The Med Student Game

A couple weeks ago, I had a series of small group classes intended to teach Psychiatric interviewing skills. As part of the assignment, we had to interview a patient with a Psych issue, and write a formal note about the information we got from the interview. We have to write patient notes fairly often, but this one was a different format than I was used to, so it took a little extra effort (though they were nice enough to give us an example that we could copy from). After I did my interview and wrote my note, I emailed it to the Psychiatrist who led the group. A short time later, I got this email response from him:

Abby
you are both very good at playing the "med std game", that is making it easy for me to check off that you have done all parts of the required interview, and also you did a very nice interview--even though that is less a part of the formal scoring it is the most important of being a physician.
nice job

Every time I read this, I don't know quite what to think. The part about being good at the "med student game" gives me pause, because, while it's technically a compliment, I don't want to be the kind of student who just plays the game, and ignores the things that are actually important in learning to become a doctor. I'm pretty sure that's not what this doctor was saying, given the second part, complimenting my interview. Plus, this doc is the kind of guy who is enough of a pragmatist to know that we students have to play the game, at least to a certain extent.

But there are some people, I think, who only play the game, either because they don't want to worry about the actual important stuff, because they care so much more about grades and being "perfect", or because they don't have the skills to get through without "playing the game". I can't really say that these people are going about it the wrong way, because I certainly prioritize "the game" over learning for its own sake, like when I decide not to study a certain topic because I think it's unlikely to be tested, even though I can see how it might be important to practice someday. Med school is rough, and I'm not sure it's even possible to get through without learning to play the game well. So I guess I should be glad to hear that I'm good at it, but it is still an unexpected compliment.

A new chapter...

So, this blog has been pretty quiet lately, which was not intentional, but appears to have been an unavoidable side effect of second year medical school. I think it's probably more surprising that I managed to make a fair number of posts last semester than it is that I made almost none second semester.

But! The semester is finally over, and now that "summer" is here, I may actually have a bit more time for this. I don't really get a break in any meaningful sense of the word, as I am studying 40+ hours a week for my Board exam in a month, then I start my surgery rotation at the beginning of July. But this is much improved over last year, when I spent all morning and afternoon studying at school, only to come home and study a bit more before bedtime.

I don't want this blog to die off, because even though I haven't had much time for it, I still like the idea of track of this journey through medical school. Even if almost no one even knows it exists, hopefully I'll have some stories and insights over the course of my education that are meaningful to me. Someday, when I'm a happy doctor, looking back fondly on my med school days, I'll have a reminder of what things were really like.

My somewhat optimistic goal is one post per week, though I'm not sure if that will be manageable past July. But we'll see...

I think I'll end this post with a list of all the reasons why next year has to be better than the last two years. I've been told by several people that it will be, but I also thought that second year would be much better than first, and that didn't exactly go as planned. But maybe if I make a list, I'll be able to remember why the pre-clinical years were no fun, so I don't get too depressed with my crazy on-call schedule next year or whatever.

1. Patients! Finally, finally, finally, I will be able to stop spending every waking hour reading or thinking about reading about whatever random organ system. I mean, if course I'll still be looking things up and studying, but that should be nicely weighed out by getting to see and help real people (which is way better than the standardized patients that I had mostly been working with).

2. Individual attention. I didn't really think I'd mind that much, but I actually quite disliked not knowing my professors and having them not know who I was. Next year, there should be more opportunity to work more closely with Residents or Attendings or 4th years, or SOMEONE who will know who I am outside of the name on the top of the test. (Though I don't even think my current teachers had that, since our tests are computerized.)

3.Tests worth less than 50% of the course grade! This year especially, most of our tests were upwards of 60-70% of the total grade (and this is a single final exam, not two tests each worth 35% or something). That's stressful, having to worry so much about the single exam. And add to it the fact that most courses were curved, meaning there was no set grading scale and so no way to anticipate how well you needed to do to get whatever grade. Instead, I just had to hope that I studied harder than most of the rest of the class. In med school, that's less likely than it might have been at other points in my life.

4. Showing off clinical skills. I've generally gotten good feedback from instructors in my Doctoring class, saying that I do a good job working with patients. But that hasn't meant that much up to this point, as basically anyone who can talk coherently to a patient gets an A in Doctoring, so I didn't really have anything to show for it. But next year, this is a much bigger deal and a bigger part of our grades, so I'm hoping it will give me an advantage.

I'm sure there are more, but it's just about time to start getting ready for bed, so maybe I'll continue the list in a later post. Either way, this already has me looking forward to July. Let's hope I'm not deceiving myself!

It was only a matter of time....

I think I just became a coffee-drinker.

For the first 23 years of my life, I never drank coffee, minus the occasional sip at a wedding or other occasion (followed by dislike of the taste and continued non-consumption). But this year, as med school continues unrelentingly, I began to think it was time I learned to like coffee. So far, I've been able to maintain my 8 hours of sleep nearly every night, but there are still days that I feel sleepy and in need of caffiene. Plus, I know my future holds many a night of on-call or other long shifts, so I doubted I'd be able to handle that lifestyle with caffiene from tea or Coke alone, as I had done so far.

