As a second year medical student, every time I hear someone mention The Boards, I see this in my head:
http://www.youtube.com/watch#!v=HqqQ-3tTZig&feature=related
I believe that creeptastic music plays in the minds of every 2nd year whenever we hear the words "USMLE" or "The Boards." You can't help but flinch.
So what is this "boards" business? It's Step 1 of the US Medical Licensing Exam (USMLE), aka Step 1 of "The Boards." USMLE Step 1 is a standardized multiple-choice exam that all medical students around the country take. Step 1 covers basically everything that you learn during the first two years of medical school (or everything you should have learned), including biochemistry, microbiology, physiology, pathophysiology, pharmacology, behavioral science, and anatomy. It is the gateway to the second half of medical school (the clinical years), and it can be a major component of your residency applications down the line. Depending on what you want to go into, your Step 1 score can profoundly influence your decisions about what specialty to pursue and which programs you can apply to. In other words, it's a Big F#*%!ing Deal.
People have a tendency to freak out about it. Which is understandable, but probably not helpful. It's an important test, but it's still just a test. Multiple choice, just like the SAT, and the MCAT. No written portion. And sure, it covers more material than probably any other test you've ever taken, and the questions probably demand a more advanced level of reasoning and synthesizing information than you're used to, and OK so it could potentially have a major effect on the rest of your life, but... I'm sorry. I forgot where I was going with that thought. I know it was going to end on some hopeful, inspiring thought, but I'm having trouble thinking of one right now.
If you want to be a plastic surgeon, then you really need to rock out on the Boards and score well above the national average. If you want to be a pediatrician or a psychiatrist, you really just need to pass. And most people pass. The Boards are hardest for people who went to medical school outside of the US and are taking the exam so they can do a residency and/or get licensed to practice in America. The vast majority of American medical students who don't have some horrific breakdown the day before their exam date do just fine. And if you fail, you can take it again. It will suck, and you may have to take a year off to study and do research or something while all your classmates continue on through 3rd year rotations, but it does not necessarily mean the end of your medical career.
Oh, and, yes, there is a USMLE Step 2 exam. That tests knowledge about medical treatment and management of illness; basically it tests everything you should have learned during your 3rd year rotations. There is also Step 2 CS which is a practical exam assessing your clinical skills, such as your ability to wash your hands before touching a patient, your facility with an H&P (medical history and physical exam), and whether or not you can interact with patients like a normal human being.
Here's some info on the basics of The Boards (duh duhhhh):
http://www.usmle.org/examinations/step1/step1.html
http://en.wikipedia.org/wiki/USMLE_Step_1
What I want to do over the next couple of posts is provide some insight into the boards preparation process, and hopefully give some insightful reflection on things that you can do throughout the first two years of medical school in order to reduce stress and anxiety about The Boards (duh duhhhh) and be ready to completely kick ass when it comes time to take the test. Any advice I might dole out will probably come from the department of, "Dear God, why oh why didn't I do __blank__ last year?!" I've noticed I'm pretty good at knowing what I should do, and really bad at actually doing it. So, I'm going to write down all my brilliant thoughts here, and maybe someone else who's good at that kind of thing can actually put my plans into action.
To recap: USMLE Step 1 -->
http://www.youtube.com/watch#!v=HqqQ-3tTZig&feature=related
Thursday, April 22, 2010
Curriculum Issues
There are several major types of med school curricula. I found this article on "How Becoming A Doctor Works" which purports to speak for all medical schools as to what kinds of courses you take during the first and second years of med school: http://money.howstuffworks.com/becoming-a-doctor9.htm.
That article is wrong.
Ok, well, it's on the right track. The most "traditional" academic calendar is: first two years in the classroom, second two years on the wards, doing doctory shit (well, med student scut work shit). Year 1: physiology; how everything in the body is supposed to work. Year 2: pathophysiology; how it all goes wrong in disease. Year 3: head out into the hospital for your first year of clinical experience. Year 4: more clinical experience in the hospital, with the opportunity to do "away rotations" at other schools/hospitals, plus apply for residency. And some school's probably do it that way, but a lot of schools have evolved past that rather antiquated system. My school integrates coursework on clinical skills and arranges for on-site hands-on experiences throughout the first two years, for example. That way, we don't pee our pants the first time we're asked to touch a patient as 3rd years.
The major curricular advances of the 20th century were the systems-based approach and problem-based learning. I've never experienced PBL-style, but what I understand is that you spend a lot less time in lecture and a lot more time in small groups of students who work through clinically-based problems. You look everything up, check on the latest research in the field, work through the clinical reasoning, figure out what tests you'd need to order and how to interpret the results, etc. The one comment I've heard from a student at a top school that had recently switched to PBL was that you "live or die" by your group. When y'all are teaching each other and yourselves, it's critical that you guys can match up your learning styles and work together well enough to really get it done - without wanting to kill each other or yourselves. But, like I said, I've never really done school that way, and it was just one student's evaluation. I have to admit I don't know much about it, and I don't really have an opinion on PBL as a pedagogical model.
Recently, however, I have decided that a systems-based approach makes the most sense. We do not do it that way here, but I wish we did. Instead of learning all of gross anatomy, and then having a course on cardiovascular physiology, and later having a class cardiovascular pathophysiology, and at some point during your pharmacology course learning alllll of the drugs that treat the heart (and, oh boy, it's a lot of them), you have one all-encompassing Cardio class in which you learn the functional anatomy of the heart, it's physiology and pathophys, the cardio drugs, how it all fits together. That sounds much preferable to me than learning it all in bits and pieces and trying to reach way back into your memory to recall basic physiology when you're attempting to learn all the new, complicated pathophys a year later, and even later learn the drugs in a different class, out of context.
Like I said, at my school we don't do a systems-based approach. As such, I'm not familiar with its possible shortcomings and pitfalls. But throughout 2nd year, I've become increasingly convinced that it is a more logical and seamless approach, and that it's a better way to really learn all of this stuff, instead of just memorizing things and then forgetting them 5 minutes after the exam. When it comes to studying for The Boards (duh duhhhhh), I will be using a systems-based approach as I organize my 5 weeks of self-directed study.
