Medical State of Mind

Reflecting on the OSCE

Tue, 18 Jun 2013 10:23:00 -0700

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.

What the Internet is Doing to Our Brains by Epipheo. The other...

Mon, 17 Jun 2013 22:38:06 -0700

What the Internet is Doing to Our Brains by Epipheo.

The other day, I had a discussion with a specialist. We went through some academic topics and theories. As new thoughts emerged into my mind, I would ask around them, taking us further and further away from the original point he had tried to make.

“Stop,” he said. “This seems to be a generation-issue of yours. If you keep changing the topic like this, you will not learn any of it; you will not remember the point I tried to make.” I recoiled back for a moment, embarrassed. I politely apologized. He was right. Had I really been absorbing any of the information? Or had I just glossed over it?

As the flow of information in our lives becomes and much greater and more powerful force, we will need to be ever diligent not to allow ourselves to be distracted. To not lose sight of our focus and our goals amidst the torrent of random stimuli will be a cornerstone to proper learning.

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?

Mon, 17 Jun 2013 22:25:43 -0700

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.

Fit Test. I had a chance to re-certify my N95 fitting with my...

Sun, 16 Jun 2013 08:08:40 -0700

Fit Test.

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.

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!

Sat, 15 Jun 2013 09:19:28 -0700

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.

Good luck!

Would you suggest medical school to someone who doesn't want to practice medicine, but wants to do research, possibly biomedical research?

Sat, 15 Jun 2013 09:05:52 -0700

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...

Sat, 15 Jun 2013 08:54:46 -0700

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?”

Next pearl: ?…
Previous pearl: Tailored Presentations…

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?

Fri, 14 Jun 2013 18:17:44 -0700

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...

Thu, 13 Jun 2013 19:03:03 -0700

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.

Sincerely,
Tom of the Medical State of Mind

Study Shows Pill Prevents H.I.V. Among Drug Addicts

Wed, 12 Jun 2013 21:00:02 -0700

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.

Road to Residency

Wed, 12 Jun 2013 08:32:09 -0700

Road to Residency:

Steven McGaughey, first featured here with his Gastric Subway illustration, has been hard at work on a new website for medical students. A primer to the residency journey, he and his fiancée have worked over the last few months compiling information and useful resources for the application, the interviews, and the match. Check it out.

Actors by Still Parade. I have another exam within a...

Tue, 11 Jun 2013 17:25:25 -0700

Actors by Still Parade.

I have another exam within a week’s time. The best way for me to ease the stress is to listen to some nice reflective music. Here is my musical choice of the day.

A Concentrated Shift

Tue, 11 Jun 2013 17:11:52 -0700

It was an unusually busy shift in the emergency department. There was no time to rest, no time to sit, and no time to catch our collective breath. The patients kept coming and the wait list kept growing.

Between me and the only physician on the ward, we were heavily outpaced and outmatched to meet demands. The teachings were suspended as I helped deal with the easier cases as my attending tended to the sicker patients.

As the clock struck noon, we finally had another doctor on site to help us with the growing stack of charts. Tensions eased. We could finally go for a break.

In those few short hours, I had seen a few fractures, dislocations, diabetic crises, electrolyte disturbances, chest pains, and acute abdomens. I had an opportunity to insert foley catheters, reduce shoulders, intubate a trauma patient and assist with a central line.

It was a concentrated shift of experience.

“You earned your stripes today, kid,” said the exhausted doctor as our shift together came to an end. “Go home and get some rest.”

Anatomy of a Human Being by Eva Di Martino.

Tue, 11 Jun 2013 05:47:00 -0700

Anatomy of a Human Being by Eva Di Martino.

