Posts tagged education

Seven-Eighths MD: The Penultimate Review

There has always existed, deeply seeded beneath the surface of my conscience the burning question: where did all of the time go? I have asked myself that many times through my medical training. Now, standing at the threshold of my last semester as a student, the question is even more relevant. What have I been up to these past few months?

Three-Quarters MD: A Year In Review

And just like that, year three passes into my memory, a destination in the rearview mirror. There has been so much to see, so much to process, so much to reflect on this entire year it is difficult to know where to start. Perhaps we should go back to the beginning.

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Neil deGrasse Tyson speaks about learning mathematics from the Great Debate: the Storytelling of Science.

I watched this last night and I think it is advice that applies to many of the readers who have asked through the years what to do about their struggles with math, chemistry, physics etc. Certainly, I feel that it applies to those who question if medicine is too hard for their passion to stay alive.

With practice, you can become better at your craft, no matter what discipline you pursue. It takes time, it takes work, and it takes practice. But you do eventually get there.

Watch the full Q & A session linked above for other responses by Dr. Lawrence Krauss and Bill Nye to this question.

More than a year ago, I took my first steps into clinical training by starting my summer medicine rotation. It had begun a new chapter in my development and left a profound impression on me. It was during that brief one-month window that I first started to hone my skills out in the field under the tutelage of not only my preceptors but also the residents.
Now, I find myself on the opposite end of that spectrum; I had an opportunity to meet an up-and-coming third year medical student, a graduated second year clerk in his summer medicine rotation. For a morning, I was tasked to work alongside him and offer some support as I helped him with his patients. 
When we are in the thick of things, it is easy to lose perspective of how far we have come. With only a year separating us, it was surprising to me how far I had grown.
The man was bright and had a very academic mannerism of speaking, the hallmark of two years of lectures. Despite a formidable understanding of theory, there lacked experience and comfort with the practicalities of medicine. This was the great divide between us. I could see his unease at handling a presentation, at coming up with an approach and a differential. It was the same unease I had felt so many months ago, and one that I still feel often, albeit not as often or as strongly as I had before. 
But still, what a difference a year has made! Being able to see him, to work with him, and help him in this moment of his journey enabled me to appreciate and to put my own learning in perspective: there has been progress; there will be progress.

More than a year ago, I took my first steps into clinical training by starting my summer medicine rotation. It had begun a new chapter in my development and left a profound impression on me. It was during that brief one-month window that I first started to hone my skills out in the field under the tutelage of not only my preceptors but also the residents.

Now, I find myself on the opposite end of that spectrum; I had an opportunity to meet an up-and-coming third year medical student, a graduated second year clerk in his summer medicine rotation. For a morning, I was tasked to work alongside him and offer some support as I helped him with his patients. 

When we are in the thick of things, it is easy to lose perspective of how far we have come. With only a year separating us, it was surprising to me how far I had grown.

The man was bright and had a very academic mannerism of speaking, the hallmark of two years of lectures. Despite a formidable understanding of theory, there lacked experience and comfort with the practicalities of medicine. This was the great divide between us. I could see his unease at handling a presentation, at coming up with an approach and a differential. It was the same unease I had felt so many months ago, and one that I still feel often, albeit not as often or as strongly as I had before. 

But still, what a difference a year has made! Being able to see him, to work with him, and help him in this moment of his journey enabled me to appreciate and to put my own learning in perspective: there has been progress; there will be progress.

A Rookie Cut

Over the past year, I have noticed a young man attending the barbershop I frequent. A tall and well-dressed adolescent who bared some resemblance to my barber, he initially started off with the scut work: sweeping the floor, greeting the customers, and watching. Always watching intently as my barber trimmed my hair.

Slowly, over time, he had begun to learn the tools of the trade - the different scissors and the brushes; the straight razor and the strop - and began to practice on the dummy heads.

Today, I went to the barbershop to find him cutting what must be his first set of heads full of hair. All the while, he was receiving pointers and tips from my barber, his father.

His eyes were focused, his body was tense, as he trimmed the weight from the man’s temple. Snip. Snip. As the locks fell to the floor, he re-examined his work. Was it too little? Was it too much?

“Remember to angle your brush up. It’ll give you more room to work with,” his father would say, and he would oblige and try again, with more angling of his left wrist. In the end, the older man seemed satisfied with the young man’s work. A sizeable tip came the trainee’s way, to which he hurriedly returned to the man.

“The cut is free. I’m still practicing.”

“You’re always going to be practicing. Besides, you’ve earned it. Keep the change.” The customer gathered himself and took his cane as he thanked the barber in training yet again. The young man was pleased.