I should point out that PBL is a way to structure course time and systems-based is a way to structure the overarching curriculum. They are not mutually exclusive, and there may be med schools that teach a systems-based approach in a PBL format.
Finally, a few schools have switched to a totally different calendar. They've shrunk the first two years of book learnin' down to about 18 months. That means that students at those schools take The Boards (duh duhhhh) earlier, and start rotations earlier. They have more time gaining clinical experience, can do more electives, and they can feel cool cause they're all different and special. It sounds like it's also a bit more of an intense approach. UVM and UPenn both have different versions of this type of curriculum.
One more thing to consider when it comes to judging a school by its curriculum: what does it say about the general approach of the administration? Is this a school that considers itself a vanguard of tradition, and which is confident that its model has worked for 50+ years and so will continue to work? Does that mean that that school will probably also foster more of the old-school strict hierarchy and intense competition? On the other hand, are schools that adopt new curricula or develop their own novel approach more progressive in general? Will they be more modern, flexible places with a more responsive administration? Or are they just trying to find some way to distinguish their school from the rest in order to improve rankings and admissions yield?
On a day-to-day basis, the grading system your school employs probably makes more of a difference in your quality of life. The classes you're taking are the classes you're taking, what you really care about is how you're doing in them and whether/where you're ranked in the class. You probably won't spend much time pondering the possibilities of a different curricular schedule. But as a 2nd year with The Boards (duh duhhhh) looming over me, inspiring me to reflect on the totality of my medical education thus far, I wonder how I might have learned more or learned better had my school organized the basic curriculum differently.
That article is wrong.
Ok, well, it's on the right track. The most "traditional" academic calendar is: first two years in the classroom, second two years on the wards, doing doctory shit (well, med student scut work shit). Year 1: physiology; how everything in the body is supposed to work. Year 2: pathophysiology; how it all goes wrong in disease. Year 3: head out into the hospital for your first year of clinical experience. Year 4: more clinical experience in the hospital, with the opportunity to do "away rotations" at other schools/hospitals, plus apply for residency. And some school's probably do it that way, but a lot of schools have evolved past that rather antiquated system. My school integrates coursework on clinical skills and arranges for on-site hands-on experiences throughout the first two years, for example. That way, we don't pee our pants the first time we're asked to touch a patient as 3rd years.
The major curricular advances of the 20th century were the systems-based approach and problem-based learning. I've never experienced PBL-style, but what I understand is that you spend a lot less time in lecture and a lot more time in small groups of students who work through clinically-based problems. You look everything up, check on the latest research in the field, work through the clinical reasoning, figure out what tests you'd need to order and how to interpret the results, etc. The one comment I've heard from a student at a top school that had recently switched to PBL was that you "live or die" by your group. When y'all are teaching each other and yourselves, it's critical that you guys can match up your learning styles and work together well enough to really get it done - without wanting to kill each other or yourselves. But, like I said, I've never really done school that way, and it was just one student's evaluation. I have to admit I don't know much about it, and I don't really have an opinion on PBL as a pedagogical model.
Recently, however, I have decided that a systems-based approach makes the most sense. We do not do it that way here, but I wish we did. Instead of learning all of gross anatomy, and then having a course on cardiovascular physiology, and later having a class cardiovascular pathophysiology, and at some point during your pharmacology course learning alllll of the drugs that treat the heart (and, oh boy, it's a lot of them), you have one all-encompassing Cardio class in which you learn the functional anatomy of the heart, it's physiology and pathophys, the cardio drugs, how it all fits together. That sounds much preferable to me than learning it all in bits and pieces and trying to reach way back into your memory to recall basic physiology when you're attempting to learn all the new, complicated pathophys a year later, and even later learn the drugs in a different class, out of context.
Like I said, at my school we don't do a systems-based approach. As such, I'm not familiar with its possible shortcomings and pitfalls. But throughout 2nd year, I've become increasingly convinced that it is a more logical and seamless approach, and that it's a better way to really learn all of this stuff, instead of just memorizing things and then forgetting them 5 minutes after the exam. When it comes to studying for The Boards (duh duhhhhh), I will be using a systems-based approach as I organize my 5 weeks of self-directed study.
I should point out that PBL is a way to structure course time and systems-based is a way to structure the overarching curriculum. They are not mutually exclusive, and there may be med schools that teach a systems-based approach in a PBL format.
Finally, a few schools have switched to a totally different calendar. They've shrunk the first two years of book learnin' down to about 18 months. That means that students at those schools take The Boards (duh duhhhh) earlier, and start rotations earlier. They have more time gaining clinical experience, can do more electives, and they can feel cool cause they're all different and special. It sounds like it's also a bit more of an intense approach. UVM and UPenn both have different versions of this type of curriculum.
One more thing to consider when it comes to judging a school by its curriculum: what does it say about the general approach of the administration? Is this a school that considers itself a vanguard of tradition, and which is confident that its model has worked for 50+ years and so will continue to work? Does that mean that that school will probably also foster more of the old-school strict hierarchy and intense competition? On the other hand, are schools that adopt new curricula or develop their own novel approach more progressive in general? Will they be more modern, flexible places with a more responsive administration? Or are they just trying to find some way to distinguish their school from the rest in order to improve rankings and admissions yield?
On a day-to-day basis, the grading system your school employs probably makes more of a difference in your quality of life. The classes you're taking are the classes you're taking, what you really care about is how you're doing in them and whether/where you're ranked in the class. You probably won't spend much time pondering the possibilities of a different curricular schedule. But as a 2nd year with The Boards (duh duhhhh) looming over me, inspiring me to reflect on the totality of my medical education thus far, I wonder how I might have learned more or learned better had my school organized the basic curriculum differently.
Wednesday, February 10, 2010
Hugh Laurie, I'm sorry, but... we're through.