Emotionally Invested

Sun, 09 Jun 2013 17:26:00 -0700

SPOILER: If you watch Game of Thrones but have not yet seen the episode the Rains of Castamere, stop reading the following conversation.
Me: ...So anything else on your mind today? You seem a bit upset.
Patient: I think I'm depressed.
Me: Do you want to talk about it? Did something happen recently?
Patient: They all died. So many of them.
Me: ...Who died?
Patient: Robb. Talisa. Catelyn. They're all gone...
Me: ...Stark?
Patient: Why is that old man so evil? I hate him...
Me: Sigh...I know...

"Hi! My name’s Ridha and I am a 19 year old student living in Australia. I am keen to enter med..."

Sun, 09 Jun 2013 17:19:00 -0700

“Hi! My name’s Ridha and I am a 19 year old student living in Australia. I am keen to enter med school here in Sydney, but unfortunately my current abilities in the UMAT (Undergraduate Medicine Admissions Test) are affecting my chances of getting in. I sat the 3 hour exam last year and did very poorly, and despite doing more intensive prep this time round, I still feel inadequate, and that my marks are not improving sufficiently enough. What could I be doing wrong?

You are probably not familiar with this specific test, but I was wondering what your thoughts on these Medicine entrance tests are, and if you could kindly share some advice on how to generally approach this exam, which is on the 31st of July this year. (Just to give you some background,I am generally above average in academics, this may be completely irrelevant tho).I really enjoy reading your blog, and you make me more and more determined to try to turn every stone to be where you are at now.”

- Hi Ridha,

Thanks for your message. You can check out some of my replies regarding taking the Medical College Admission Test (MCAT) by searching the tag mcat on my blog. You can also find some more long-winded answers regarding the MCAT in the index here.

Having said that, I cannot claim to know how the test is compared to the MCAT nor do I know what you have tried in terms of studying. I think that it is alright not to feel ready. If you were overconfident that would be worse. Focus on taking a lot of practice exams. Get a feel of the questions, the style, and the pacing you need to work on. If you have the time, set up a mock exam and sit there, as you would for three hours and write a practice exam.

Part of the stress of writing these kinds of exams is being put into a very artificial environment, writing exams that are designed in such a way to be objective and may not be the easiest or best way to gauge your aptitude. It can be very stressful and cloud your thinking. The more comfortable you can make yourself before that test day, the better you can be as you focus on the task and not the situation.

At the end of the day, the exam is secondary. It is a proxy measurement that, in the real world context does not reflect who you are or what you are capable of. When you become a doctor or any professional, it is not how well you can decide between four choices but how you react to problems. So do not get bogged down by the test and let it ruin your day. Granted you still need to perform well enough to be competitive, but think of it as a hurdle to overcome and not as the end-all-be-all.

If you would like more clarifications or ask more questions, leave me a comment in the inbox. Good luck on your studies and take care.

Yours sincerely,
Tom of the Medical State of Mind

Seven-Eighths: Reply

Sat, 08 Jun 2013 17:17:01 -0700

MD-Admissions: Kudos to that guy with the killer blade skills and hand-eye coordination for pulling that thing out!
He does have very steady hands so definitely hats off to him for that. My only concern watching him work was how much he was torquing the blade on the patient's teeth. He could have very easily chipped them.

Seven-Eighths. Not for the faint of heart, I will stop short of...

Sat, 08 Jun 2013 16:56:00 -0700

Seven-Eighths.

Not for the faint of heart, I will stop short of explaining what it is that happens in this video. You will just have to see it to believe it. After you watch it, the first question is inevitably how? The next question is of course why? To them I have no answers.

Let us start a MOVIE

Sat, 08 Jun 2013 16:43:59 -0700

Monitoring bed
Oxygen
Vitals
IVs
ECG

"It is not about the biological therapies we give patients. It is not about the medicine. At the end..."

Fri, 07 Jun 2013 07:02:17 -0700

“It is not about the biological therapies we give patients. It is not about the medicine. At the end of the day, it is about the relationship you forge with your patient and the trust and understanding that comes with that that dictates their compliance and willingness to continue.”

- A psychiatrist discussing the importance of the therapeutic relationship.