Last night, over the period of three hours, we went through the last OSCE, a clinical skills examination involving a scenario with a simulated patient.
As usual, I began quite nervous with butterflies fluttering in my stomach. From station to station, I became more confident and more relaxed, as the differential and the questions flowed through more easily through my mind.
At my last station, I was met with a scenario I had never encountered before in practice. I struggled at the door, scratching my head as I read the scenario. The bell rang and, without any solid grasp of what I wanted to ask or what physical exams I needed to perform to find the cause, I went in.
My struggle was obvious. I had elicited a passable history that helped to point me in the right direction; however, my focused physical yielded no findings. I was stuck.
I paused for a moment, and excused myself as I gathered my thoughts. Ding. One minute remaining. Think Tom. Think! Hastily I added a few extra tests. Again, no findings. Ding. Your exam is now over.
I looked to the doctor marking me, whose eyes asked with disappointment: did you study this topic at all?
No. I guess I probably should.
Anonymous asked: Hi Tom! I am an incoming M1 student and I feel extremely unprepared mentally and emotionally for medical school. It will be the first time I move to the other side of the country from my family. I also do not have a lot of previous medical knowledge. Do you have any advice on how to tackle the beginning of first year - any advice you wish someone told you when you were a M1?
First off, congratulations!
I just want to take the opportunity to welcome you to the world of medicine. I have a post sitting here that I wrote for incoming first year students. It might be helpful for you.
When I think back on the beginning of medical school, I think of it as the beginning to the rest of my life. And that is a scary prospect. It definitely is compounded when you have to move away and in a way, start from scratch.
But fear not.
Some people might have medical knowledge but that is a minority. You will meet a diverse number of people in your class from the sciences to the arts. Everyone will learn the medical knowledge together, from scratch. Together. Take some deep breaths and enjoy the process. Part of medical school is not just learning to discover and understand patient and lab findings, but also learning to discover and understand yourself. It is an emotional and intimately personal journey where, through your experiences, you will get to know yourself better than you thought you did.
Keep those thoughts in mind as you move forward and you should do fine. Take care and best of luck in your future studies.
I had a chance to re-certify my N95 fitting with my peers. The atmosphere was relaxed that morning. My friend asked me to take his picture with the N95 mask on as he pulled an intense stare down. I am watching you.
Anonymous asked: Hello! I am a 2nd year medical student, and I love your blog! I'm in the last 2 weeks before my boards. Do you have any advice?Thanks!
Hello and welcome,
This goes without saying: remain calm. Take some nice deep breaths and relax. Set up a plan for yourself for the next two weeks. Look at the topics you need to review and dedicate yourself to a checklist and focus on a few things from your checklist per day. Learn them and study them well. Do practice questions around them if available. Try to work at a constant pace and try not to let the workload pile up closer to your exam.
Most importantly: take care of yourself. It might be tempting to pace yourself to the point where you lose the time to sleep, eat or relax but you need all of those things still. Take regular breaks, let your brain unwind. At the end of the day when your mind is exhausted and you feel you cannot retain more information, do not push yourself. Everything beyond that point you are not going to remember anyways so just take the rest of the night off.
The night before your exam, keep the studying lighter and get more sleep. Eat well the next morning. A higher protein meal (but not extreme) in the morning about two to three hours before your exam will help keep you feeling satiated and your mind clear. Keep a bottle with you and a light snack for the exam. And again remember: deep breaths; everything will be all right.
Anonymous asked: Would you suggest medical school to someone who doesn't want to practice medicine, but wants to do research, possibly biomedical research?
I know of only one person who did something like that and he did it because he enjoyed medicine but discovered eventually that he enjoyed research more.
I am not sure what your situation is but I think if you already know that you are interested in biomedical research - unless you feel that the research you want to do is heavily based on medical expertise - I think that pursuing medical school might not be the best option. It is a lot of training, stress, and debt for a set of skills that you will not use at the end of the day for your preferred career choice.
In short: there are a lot more easier, less stressful ways of pursuing a career in research.
I Need Backup.
When we work, we do not do it alone. We are in the company of people working towards a common goal. We are surrounded by backup.
One of the biggest fears of going into any new situation is that you might not be equipped to deal with what you see. As a student learning, seeing, experiencing foreign and exotic subjects for the first time, it can be even more daunting.
Remember that you can always find help in your classmates, your senior residents, your attending. They can help give you a starting point, walk you through tricky topics, or see the patient with you.
Never feel bad about enlisting the help of your allies: the nurse, the physiotherapist, occupational therapist, the dietician, the pharmacist, the social worker etc. They are masters of their own domain, areas that overlap with your own and can provide you with significant amounts of support and collateral information that you may not have the capacity or time to explore on your own.
More often than you think, a difficult situation is remedied by asking for help. It is never a sign of weakness to seek help; it is a strength to be able to recognize your boundaries and limitations. That, at the end of the day, is how we become better care providers.
Even in the dire circumstances where you might have to call someone in the middle of the night when no other help is available, that is still a better alternative than allowing patients to deteriorate beyond help.
In any situation, always ask yourself: “Am I in over my head? Do I need backup?”
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Anonymous asked: Hey... I need help. A lot of people have been encouraging me to go and proceed, to study medicine. Even people in my workplace (I'm a nurse, btw. And I'm almost through my first hospital experience post boards). I'm not sure if I want to. When did you really know you wanted to become a doctor?
I thought about it for a long time but eventually the triggering event that set things in motion for real was when my father was diagnosed with cancer. I felt compelled to pursue medicine because I wanted to help people through the same ordeal I went through and hopefully prevent or treat the illnesses that ailed them.
You can read a more thorough response here.
Everyone in my class have different motivations and reasons for pursuing medicine. As it turns out there is no right or wrong answer as long as its true to your feelings. Do not feel pressured to study medicine if you do not feel that it is for you. Find something that you are passionate about and resonates with you. Good luck and take care.
To the readers and followers,
Third year is slowly drawing to a close. It has been an incredible year filled with excitement and hardship, with joy and sorrow, with life and death. It has been a year filled with challenging days and busy nights. It has been a year that has time and time again made me reconsider and reaffirm my decision to pursue medicine.
Through all of this and the scattered, speckled entries of this blog, you have continued to follow, to read, and to comment.
Today I reach another milestone, one that I would never have thought possible when I first began writing this blog.
Over these last few months, it has been a pleasure to be able to share this journey with all of you. From my first reader to the last, thank you all for your continued support and readership. You have continued to be a source of inspiration and one that has helped me to reflect on and to marvel at what medicine and humanity can achieve.
Tom of the Medical State of Mind
Study Shows Pill Prevents H.I.V. Among Drug Addicts -
Drug-injecting addicts who took an antiretroviral pill were half as likely to become infected with H.I.V. as those who did not, completing a body of evidence that such treatments can prevent AIDS in every group at risk.
It was long assumed that pre-exposure prophylaxis did not work for drug addicts because of the rate with which HIV spread in these populations in the 1980s. Studies have since focused on other risk groups like sexual partners and children. A new study conducted in Thailand has shown that pre-exposure prophylaxis does work in the high risk drug addiction group.
This is a great study that offers us another targeted area where we can curb HIV infection. However, the challenge will be to promote and sustain therapy and follow up in this highly transient population.