That's it. I can't do it anymore. I'm done with medical shows. They're driving me nuts. It's lawyer shows for me from now on.
The big problem is House. I mean, the man's supposed to be a genius diagnostician but he and his team never generate a differential diagnosis! They just come up with some idea, and then run with it. Then, when it inevitably turns out to be wrong, they come up with another idea and run with that. And on, and on... Does that sound logical, organized, or safe? In a recent episode, they decided a patient had lymphoma based on the fact that he was itchy. (Without even looking at the area of skin that was itching, I might add.) So, they did the next logical thing: they took him into surgery to take out his spleen. While in surgery, they realized it wasn't lymphoma. So then -- and only then -- did they run and wait for results of the blood tests that revealed that patient did not have lymphoma. Does that make sense to you? Do the surgery before the routine blood tests? Based on itching???
And so many of the "brilliant" breakthroughs that Dr. House makes in each episode are "astute" observations at the bedside when he finally deigns to visit the patient. Funny story: if you actually do a good history and physical on your patient when s/he first comes in, it might not actually take the whole episode to figure out what's going on! Arrrrrrrrrgh.
And then there's stuff like the case of Wilson's disease which they missed because they didn't run a Ceruloplasm (the standard blood test), but which they finally caught because the patient had blue nailbeds under her bloodred nail polish. If they had generated a differential for the patient's symptoms, Wilson's would have been a "can't miss" and they should have run that relatively simple test right away. I watched that episode the same day we had covered Wilson's and other liver diseases in GI small group, and it just drove me up the wall. The dramatic conclusion left me screaming at the television. That's not supposed to happen when I'm watching my stories -- only when I'm watching sports.
The new season of Scrubs is OK. It speaks the emotional truth about med school, and its absurdist angle gives a lot of leeway to bend the logistical truth. I give them the benefit of the doubt that at another med school, in another dimension, things could work that way. They don't actually practice medicine, so it doesn't bother me too often.
From now on, I'm switching to lawyer shows. I don't know nearly enough about the law to let the fudgings in the name of poetic license, the inaccuracies, and the occasional flagrantly absurd moment get in the way of my enjoyment. The Good Wife is good. And so far, The Deep End is very promising; the cast is attractive, at least. I like looking at pretty people. :)
The big problem is House. I mean, the man's supposed to be a genius diagnostician but he and his team never generate a differential diagnosis! They just come up with some idea, and then run with it. Then, when it inevitably turns out to be wrong, they come up with another idea and run with that. And on, and on... Does that sound logical, organized, or safe? In a recent episode, they decided a patient had lymphoma based on the fact that he was itchy. (Without even looking at the area of skin that was itching, I might add.) So, they did the next logical thing: they took him into surgery to take out his spleen. While in surgery, they realized it wasn't lymphoma. So then -- and only then -- did they run and wait for results of the blood tests that revealed that patient did not have lymphoma. Does that make sense to you? Do the surgery before the routine blood tests? Based on itching???
And so many of the "brilliant" breakthroughs that Dr. House makes in each episode are "astute" observations at the bedside when he finally deigns to visit the patient. Funny story: if you actually do a good history and physical on your patient when s/he first comes in, it might not actually take the whole episode to figure out what's going on! Arrrrrrrrrgh.
And then there's stuff like the case of Wilson's disease which they missed because they didn't run a Ceruloplasm (the standard blood test), but which they finally caught because the patient had blue nailbeds under her bloodred nail polish. If they had generated a differential for the patient's symptoms, Wilson's would have been a "can't miss" and they should have run that relatively simple test right away. I watched that episode the same day we had covered Wilson's and other liver diseases in GI small group, and it just drove me up the wall. The dramatic conclusion left me screaming at the television. That's not supposed to happen when I'm watching my stories -- only when I'm watching sports.
The new season of Scrubs is OK. It speaks the emotional truth about med school, and its absurdist angle gives a lot of leeway to bend the logistical truth. I give them the benefit of the doubt that at another med school, in another dimension, things could work that way. They don't actually practice medicine, so it doesn't bother me too often.
From now on, I'm switching to lawyer shows. I don't know nearly enough about the law to let the fudgings in the name of poetic license, the inaccuracies, and the occasional flagrantly absurd moment get in the way of my enjoyment. The Good Wife is good. And so far, The Deep End is very promising; the cast is attractive, at least. I like looking at pretty people. :)
Wednesday, January 6, 2010
Getting Touchy Feely is Not Optional
a dispatch from the department of Things They Didn't Tell You About Medical School:
As a med student, your body is no longer private property. By matriculating at an institution of medial education, you have donated your body to science. This is not to say that when you die, your corpse automatically gets shipped off to the Gross Anatomy lab to be hacked up by first-years with bone saws. No, it just means that whenever your classmates need to learn an aspect of the physical exam, you are automatically volunteered to groped by them. It's a time-honored tradition, feeling up your fellow students. It's also a perfectly logical scheme. Why not learn on each other? It's cheap, convenient, fair. But at a certain point it can also feel fairly invasive.
During our first year, we were split up by gender so that girls learned the heart, lung, and abdominal exam on female colleagues, and the boys practiced on boys. For me, having my soft belly poked by some of my more waifish classmates was more intimidating than the idea of having the boys nervously trying to work around my bra as they listened to my heart. But then again, boys have cooties.
During second year, they've really kicked the classmate molestation into high gear. We manipulate each other joints, stare up each others' noses and into our waxy, hairy ears. We had our pupils dilated and enjoyed having bright lights shone in them as our friends stared through ophthalmoscopes, muttering, "Can't see a damn thing... Do you even have a retina?"
This week we got to everybody's favorite lab: venipuncture. Yes, that's right, we learned how to draw blood by assaulting each other repeatedly with needles. It went kind of like this: "Ok...You ready? I'm ready. You ready? You sure? Ok. I'm going in. ... You're sure you're ready? Ok. Here I go. Am I hurting you? You sure? How about now? Now am I hurting you? No? How about now? Ok, I give up."
