Things I learned in my first year of med school

Tomorrow classes will start again and I will be a second year medical student. My first year of medical school was really difficult. During that time, I feel that I learned a little about myself.

The most productive place to study is a desk in a silent place. 
It's not the most pleasant place. I'm depressed and angry when I'm studying here but I actually get studying done. I still sometimes study at coffee shops but I'm ultimately doing a disservice to myself because I'm less efficient when the environment is noisy so I end up spending more time studying.

I enjoy seeing patients even when I can barely remember questions to ask or the components of a physical exam. 
Most of my patient interactions have come from volunteering at a weekend clinic for uninsured and underinsured people. Medical students are responsible for taking vitals, interviewing patients to find out the reason why they're in the clinic, their health history, and conduct a physical exam.

I can learn an enormous amount of material when I have to.
I listened to an NPR segment about children competing in a Koran memorization competition. I'm impressed by their abilities but more so by their dedication. I don't believe it requires a prodigy to memorize the Koran or to be a doctor. It requires a lot of work and time. I could memorize Robbins and Cotran's The Pathologic Basis of Disease by heart if I needed to.

I can make sacrifices for medical school.
I don't find it enjoyable to study on Friday and Saturday night but I do because that is the only way I will pass my exams. I look back on my old blog entries on my undergraduate days and at my flickr photos from when I traveled throughout Europe. That seems like a different life.

I can make time to spend time with the people who are important to me.
One of my greatest fears about medical school is that I would not have any friendships or relationships with non-medical students because I had to study all the time. This was proven by the fact that during my first semester I spent almost every night studying until about 11pm or midnight and I still found exams difficult and the material overwhelming. I didn't spend time with friends I had made during undergrad who were still in the area even though I missed their company.

But second semester showed me that it is possible to sustain meaningful relationships with people outside med school! I felt less isolated and more hopeful that I wouldn't be stuck in the medical world forever. I sometimes quit studying at 9pm so that I could spend time a couple hours with my boyfriend. That was a big decision for me even though it doesn't seem like much. I thought I was so close to failing exams during first semester that the only option was to study more during second semester.

But somehow during the second semester I had more exams -- one almost every Monday -- but spent more time with and got better grades than I did first semester. It's was very strange. I still can't figure out why but I hope that I can do that again.

Medical school is really hard but not impossible. 

med student pickup lines

An incoming freshman asked me what the nerd cave was. I didn't tell him because he'll find out soon enough. 

Heard this from my fellow student. It's a nerd cave pickup line: "The cubicle next to mine is empty. Wanna study there?"

"Research" or Glorified Microsoft Office suite operator

I'm doing research this summer. It's not any research. It's cancer research, which automatically makes people think it's important research. This means I'm getting paid by my medical school to work with a faculty mentor full time for seven weeks.

It's actually epidemiology research that's sort of related to cancer but not really. To most people, that sounds a lot less impressive than cancer research because they don't know what the hell epidemiology is about. (Wait, I don't know what epidemiology is...) It actually means that I wait around for my mentor to give me some numbers that I can make into a diagram, textbox, or table and put it in a powerpoint slide. My chief job responsibility is formatting a powerpoint slide that's to be a poster and writing the manuscript for a paper that I really don't understand.

I'll be getting a W-2 this year! This is the first paying job I've had since ... summer 2009? I had forgotten about the magic that is direct deposit.

Does anyone have experience carrying a large poster tube on the airplane? Please get in touch with me. I will have to do this in about a month's time.

The good news is that I felt a little less incompetent during my weekly meeting with my research mentor and Skype call with her collaborator, an epidemiologist at the University of South Carolina). Usually It was not because I contributed meaningfully to the discussion between my mentor and her collaborator because another (soon-to-be) second year student was there who seemed just as clueless as I was.

I've been reading a somewhat famous blogger on the med student blog circuit, Action Potential (http://apotential.wordpress.com/), who wrote about her summer research frustrations here. She's funny.

You might not believe it but I did learn how to do a complete physical exam

There's an order to conducting a physical exam. I took a class on it and passed the exam, which consisted of doing a physical exam on a classmate including memorizing the steps and performing them in the correct order.

You wouldn't know this if you had seem me at the weekend clinic where I volunteer.

What goes on in my head:
Me to patient: I'm going to conduct a physical exam on you.
OMFG WHAT'S FIRST??? OHHH I SEE EYES. OHH I SEE AN OPHTHALMOSCOPE AND OTOSCOPE ON THE WALL. WAIT. IS IT EYES FIRST OR NOSE FIRST??
Me: I'm going to look into your eyes now.
AHHH I CAN'T CLOSE MY RIGHT EYE WHILE KEEPING MY LEFT EYE OPEN...
OH SHIT. WHAT'S NEXT AFTER EYES AND EARS???

