Posts tagged education

42 CME Credits

Now that I have started residency, I have also invested into an UpToDate subscription. This online clinical resource logs the time you spend researching and reading different topics. In less than three months’ time, I have already amassed 42 continuing medical education credits. 

A single credit is the equivalent of an hour of additional reading. 

In essence, I am averaging roughly 12 hours of reading every month on UpToDate. This is in addition to some other bits of reading I do here and there on guidelines, position statements, and textbooks. 

However, it just goes to show that a little bit every day goes a long way.

Medical Education, Beware the Hidden Curriculum

The hidden curriculum is taught by the school, not by any teacher…something is coming across to the pupils which may never be spoken in the English lesson or prayed about in assembly. They are picking-up an approach to living and an attitude to learning.

-Dr. Roland Meighan

Note Taking Tips by sarahsaysmd:

In med school, taking notes is hard because there’s SO much material. I remember going through one of my lectures and wondering how the hell I was going to simplify it to something I could actually remember. I usually make what are called “study sheets” after each lecture, and this is how I do them!

  • If there’s learning objectives, follow those. Use them to guide your notes. If there’s not, then use your intuition (based on what was heavily emphasized or covered the most) to figure out where to focus your notetaking. Just make sure you’ve organized everything in your head before putting it down to paper, because notes only work if they’re clear! 
  • Use categories to break up your learning. In one lecture there’s often multiple components, so I use headings to separate the main points. That way they don’t all blur together in my head.
  • Whenever possible, make charts, diagrams, or drawings. I can’t tell you the amount of times I’ve remembered something on a test because I took the time to draw it out! If you’re a kinesthetic or visual learner, this is super helpful. It really simplifies the material and organizes it thoroughly. It’s much easier to study from a clear chart than a block of text.
  • When you do use text, keep it concise. Use different colors to write out key phrases and terms, and try not to write out paragraphs and paragraphs. Sometimes, it unavoidable, and you need a lot of text to understand a key concept. Short and sweet wherever possible, though, makes life easier for you! 
  • Transform, transform, transform. Always try to put things in your own words wherever you can. Manipulate the material so that it coincides with what you’ve learned. When you think about a topic from multiple perspectives, you understand it a million times better.
  • When reviewing notes, read them aloud! Sometimes, I cover up one section and say everything I can remember about it. Then I check to see if I missed anything. It’s a great way to review (might be awkward if you have roommates, but mine is used to my impromptu lectures by now!). 

The First Week: Thoughts on Being a Doctor

Today marks the end of my first week as a doctor. To say the least it has been exciting, interesting, but above all, scary.

I have hit the ground running here, starting my first rotation in internal medicine. The days thus far have been long, hard, and busy. Everything feels more real, more high stakes; after all, I am now the one who needs to make the decision overnight. 

However, every resident feel like this when they begin practice. What I would like to share instead are some of my other experiences:

  • People are addressing me as doctor: This continues to feel very out of place to me. While I now do refer to myself this way, I still ask people to address me as Tom.
  • I can give verbal orders over the phone: As a medical student, I was never allowed to give a verbal order over the phone. In order to start investigations or medications, I always had to go to the ward and write it myself. Not anymore.
  • What orders should I give over the phone?: While I used to have time to think on my way to the ward as well as the luxury to phone the resident for approval, this is no longer the case. I cannot emphasize enough how awkward it is to be asked for directions on the spot. “Can I call you back?” or “Let me lay eyes on the patient first.” are my go-to phrases now.
  • Accepting my orders as they are: On very few instances when a pharmacist is on hand, no one has questioned my orders. It is a scary burden to carry as a new resident. “Is what I am about to order safe?” Unfortunately, no switch flips on in our head when we become a resident, granting us all the knowledge and competence we need to make these decisions on our own. Even for some of my simpler orders, I still run them by my senior resident first.
  • The work does not change: Honestly, while the responsibilities have increased, the work we must do is the same. That also means that time for sleeping, eating, and peeing is still at a premium. Already, I have done a 36 hour straight call shift. And more are to come I am sure.
  • Billing: I never had to learn about earning money as a medical student but now it is part of my daily life. The flip side to doing all of the clinical work is all of the paperwork, now billing included.

There are still two years ahead of me in this residency and much to learn, see, and do. Expect more thoughts on this transition in the future.

Why You Are Still Alive - The Immune System Explained by Kurzgesagt.

Four Stages of Competence

In the 1970s, Noel Burch described four stages of learning any new skill and it could be summarized as follows:

  • Unconscious incompetence, where one does not recognize a deficit;
  • Conscious incompetence, where one does recognize a deficit and how to improve their skill;
  • Conscious competence, where one is competent but requires concentration to perform the skill, and;
  • Unconscious competence: where the skill has become second nature.

Everyone strives for unconscious competence. The mastery of a skill has become so complete that you can do it effortlessly. The scariest state to be in is the first stage. “You do not know what you do not know.” That can be a terrible position to be in, especially when a patient’s life is on the line.

That is why receiving feedback is so important. That is why we train for so many years, under the watchful eye of so many experts to be a master of the craft. Sometimes, in order to make that transition to the next step of our competency, it requires someone else to point out where we need help.

MD: A Degree in Review

It still shocks me that I am only a few days away from beginning my residency. Four years have come and gone. I now have a degree and letters behind my name to show for it. This last year has presented with its own unique challenges and a lot has changed in four years. Let’s have a look back.

Year One

It was here that I first learned how to correctly use my stethoscope, how to speak with patients, and how to act like a doctor. These were my baby steps. I studied a whole host of topics, covering the broadest and biggest organ systems. It was also here that I learned anatomy and had the privilege to work with cadavers. 

Year Two

In many respects this was the most stressful year. While clinical work is taxing in its own right, nothing came close to the mental toll this year had on me. Studying was both a necessity and a compulsion. Easily I spent entire days sitting a library, reading, memorizing, understanding. I had never studied that much in my entire life.

Year Three

This time, the stresses of clinical work were balanced between the mental and the physical. By far the most challenging year of all but also the most enjoyable. Having sat in class for the better part of my life, now I would have to do.

It was an adjustment to work in a hospital, to see volumes of patients, to do call shifts. But I adjusted and grew used to the pace of the ward. Gradually, I learned to move from knowing how, to showing how, to doing.

Year Four

On top of the clinical work, I had a number of additional challenges this year. I had an all encompassing OSCE, residency applications and touring, and a licensing exam to complete. By this point, clinical rotations were not quite as overwhelming or scary as they used to be, but I still had many hard days.

The brunt of the stress this year came from the latter additions. Those three things were for all the marbles, and the consequences of missing any one of those were a constant worry. The OSCE wound up showing some of my weaknesses that I would need to improve on. The CaRMS tour would take me across the country from colder to coldest winters in Canada. The licensing exam ended up being a two-week mad dash to the finish line. For six months, the pressures mounted through these three main events.

But I eventually reached the end of my four year journey. I graduated, I was admitted to a residency program, and I passed my exam. 

It has been a roller coaster ride through four years of medical school. I am happy I could document it all here in these posts. Now I start a different journey through residency and look forward to reflecting more on this new adventure.

Last Day of Class.
This is it. The final class of my four year journey through medical school. I may not have come out of it unscathed, but I have survived to see a new dawn and a new day as a resident.

Last Day of Class.

This is it. The final class of my four year journey through medical school. I may not have come out of it unscathed, but I have survived to see a new dawn and a new day as a resident.

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.