After what seemed like hours of pocking and prodding with sharp objects, some of us were lucky enough to be proud owners of vials of our own blood! Then we smeared each others blood on slides (harder than it sounds), and attempted to determine our hematocrits by centrifuging samples of our blood. But somebody forgot to put the cap on the machine and so all the tiny little glass tubes of blood went flyyyyyyyyying across the room. I'm sure that's not a biohazard.
Apparently, it's better than it used to be. Back in the day, med students were not only forced to mutually assault each other and call it "learning," they were also used as lab rats and guinea pigs in all sorts of ethically questionable scientific studies. For example, yesterday in GI small group we learned about melena. That's when a gastrointestinal bleed causes your poo to come out all black and tarry (because the blood basically gets digested. Yeah, it's gross.). The professor asked my group how much bloodflow has to hemorrhage into your gut in order to produce this phenomenon. I don't remember the answer to his question (it's something like 500mL), because whatever number he mumbled was completely eclipsed in my memory by the words that next came out of his mouth.
"You know how they discovered that? They had medical students phlebotomize themselves and then drink their own blood."
They made med students draw their own blood (which must have been painful and traumatic in its own right, judging by the righteous bruises my classmates are sporting all over their arms after venipuncture lab), and then drink it until their poo turned black. Made them drink their own blood until their poo turned black.
All in the name of Science.
As a med student, your body is no longer private property. By matriculating at an institution of medial education, you have donated your body to science. This is not to say that when you die, your corpse automatically gets shipped off to the Gross Anatomy lab to be hacked up by first-years with bone saws. No, it just means that whenever your classmates need to learn an aspect of the physical exam, you are automatically volunteered to groped by them. It's a time-honored tradition, feeling up your fellow students. It's also a perfectly logical scheme. Why not learn on each other? It's cheap, convenient, fair. But at a certain point it can also feel fairly invasive.
During our first year, we were split up by gender so that girls learned the heart, lung, and abdominal exam on female colleagues, and the boys practiced on boys. For me, having my soft belly poked by some of my more waifish classmates was more intimidating than the idea of having the boys nervously trying to work around my bra as they listened to my heart. But then again, boys have cooties.
During second year, they've really kicked the classmate molestation into high gear. We manipulate each other joints, stare up each others' noses and into our waxy, hairy ears. We had our pupils dilated and enjoyed having bright lights shone in them as our friends stared through ophthalmoscopes, muttering, "Can't see a damn thing... Do you even have a retina?"
This week we got to everybody's favorite lab: venipuncture. Yes, that's right, we learned how to draw blood by assaulting each other repeatedly with needles. It went kind of like this: "Ok...You ready? I'm ready. You ready? You sure? Ok. I'm going in. ... You're sure you're ready? Ok. Here I go. Am I hurting you? You sure? How about now? Now am I hurting you? No? How about now? Ok, I give up."
After what seemed like hours of pocking and prodding with sharp objects, some of us were lucky enough to be proud owners of vials of our own blood! Then we smeared each others blood on slides (harder than it sounds), and attempted to determine our hematocrits by centrifuging samples of our blood. But somebody forgot to put the cap on the machine and so all the tiny little glass tubes of blood went flyyyyyyyyying across the room. I'm sure that's not a biohazard.
Apparently, it's better than it used to be. Back in the day, med students were not only forced to mutually assault each other and call it "learning," they were also used as lab rats and guinea pigs in all sorts of ethically questionable scientific studies. For example, yesterday in GI small group we learned about melena. That's when a gastrointestinal bleed causes your poo to come out all black and tarry (because the blood basically gets digested. Yeah, it's gross.). The professor asked my group how much bloodflow has to hemorrhage into your gut in order to produce this phenomenon. I don't remember the answer to his question (it's something like 500mL), because whatever number he mumbled was completely eclipsed in my memory by the words that next came out of his mouth.
"You know how they discovered that? They had medical students phlebotomize themselves and then drink their own blood."
They made med students draw their own blood (which must have been painful and traumatic in its own right, judging by the righteous bruises my classmates are sporting all over their arms after venipuncture lab), and then drink it until their poo turned black. Made them drink their own blood until their poo turned black.
All in the name of Science.
Tuesday, December 15, 2009
The '64 Impala That Got Away
Or,
Whether tis nobler to suffer the slings and arrows of outrageous med school, or to take up arms against a sea of troubles and, by dropping out, end them.
Last night, a trio of med students was gathered in a study room, attempting to scale the precipitous slopes of Mount Pharmacology. Frustrated by his lack of progress up the sheer face of that peak, S--- turned to his friend K--- and asked if she ever wondered if med school was worth it. K--- replied that she often wondered if med school is worth it on a global level--whether doctors, as a group, really need to go through this demeaning process in order to become skilled physicians. I think she's got a point, but trying to reimagine the entire medical education and training system is well beyond the scope of this blog. S--- clarified that he meant it in a more personal way. Did she ever wonder if it was worth it for her? K--- said something that I've thought many times: I really look forward to being a doctor, and I think I'll be a good one, but med school sucks. S---, apparently, has more doubts about whether this whole ordeal is worth it. He often wonders whether he will actually reap rewards as great as the magnitude of our current suffering.
Med school is a massive investment--financially, emotionally, time-wise. In the American system, it requires students to give up $200,000+ and four years during the prime of our lives. Med school means a whole lot of dreams get deferred and all your gratification is majorly delayed. We probably won't know for another 20+ years whether our investment paid off. But we still need to be able to reassure ourselves in our dark moments that it is worth it. If there's a possibility that our effort's won't pay off, then maybe shouldn't we be thinking about dropping out to pursue a different dream?
Sometimes, I think about how easy it would be to get some dayjob for which I am ridiculously overqualified. I could earn enough to pay the rent, to pay for food, to pay for a life in which I'm unburdened of the med school stress-albatross. I could have a real social life, have hobbies, could enjoy the cheap, normal things which I love but don't have time for: cooking, reading, writing, art projects. I could work retail, or get some office job. I was a hell of a lot happier being the copy-and-file bitch who hung out with her friends after work and wasn't rich but had no problem paying the bills, than I am being stressed, broke, and lonely.