This went on until I went through the motions of enough components of the physical exam in no particular order until I thought maybe  the patient was fooled into thinking I gathered any useful information. (I didn't.)
  
When I left the exam room to report to the attending physician, I realized that I forgot to palpate lymph nodes. Oops.

Ridiculous mnemonics

Hey everyone! It's my revamped blog! I figured since medical school consumes my entire life now, I'll make this blog about medical school.

There are a lot of things to memorize in medical school so students and doctors come up with mnemonics to help remember them. However in my experience, some of them don't actually help you remember whatever it is you're supposed to remember. Furthermore, clinicians tend to publish papers introducing their mnemonic as if it's the greatest thing ever. This I find ridiculous.

HEADSSS is supposed to help pediatricians remember important questions to ask adolescents. However, all I could remember was that it was sort of like the word "head" but with some extra letters but I couldn't remember which letters, let alone what each stood for. I had to Google it when writing up this post.

HEADSSS:
H: home
E: education/employment
A: activities
D: drugs
S: sexuality
S: suicide/depression
S: safety

PPQRST has the honor of being the first ridiculous mnemonic I learned back when we were all bright-eyed first semester students. It's purpose is to help clinicians thorough assess a medical complaint. The problem is that we can't phrase the question to the patient the way the mnemonic is. We are supposed to ask questions simply and directly. Words like "palliative" and "provocative" are out so we have to remember to ask what makes the pain better and what makes it worse.

P: palliative factors
P: provocative factors
Q: quality of the pain
R: radiation
S: severity
T: temporal course
T: treatment

An internal medicine resident told me that for Step 2, PPQRST doesn't cut it because the student has to elicit a lot more specific information about the complaint. He has many more mnemonics for that. Yikes.

Hymen Shmymen

 Just want to say that I and two other smart young ladies write a blog focused on gender and science. This entry is cross posted at herstoryofscience.blogspot.com. Please check it out!
 
Since medical school began, I've only managed to read one non-required book in the last two months. It's not a fact I'm proud of but I think I spend my scarce time wisely. I read Hanne Blank's Virgin: The Untouched History, an account of the history and nature of virginity. It's an accessible and entertaining read for my overtaxed brain.

This was one thing I learned:

Despite the lack of any actual studies in the literature regarding whether horseback riding, gymnastics, or riding bicycles might have to do with womens' hymens, virtually every contemporary writing about virginity aimed at teen girls is duly equipped with a disclaimer that says something along the lines of 'many girls tear or otherwise dilate their hymen while participating in sports like bicycling, horseback riding, or gymnastics.'"

Woah. There is no scientific evidence that these activities stretch or tear the hymen! Yet I've heard this countless times in teenage girl magazines or otherwise informative literature on puberty and sexuality. Be sure, this "fact" is not just something from conservative abstinence-only sex education curriculum but widely seem in popular and generally accurate sex ed. It's probably in those puberty books your pediatrician recommended you to read. Understandably this belief was popularized in order to dissociate hymen with virginity. In recent years (decades?), it's become more acceptable for girls to participate in sports and the hymen less a gauge of virginity.

I think it also shows that the empirical evidence or lack thereof don't affect people's beliefs that much, in sexual matters and otherwise. In medical school we grumble all the time about evidence-based medicine. It should dictate medical practice but often it doesn't. Doctors and patients often want and perform procedures that aren't medically better than the other options.

Have you heard this when you were growing up?

history, culture, politics, and religion. oh my.

I have the pamphlet from the Mosque-Cathedral of Cordoba! Actually my travel companion graciously sent me these photos of hers, which she managed to carry back to the States. I re-read the pamphlet and it confirmed the feelings I had when I first read it standing under the red and white striped arches. The Church has a narrative of Andalucia's history and it's eager to let the visitors know that it has the moral high ground. 

According to the pamphlet, the Church is protector of other cultures. It preserved the mosque by converting it into a church.

It is the Church, through its Cathedral Chapter, that has made it possible to keep the former mosque of the Western Caliphate, the oldest cathedral in Spain, and a World Heritage Site, from becoming a heap of ruins. In fact this has always been one of the missions of the Church, to safeguard and inspire culture and art.

On the other hand, Moors destroyed the first church that was at this site in order to build the mosque on top of it: "Following the Islamic invasion of Cordoba, the dominating Muslims proceeded to the demolition of the [unintelligible] church of San Vicente and in the year 785, began construction of the Mosque..."

Therefore, everyone should be grateful that the church was so generous in preserving the mosque even those the Muslims destroyed the previous church.

It is a historical fact that the basilica of San Vicente was expropriated and destroyed in order to build what would later be the Mosque, a reality that questions the theme of tolerance that was supposedly cultivated in the Cordoba of the moment.