“Next?” Of all the people waiting in the barbershop, no one took a second glance.

“Does your son know what he’s doing? I mean it’s a rookie cut,” came one snappy customer. No one moved. They wanted the expert, the experienced barber, the man who knew every bump under every patch of hair on their heads. They wanted his father. The brilliance of the man’s eyes that a moment ago seemed so alive, dulled. He put down the gown and reached for the broom.

“Sure, I’ll go,” I said, taking up his offer. He gave me a smile and motioned me to the chair. “Have a seat.”

I understood his plight. We were all in the same boat together. As learners, we depend on the good will of the people we see for us to gain experience, to be better, to become professionals. The process must start somewhere. It was time I returned this favour to another student.

“Caesar trim. Sides short. Front long,” his father called out.

“Hey.”

“Hello.”

“Thanks for giving me the opportunity.”

“No problem. We all have to start somewhere.”

Five-Eighths MD: A Six Month Review

Third year has been a year of firsts thus far. I have seen and learned a great many things. It has wowed me, excited me, frustrated me, exhausted me, saddened me, and disturbed me in my every day encounters. With half the year behind me now, I would like to talk about my experience.

I remember one of the first students I was training here. He was a journalist. Was a journalist for nearly thirty years. He well could have been my father at his age!

But he was still learning.

This is a profession where even the old dogs learn new tricks, where the learning does not stop until the day you stop working.

A physician recounts a revelation about continuing education.

Canadian Medical Residency Guide

Third year is an opportunity for us to be exposed and familiar with all of the various specialties of medicine. In the second half of the year, we must also begin choosing electives for fourth year, specialty experiences in our fields of interest. 

This guide, recommended to us by fourth year students, is a primer that goes through the programs available, where they are and what they entail. As I go through the specialties, this will be something I will need to keep in the back of my mind.

One-Half: A Year in Review

With two months to organize myself for the coming year, it has given me a lot of time to think about the last year. Three-eighths of the way, I gave a review of the first term of second year. Now, another term complete and having earned half my M.D. title, it feels right to write another summary. 

Given that it is the largest organ by surface area, it was amusing to see dermatology condensed into a single week. I suppose once you know the ABCDEs of categorizing skin lesions, you are well equipped to handle any situation. However, sometimes lesions are vague or very similar in appearance to others. Land mine or dud? Tread carefully.

Then came the brain. Over a gruelling two month period, we explored the deepest anatomical corners of the brain, learned tracts from top to bottom, and studied behaviour and psychology. The challenges of this block were two fold. First, some of the concepts were difficult to abstract, especially understanding the relation and integration of various tracts, in itself a complex web of interactions. Secondly, due to the complexity of the brain, some concepts could not be covered without mentioning other points of interest that would be covered further in the block. It was constantly a struggle to keep up with concepts A and B, when concept B was to be further discussed a few weeks later. Only at the end of the block could we  finally see the big picture.

After the struggles above, we went down into the reproduction block, a simple and easy to follow curriculum that was a welcome change of pace. This block was noteworthy for its overabundance of graphic pictures and videos and the fair warning to the ladies of our class to be weary of advanced maternal age. 

The last block, following the reproductive block nicely was paediatric and adolescent development. The big talking points in this block were milestones and nutrition factoids. The key to understanding this block was to memorize the facts cold. Getting the short end of the stick, the study time for this block suffered in light of its close proximity to our final exams. We held our breath that the few factoids we tried to memorize each day would stay fresh enough in our minds for the exam. 

Histology, pathology, and anatomy continued to be integrated into the curriculum wherever it applied. Anatomy in particular took centre stage for the brain, while histology was important for the skin, the brain, and for reproduction.

Family practice and clinical skills courses continued to give us exposure to the routines we would need to know for our careers. 

The exams this term were again challenging. I would rank them as equal to those from last term. The questions that caused me the most difficulties were the scenario questions. Reading and digesting the information presented in the scenario took time and slowed me down to a panic. Time was of the essence and I had to work fast. I dreaded every one of these questions.

For my rural rotation, which is actually part of my third year, I have already written my thoughts on that in a prior post. Now I am just trying to get my affairs in order and enjoy the summer while I still can.

Final Month

Two years of lecture-based medical education has come down to these last four weeks. I have sat in lectures for so many years now that it seems unreal that that reality will soon be coming to an end.

Following two weeks of exams, I will begin a one-month summer clerkship that is the stepping stone to third year, where the true medicine starts. The anxiety and excitement of change is slowly building up inside me. These are the final moments of another chapter in my story.