See? It's easy to start spinning out these alternate scenarios in which life is simpler, easier, happier. But then I remember that I'm already massively in debt. No way could I afford that life anymore, not while also paying off my loans. Not in this economy. So, I stick around. Because I have no other choice.
It sounds a little fatalistic to suggest that anyone should become a doctor out of lack of other options. But it is also true, in a bigger way than might be immediately evident. I thought about all this before I was in prohibitively deep debt. I had a few weeks of mini-crisis before first year started during which I questioned my decision to attend medical school. I wasn't positive this was the right thing for me to do, and I felt it was my last chance to make a clean break--to get out before I got in over my head. I made an active choice then (or was it actually passive? Who knows.) that the MD thing was my only option.
Like many other people out there, I've long had fantasies of becoming a rockstar. True, I'm not a very good singer; I was never going to be the next Kelly Clarkson, or Matthew Bellamy, or even Julian Casablancas. But I am a musician. If I had felt compelled to pursue music in any sort of serious way, I could have. I love music, I love playing, I love performing. My parents would have supported me (I actually think my mom's a little disappointed that I didn't become a profesisonal musician). I've got a bit of talent; certainly enough to make some kind of career in music if I had any real determination. But I wasn't determined. I never joined a band or started one, I never tried to write a single song. I never let myself try because the prospect of failure overpowered my minimal ambition.
It's the same with writing. I love to write, and I have made it a major focus of my academic and personal life. Yet I never wrote for the school paper or did any other resume-building activities. I went out on a limb for my writing a little more often than I did for my music: I entered contests here and there (I never won). I cared enough to risk rejection every once in a while, but I never went the extra mile. I never made a real go of it, never put my theoretical desire to be a Writer to the test.
I am arguably better-suited to being a musician or essayist than I am to being a doctor. I am definitely a better performer and writer than I am a med student. I have some natural talent in music and letters, and I enjoy them a whole lot. On the other hand, I am an organizational disaster with no study skills who gets zero pleasure out of the academic rat race. And yet, I've chosen to attend med school.
Despite the fact that it is, in the short term, so much more challenging, and less rewarding, I have decided to sink huge sums of (borrowed) money and years of my life into the pursuit of an MD. The threat of failure looms large, and the consequences if I fail are gigantic. The simple fact that I persevere in the face of all that must mean that this is what I really want. During those panicky weeks leading up to the start of first year, I had the option to not go to medical school and instead pursue some other career. My parents would have been totally cool with that. I did not get a retail job, though. I did not start taking guitar lessons (my primary instrument, the flute, is not very rock 'n roll), I did not apply for jobs at magazines, or try to get my foot in the door at a publishing house. Instead, I took the path of most resistance. I must have done so because medicine is my truest, strongest ambition. I must have chosen med school because deep down I know that it is worth it.
Right?
Either that, or I'm a masochist.
Still, you can't but help but occasionally get sidetracked down a path of wishful thinking, dreaming of what could have been. In the words of the immortal Skee-Lo, "I wish I was a little bit taller. I wish I was a baller. I wish I had a girl who looked good; I would call her. I wish I had a rabbit in a hat with a bat and a '64 Impala."
Whether tis nobler to suffer the slings and arrows of outrageous med school, or to take up arms against a sea of troubles and, by dropping out, end them.
Last night, a trio of med students was gathered in a study room, attempting to scale the precipitous slopes of Mount Pharmacology. Frustrated by his lack of progress up the sheer face of that peak, S--- turned to his friend K--- and asked if she ever wondered if med school was worth it. K--- replied that she often wondered if med school is worth it on a global level--whether doctors, as a group, really need to go through this demeaning process in order to become skilled physicians. I think she's got a point, but trying to reimagine the entire medical education and training system is well beyond the scope of this blog. S--- clarified that he meant it in a more personal way. Did she ever wonder if it was worth it for her? K--- said something that I've thought many times: I really look forward to being a doctor, and I think I'll be a good one, but med school sucks. S---, apparently, has more doubts about whether this whole ordeal is worth it. He often wonders whether he will actually reap rewards as great as the magnitude of our current suffering.
Med school is a massive investment--financially, emotionally, time-wise. In the American system, it requires students to give up $200,000+ and four years during the prime of our lives. Med school means a whole lot of dreams get deferred and all your gratification is majorly delayed. We probably won't know for another 20+ years whether our investment paid off. But we still need to be able to reassure ourselves in our dark moments that it is worth it. If there's a possibility that our effort's won't pay off, then maybe shouldn't we be thinking about dropping out to pursue a different dream?
Sometimes, I think about how easy it would be to get some dayjob for which I am ridiculously overqualified. I could earn enough to pay the rent, to pay for food, to pay for a life in which I'm unburdened of the med school stress-albatross. I could have a real social life, have hobbies, could enjoy the cheap, normal things which I love but don't have time for: cooking, reading, writing, art projects. I could work retail, or get some office job. I was a hell of a lot happier being the copy-and-file bitch who hung out with her friends after work and wasn't rich but had no problem paying the bills, than I am being stressed, broke, and lonely.
See? It's easy to start spinning out these alternate scenarios in which life is simpler, easier, happier. But then I remember that I'm already massively in debt. No way could I afford that life anymore, not while also paying off my loans. Not in this economy. So, I stick around. Because I have no other choice.
It sounds a little fatalistic to suggest that anyone should become a doctor out of lack of other options. But it is also true, in a bigger way than might be immediately evident. I thought about all this before I was in prohibitively deep debt. I had a few weeks of mini-crisis before first year started during which I questioned my decision to attend medical school. I wasn't positive this was the right thing for me to do, and I felt it was my last chance to make a clean break--to get out before I got in over my head. I made an active choice then (or was it actually passive? Who knows.) that the MD thing was my only option.
