign up for midway through medical school or after graduation. If you’re undecided, don’t feel rushed to choose before you start school. Better to have to pay off a bit of interest than to get locked into a commitment you regret. (The National Health Service Corps charges something like 100% interest on the money they shelled out for your education should you not follow through. Those guys don’t mess around.)

It’s been awhile since I’ve done a science/medicine post, but this one caught my eye the other day. One of the things I find fascinating in a creepy way about the body is how much our personality is controlled by simple chemical reactions. Entire personalities can change as a result of damage to the brain or a change in neurotransmitter and hormone levels.

source: Re-Create Your Life Today

Oxytocin is a hormone produced by the posterior pituitary in the brain. It is responsible for uterine contractions when a woman gives birth. It is also the hormone that is associated with that warm fuzzy feeling we feel when we are close to someone we care about. It is produced during childbirth and during sex. It is often called the “love hormone” because much of the non-sexual attachment we feel for our offspring and for our significant other are attributed to oxytocin. (I also would guess it’s produced when I see fuzzy, baby animals, because something chemical has to be the reason my voice raises two octaves every time my roommate’s dog enters the room.)

Also, as the article that caught my attention points out, oxytocin might be an important determining factor in our moral decision making.

It makes sense; if oxytocin makes you feel kindly toward others it would make sense that your choices would be more aimed at the good of the whole.

But I balk a little at this term “moral.” The article seems to equate trust and generosity is a sense of morality, and even makes the point that hormones known for increasing self-preservation (testosterone in this case) counteract the effects of oxytocin. A bride, feeling warm and loved in the thrill of her wedding experiences a much higher jump in oxytocin than the groom, whose testosterone levels shoot up as the guests admire her in her wedding gown. (Or so the author conjectures.)

Generosity isn’t a bad way to measure moral fiber, I suppose, but donating money a pretty unambiguous measurement. What about the more complex moral choices we make every day? The article left me wondering; do oxytocin levels affect a woman’s choice to keep or abort a pregnancy? What about race, religious tolerance or homophobia? And does this battle with testosterone imply that morality and self-preservation are inherently at odds? Certainly the act of falling in love and out of love can have a detrimental affect on our reasoning skills.

The author does take this into account and points out that there are myriad factors besides oxytocin playing a part. But as food for thought, it certainly has my wheels turning.