So a couple of months ago, I bought a cup of coffee at the coffee cart at school, on a day when I was literally falling asleep in lecture. And I choked down about one-third of it (black, because I don't want the hassle or calories of cream and sugar). ANd, again, about a month or so after that, I bought another cup on an afternoon when I was tired and having trouble focusing. Both times, the coffee had the desired effect, and kept me up, but I really didn't like it.

But today...I got another cup, and I actually enjoyed the taste. I mean, it's not my favorite thing in the world (that would be chocolate), but I've finished almost the whole cup, and I really don't mind it at all.

Check. One more milestone on the road to becoming a doctor achieved.

Pop quiz!

My throat was numb for the better part of this afternoon because:
A. I drank too much ice water
B. It was sprayed with lidocaine
C. Of a weird side effect of my allergy nasal spray
D. Strange things like that just happen sometimes

If you guessed B, you win the prize! Now, you may ask, why did I have lidocaine in my throat? For the laryngoscopy, of course! That probably doesn't clarify much, so here's the story:

For my Doctoring class, we were learning about how to do an ENT exam, so we were assigned to a couple hours with ENT residents to learn about their exams. And instead of using standardized patients (ie actors), they had us do it with student volunteers. So for the laryngoscope exam, I volunteered to be the patient. No one else really wanted to, and our class gunner was trying to volunteer a different girl, so I said I'd do it so she didn't have to. I really didn't mind, actually, it was pretty cool to see my own throat up close, and it really didn't hurt or anything (thanks to the lidocaine, of course). And now I know what it feels like, in case I ever get the chance to do it on a patient!

Which one am I?

I think this is fitting, since for some reason I've been thinking more lately about what specialty I want to pursue once medical school is finally over (if that ever happens...) Which category am I in?



From Movin' Meat

What have I gotten myself into?

I die a little bit inside every time I see doctor bloggers complain that the 80 hour per week limit for residents is not enough time for them to learn everything.

Is is just me, or does 80 hours a week seem like too many hours already? I mean, I can see that 40 hours is really not a lot, so I'm okay with more than that. Plus, I understand that in residency, they push to get more experience in in a shorter time. And I know there is a LOT to learn, so it takes time to learn it all.

But hearing about what's coming at a time when I feel like I am already spending every waking minute studying or thinking about how I should be studying, makes me feel like the next 6 years of my life are going to be more of the same.

I guess it's good that I'm teaching myself to like coffee now, because it looks like I'm going to need it...

One of these things is not like the other...

Many time since I've started medical school, I've gotten the feeling that I don't quite fit in. I don't mean that in a whiny, "nobody likes me" way, just that in the course of typical medical school activities, I sometimes realize a new way that I am different than the my classmates. There are lots of these examples, but this post is about one that happened today, in one of the million small group sessions we have for our Respiratory course.

I forget why, but for some reason the conversation landed on "back-up plans", what we would do if medical school didn't work out. I don't think any of us are actually expecting to need these, but it's kind of nice to fantasize about an alternate life when the pressure of medical school gets too high. But after today, I'm starting to think that I need to get a new back up plan...

The other people in my group had back up plans like "wedding planner" or "librarian". Guess what mine is: Pharmacist. No, seriously, it is, and I tell people that all the time. Way less time in school than medical school, but killer compensation when you are done. (Not that I'm in it for the money, but still.)

What does it say about me that my back up is so similar to my current plan? Obviously, the fact that I have a sister who's a pharmacist has something to do with it, I think, but I can't even think of a non-medical fallback career I'd be interested in. I think I need to work on that...maybe alpaca farmer? (Come to think of it, I do think that would be a pretty sweet gig. They're so cute!)

New world order

I think one of the hardest things about medical school (besides, you know, being really hard work) is that the standards of measurement change so drastically. Medical students all come from a background of academic success; otherwise we wouldn't have gotten into medical school in the first place. But once you are actually IN medical school, it's just not possible for all of us overachievers to keep being the best.

So it's been an adjustment to try to be satisfied with managing to be merely average, and trying to be happy with "above average" when that means an 86%, when the average was 84%. I told myself this year that (after pass/fail grading last year), I wasn't going to get caught up in always trying to be the best; I was going to try to be reasonable with my expectations. But I don't think it's worked. Maybe the worst thing is that I feel like I spend every waking moment studying, but it's still not enough. I'm not really sure what I could have done that would have pushed that 86% up to the 88% it would have taken to get an A in CV (which has a massive curve, if you couldn't guess).

But I felt this way last year, too, especially at the beginning. So, I'm still holding out hope, that as I get used to the new rhythm, I'll inch closer to the top of the heap. But, really, in a class of all stars, middle of the heap's probably not so bad.

After all, what is it they say? "What do you call the person who graduates last from medical school? Doctor. " One day, I'm sure, I won't care what grades I got, but right now, it hurts a little not to be the best.