Like many other people out there, I've long had fantasies of becoming a rockstar. True, I'm not a very good singer; I was never going to be the next Kelly Clarkson, or Matthew Bellamy, or even Julian Casablancas. But I am a musician. If I had felt compelled to pursue music in any sort of serious way, I could have. I love music, I love playing, I love performing. My parents would have supported me (I actually think my mom's a little disappointed that I didn't become a profesisonal musician). I've got a bit of talent; certainly enough to make some kind of career in music if I had any real determination. But I wasn't determined. I never joined a band or started one, I never tried to write a single song. I never let myself try because the prospect of failure overpowered my minimal ambition.
It's the same with writing. I love to write, and I have made it a major focus of my academic and personal life. Yet I never wrote for the school paper or did any other resume-building activities. I went out on a limb for my writing a little more often than I did for my music: I entered contests here and there (I never won). I cared enough to risk rejection every once in a while, but I never went the extra mile. I never made a real go of it, never put my theoretical desire to be a Writer to the test.
I am arguably better-suited to being a musician or essayist than I am to being a doctor. I am definitely a better performer and writer than I am a med student. I have some natural talent in music and letters, and I enjoy them a whole lot. On the other hand, I am an organizational disaster with no study skills who gets zero pleasure out of the academic rat race. And yet, I've chosen to attend med school.
Despite the fact that it is, in the short term, so much more challenging, and less rewarding, I have decided to sink huge sums of (borrowed) money and years of my life into the pursuit of an MD. The threat of failure looms large, and the consequences if I fail are gigantic. The simple fact that I persevere in the face of all that must mean that this is what I really want. During those panicky weeks leading up to the start of first year, I had the option to not go to medical school and instead pursue some other career. My parents would have been totally cool with that. I did not get a retail job, though. I did not start taking guitar lessons (my primary instrument, the flute, is not very rock 'n roll), I did not apply for jobs at magazines, or try to get my foot in the door at a publishing house. Instead, I took the path of most resistance. I must have done so because medicine is my truest, strongest ambition. I must have chosen med school because deep down I know that it is worth it.
Right?
Either that, or I'm a masochist.
Still, you can't but help but occasionally get sidetracked down a path of wishful thinking, dreaming of what could have been. In the words of the immortal Skee-Lo, "I wish I was a little bit taller. I wish I was a baller. I wish I had a girl who looked good; I would call her. I wish I had a rabbit in a hat with a bat and a '64 Impala."
Sunday, December 13, 2009
From Forth the Fatal Loins of These Two PhD's
or, Blame It On Your P-p-p-p-p-pa-a-rents.
Some of our professors like to pander to the humanities-oriented students in the class by offering "culture dollars" to students who can answer questions about cultural correlates to the medical topics we're studying. We recently covered ethanol (a.k.a "alcohol," "spirits," "booze," "crunk juice") in Pharmacology class. By way of introducing the effects of ETOH, our professor offered a dollar to the first person who could identify the source of the following speech. He began to read:
"Drink, sir, is a great provoker of three things..."
I threw up my hand into the air, having immediately recognized the "great equivocator" speech by the porter in Macbeth. The professor continued,
"Marry, sir, nose-painting, sleep, and urine.
Lechery, sir, it provokes, and unprovokes; it provokes
the desire, but it takes away the performance..."
At this point, I had both my hands in the air. So true, what he says about provoking the desire and taking away the performance--take note, boys. The professor continued, undistracted by my antics,
"There-
I nearly dislocated my shoulder trying to stretch my hand higher. I was jumping up and down in my seat like Hermione. I was going red in the face and my classmates were starting to crack up at the spectacle of me.
Finally, the professor looked up from the page and, seeing as I was bright red and jumping around like someone in the throws of a generalized tonic-clonic seizure, had no choice but to call on me. I verily shouted out the answer with glee. MACBETH! I was acting like an ass, and I knew it, but I didn't care. I'm generally pretty acclimated to the feeling of acting a damn fool, and of course $1 is a nontrivial amount of cash monays for a med student. But that wasn't why I was so excited. I was psyched because I knew something! I knew it faster than anyone else, and I was positive that had the right answer. What a strange and lovely feeling-- feeling knowledgeable, confident, like I really had something to contribute to a classroom conversation.
I know that speech so well because my mother, who teaches English, has taught Macbeth every year for the past foreverandahalf. Every spring, she immerses herself--and by extension our whole household--in that world of witches' prophecies and murderous soliloquies and thanes descending upon Dunsinane. When she's not spouting direct quotes, she's speaking in inadvertent iambic pentameter.
In my family, when you're trying to make plans the question is, "When shall we three meet again? (In thunder, lightning or in rain?)" When you are really stinky after a workout, you might proclaim that "all the perfumes of arabia" could not wash the smell of BO out of your pits. Shooing the dog out the door, you might yell, "Out, out, damn Spot!" I can't count how many times someone's joked about "all my little chickens in one swell foop." Get it? It's funny cause it's a Shakesperian spoonerism! Yeah, it's not really funny to anybody else. Le sigh.
But what I'm trying to get at is this: I know Macbeth inside and out not because I was an English major (though I was) but because I grew up immersed in it. It is a major part of how my family communicates. If my parents had been doctors instead of teachers would I have that same kind of intimacy with the language of medicine? Do physiology and pharmacology feel as familiar to doctors' kids as the comedies and tragedies do to me? I've never read Henry V, but I know that sending tennis balls to the king of England is a major dis (Tennis balls, my liege?! Oh, snap.). I've never read Richard III but I can tell you which son of York it was who turned the winter of our discontent into glorious summer.
Nepotism is rampant around here. A quick survey of my colleagues' genealogies shows that MDs beget MDs. I find myself resenting my classmates whose parents are physicians. When mommy and daddy are both succesful surgeons, you sure as hell don't have to worry about taking out loans or sticking to an ascetic budget. And there might be more pressure for those kids to pursue a career in medicine, but I bet there is also a lot more understanding of what that pursuit entails. Setting all that aside, though, I wonder if there's another advantage to being doctor-spawn that I haven't previously considered. I mean, these kids essentially began their medical education at birth--how can that not put them ten steps ahead of my word-nerd ass?
Growing up in my house, there was a strong emphasis put on being well-read and well-spoken. It was important to my parents that I got a superb education, especially in language and literature. We cannot discount the influence of that environment not only on my choice of English as my college major but also on my ability to easily excel in that course of study. In ways both subtle and explicit I was raised to be a reader, a writer, a repository of quotations and trivia. I subsequently breezed through my college English classes feeling confident and competent. My teachers agreed; I was a natural, and I was usually at the top of the class, even as a freshwoman. Meanwhile, I was struggling in my science courses. I knew how to be a great English student, I knew how to speak the language of literary criticism, but I felt awkward and stupid in Chemistry. I always felt like I was missing something, like I couldn't put it all together into a coherent understand of Science. I didn't have a built-in context for biochem the way I did for, say, the development of the short story. I knew how to skim a too-long novel, and how to write a paper on a book that I hadn't finished. I didn't have any tricks or shortcuts through Chemistry, however. I had to start at the beginning, and slog through to the very end without really knowing where I was going.
I wonder how much easier pre-med classes might have been had I been raised by scientists rather than a pair of bookworms.
This is not to criticize my parents in the least. They're pretty fab, in my opinion. But I have found it really easy to fall into holes of endless self-criticism and self-doubt as I face the challenges of med school. I feel stupid and lazy and inadequate a lot of the time even though I was heretofore a very intellectually confident student. I ask myself, Why can't I seem to do this? What's wrong with me? Why does it seem to be so much harder for me to get the hang of all this? Have I just been getting steadily dumber since I left high school? Did all that college partying really kill my brain cells? And maybe part of the answer to those self-flagellating questions lie in the multitude of subtle but important ways that growing up in a family of medical professionals prepares you for medical school.
I think it's worth taking a look at the ways that each student's background affects her as she approaches medical education. It's a lot more than just your SES and college major that defines how you've been prepared to face this academic behemoth.
Some of our professors like to pander to the humanities-oriented students in the class by offering "culture dollars" to students who can answer questions about cultural correlates to the medical topics we're studying. We recently covered ethanol (a.k.a "alcohol," "spirits," "booze," "crunk juice") in Pharmacology class. By way of introducing the effects of ETOH, our professor offered a dollar to the first person who could identify the source of the following speech. He began to read:
"Drink, sir, is a great provoker of three things..."
I threw up my hand into the air, having immediately recognized the "great equivocator" speech by the porter in Macbeth. The professor continued,
"Marry, sir, nose-painting, sleep, and urine.
Lechery, sir, it provokes, and unprovokes; it provokes
the desire, but it takes away the performance..."
At this point, I had both my hands in the air. So true, what he says about provoking the desire and taking away the performance--take note, boys. The professor continued, undistracted by my antics,
"There-
I nearly dislocated my shoulder trying to stretch my hand higher. I was jumping up and down in my seat like Hermione. I was going red in the face and my classmates were starting to crack up at the spectacle of me.
Finally, the professor looked up from the page and, seeing as I was bright red and jumping around like someone in the throws of a generalized tonic-clonic seizure, had no choice but to call on me. I verily shouted out the answer with glee. MACBETH! I was acting like an ass, and I knew it, but I didn't care. I'm generally pretty acclimated to the feeling of acting a damn fool, and of course $1 is a nontrivial amount of cash monays for a med student. But that wasn't why I was so excited. I was psyched because I knew something! I knew it faster than anyone else, and I was positive that had the right answer. What a strange and lovely feeling-- feeling knowledgeable, confident, like I really had something to contribute to a classroom conversation.
I know that speech so well because my mother, who teaches English, has taught Macbeth every year for the past foreverandahalf. Every spring, she immerses herself--and by extension our whole household--in that world of witches' prophecies and murderous soliloquies and thanes descending upon Dunsinane. When she's not spouting direct quotes, she's speaking in inadvertent iambic pentameter.
In my family, when you're trying to make plans the question is, "When shall we three meet again? (In thunder, lightning or in rain?)" When you are really stinky after a workout, you might proclaim that "all the perfumes of arabia" could not wash the smell of BO out of your pits. Shooing the dog out the door, you might yell, "Out, out, damn Spot!" I can't count how many times someone's joked about "all my little chickens in one swell foop." Get it? It's funny cause it's a Shakesperian spoonerism! Yeah, it's not really funny to anybody else. Le sigh.
But what I'm trying to get at is this: I know Macbeth inside and out not because I was an English major (though I was) but because I grew up immersed in it. It is a major part of how my family communicates. If my parents had been doctors instead of teachers would I have that same kind of intimacy with the language of medicine? Do physiology and pharmacology feel as familiar to doctors' kids as the comedies and tragedies do to me? I've never read Henry V, but I know that sending tennis balls to the king of England is a major dis (Tennis balls, my liege?! Oh, snap.). I've never read Richard III but I can tell you which son of York it was who turned the winter of our discontent into glorious summer.
Nepotism is rampant around here. A quick survey of my colleagues' genealogies shows that MDs beget MDs. I find myself resenting my classmates whose parents are physicians. When mommy and daddy are both succesful surgeons, you sure as hell don't have to worry about taking out loans or sticking to an ascetic budget. And there might be more pressure for those kids to pursue a career in medicine, but I bet there is also a lot more understanding of what that pursuit entails. Setting all that aside, though, I wonder if there's another advantage to being doctor-spawn that I haven't previously considered. I mean, these kids essentially began their medical education at birth--how can that not put them ten steps ahead of my word-nerd ass?
Growing up in my house, there was a strong emphasis put on being well-read and well-spoken. It was important to my parents that I got a superb education, especially in language and literature. We cannot discount the influence of that environment not only on my choice of English as my college major but also on my ability to easily excel in that course of study. In ways both subtle and explicit I was raised to be a reader, a writer, a repository of quotations and trivia. I subsequently breezed through my college English classes feeling confident and competent. My teachers agreed; I was a natural, and I was usually at the top of the class, even as a freshwoman. Meanwhile, I was struggling in my science courses. I knew how to be a great English student, I knew how to speak the language of literary criticism, but I felt awkward and stupid in Chemistry. I always felt like I was missing something, like I couldn't put it all together into a coherent understand of Science. I didn't have a built-in context for biochem the way I did for, say, the development of the short story. I knew how to skim a too-long novel, and how to write a paper on a book that I hadn't finished. I didn't have any tricks or shortcuts through Chemistry, however. I had to start at the beginning, and slog through to the very end without really knowing where I was going.
I wonder how much easier pre-med classes might have been had I been raised by scientists rather than a pair of bookworms.
This is not to criticize my parents in the least. They're pretty fab, in my opinion. But I have found it really easy to fall into holes of endless self-criticism and self-doubt as I face the challenges of med school. I feel stupid and lazy and inadequate a lot of the time even though I was heretofore a very intellectually confident student. I ask myself, Why can't I seem to do this? What's wrong with me? Why does it seem to be so much harder for me to get the hang of all this? Have I just been getting steadily dumber since I left high school? Did all that college partying really kill my brain cells? And maybe part of the answer to those self-flagellating questions lie in the multitude of subtle but important ways that growing up in a family of medical professionals prepares you for medical school.
I think it's worth taking a look at the ways that each student's background affects her as she approaches medical education. It's a lot more than just your SES and college major that defines how you've been prepared to face this academic behemoth.
Monday, December 7, 2009
Pass/Fail
When deciding which medical school you might want to go to, consider each school's grading system. Most schools have some kind of "Pass/Fail" system. At many schools, this means that they've replaced letter grades A, B, C, and D with Honors, High Pass, Pass, Fail. Which is like relabeling lard as "all-natural organic butter alternative!"
At some schools, students enjoy a true Pass/Fail system, which means your final grade in each course is either a P or a(n) F. Nowhere on your transcript does it say what your final exam score was, whether it was above or below the mean. It doesn't matter whether you barely passed or got the highest score in the class, all that anyone sees is a "P." Or, you know, an F. :/
P/F reduces stress and makes life more manageable. A,B,C,D and its many variations mean that there will be constant pressure to stay on your toes, to never fall behind, and to compete with your classmates as well as your own inertia.
Here's a scenario: You have two exams in the next 10 days. In Class A, you're maintaining an average in the low 90's, you find the material relatively easy, and you've been doing well on all the problem sets. In Class B, you barely passed the last midterm, and you're pretty sure your professor thinks that you're mildly retarded. With a pass/fail system, you can feel good about putting all of your efforts into making sure that you pass both your classes. You do what you have to do, which in this case probably means you spend 9 days poring over Class B's material until your eyes bleed, and skimming Class A's the night before the test. Of course, you want to learn as much as you can, and you'll need to learn it all for the boards later and for medical practice, blah blah blah. Whatever. Failing sucks, and a pass is a pass. Ideally, we'd all learn everything and be able to ace every exam. In reality, some stuff will always fall through the cracks. You can keep your transcript pristine and full of P's by budgeting your time and efforts to make sure that your grades are always good enough. You do the best you can, you learn as much as possible, and then you move on. As we like to say, P = MD.
P/F means that getting the flu a week before the final so you're too sick to study but not so sick that they'll let you postpone your test date doesn't mean you have to make excuses for your low grade when you're applying to residency three years later. It means that your transcript doesn't have to reflect those two weeks after you got dumped when you skipped class to eat Haagen-Dazs and watch all seven seasons of Buffy the Vampire Slayer.
I'm a big proponent of P/F for the first two years of med school. It just makes life better. When you're comparing schools, you should definitely look into what kind of grading system they employ and think about how it will affect your day-to-day life as a student.
P = MD. Learn it, live it, love it.
At some schools, students enjoy a true Pass/Fail system, which means your final grade in each course is either a P or a(n) F. Nowhere on your transcript does it say what your final exam score was, whether it was above or below the mean. It doesn't matter whether you barely passed or got the highest score in the class, all that anyone sees is a "P." Or, you know, an F. :/
P/F reduces stress and makes life more manageable. A,B,C,D and its many variations mean that there will be constant pressure to stay on your toes, to never fall behind, and to compete with your classmates as well as your own inertia.
Here's a scenario: You have two exams in the next 10 days. In Class A, you're maintaining an average in the low 90's, you find the material relatively easy, and you've been doing well on all the problem sets. In Class B, you barely passed the last midterm, and you're pretty sure your professor thinks that you're mildly retarded. With a pass/fail system, you can feel good about putting all of your efforts into making sure that you pass both your classes. You do what you have to do, which in this case probably means you spend 9 days poring over Class B's material until your eyes bleed, and skimming Class A's the night before the test. Of course, you want to learn as much as you can, and you'll need to learn it all for the boards later and for medical practice, blah blah blah. Whatever. Failing sucks, and a pass is a pass. Ideally, we'd all learn everything and be able to ace every exam. In reality, some stuff will always fall through the cracks. You can keep your transcript pristine and full of P's by budgeting your time and efforts to make sure that your grades are always good enough. You do the best you can, you learn as much as possible, and then you move on. As we like to say, P = MD.
P/F means that getting the flu a week before the final so you're too sick to study but not so sick that they'll let you postpone your test date doesn't mean you have to make excuses for your low grade when you're applying to residency three years later. It means that your transcript doesn't have to reflect those two weeks after you got dumped when you skipped class to eat Haagen-Dazs and watch all seven seasons of Buffy the Vampire Slayer.
I'm a big proponent of P/F for the first two years of med school. It just makes life better. When you're comparing schools, you should definitely look into what kind of grading system they employ and think about how it will affect your day-to-day life as a student.
P = MD. Learn it, live it, love it.
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