doc w/ Pen

journalist + medical student + artist

Tag: clerkships

An altered attitude about studying

In the flurry of ob/gyn, I neglected to share this news:

That image comes from my score report for USMLE Step 1. I have never been so happy to pass a test in my life. The six weeks of studying for Step 1 were brutal and often demoralizing. The amount of content tested is more than anyone could ever possibly learn. Much of it is clinically irrelevant, which made it harder for me to motivate. But I slogged through. And thankfully, I never have to think about Step 1 again. Later I will take Step 2 and Step 3, but my understanding is that these exams aren’t so bad.

Medical school, you see, is full of tests. This includes clerkships. At the conclusion of each rotation, we take a comprehensive, multiple choice exam called the “shelf.” My ob/gyn test is tomorrow. It covers everything I’m expected to have learned during these six weeks. Everything from delivering a baby (and all the possible complications that entails) to diagnosing uterine cancer to dispensing appropriate contraception to dealing with sexually transmitted infections — and all manner of women’s health issues in between. Some of this, we learn during our actual time in the clinic or hospital. But there is still book learning to be done.

In the last six weeks, I have spent many weeknight and weekend hours poring over ob/gyn review books and doing practice questions. In doing so, I realized that my attitude about this kind of studying — clinically applicable studying — is markedly different from how I felt while studying for Step 1. I’m finally learning real medicine. I don’t just want to pass. I want to surpass. My future patients are counting on it.

Getting back up

In addition to sharing my experiences here on this blog, I write a monthly column for the online magazine The American In Italia. This month’s piece, published yesterday, is about how humbling medicine is — in more ways than I expected. Here’s the link: Getting back up.

Becoming my own advocate

The first day of my ob/gyn rotation, I remember the clerkship director telling us one way in which pre-clinical and clinical experiences are different. In the classroom, she said, the focus is on you the student. In the hospital, the focus is on the patient. That seems obvious. I quickly learned what that means, though, is that I need to be a constant, assertive advocate for my education.

While on labor and delivery, for example, I’ve discovered that keeping my eyes and ears open is the best way to stay involved. When I overhear a nurse saying that the patient in room 5 is fully dilated and starting to push, I rush to the room so I can help — and learn. When I see on the patient list that someone new has just arrived in the triage area, I quickly tell the nearest resident that I can go see her. I pull up her outpatient chart to review and start a note with our triage template so we can easily add the information from the patient interview. When I hear a resident mention that she needs to do an EKG on a patient with an irregular heartbeat but our machine is broken, I offer to run to the SICU (surgical intensive care unit) the next floor up and borrow theirs. Then I finish the EKG myself.

There are certainly times when someone specifically invites me to participate. One night, for example, a resident told me they were removing a cerclage (a stitch that holds the cervix closed), took the time to briefly describe the case to me, and suggested I go watch. But often, it’s up to me to insert myself. Then once I’m in the room, the resident or attending will explain what’s going on. It’s not that the doctors and nurses are trying to withhold information from us medical students. It’s that they’re busy taking care of patients — that’s their priority, and understandably so.

Assertive self-advocacy wasn’t necessarily a skill I expected to strengthen in medical school. I’m realizing, though, that while medical education entails learning about medicine, it’s also about so much more.

Learning to adjust, and keeping the faith

I made scrambled eggs for myself today around 8. Making eggs isn’t unusual for me. I do it almost every day. What’s odd is that I made them at 8 p.m., not 8 a.m. I’ll tell you, it’s disorienting to eat breakfast after the sun has gone down rather than after it has come up. But that’s what you do when you’re working the night shift.

I’m so glad to finally be working in the hospital rather than sitting in a lecture hall. Like every transition though, there are elements that take some getting used to — like being awake when it’s dark outside.

One aspect of clerkships I’m adjusting to is how little time I spend in one place. Every team has a rhythm and it takes a while to fall into sync. My first two weeks of ob/gyn, I was on the gynecology service. As my first clerkship, there was lots of generalized adjusting. Then there was learning the gyn team’s workflow, figuring out where to find things (I have a horrible sense of direction so this probably took me longer than the average person), and developing a better understanding of gynecologic surgery. Just as the two weeks were ending, I finally felt like I’d gotten a better grasp of it all. And then I moved on to rotate through maternal fetal medicine, with a completely different schedule, team, workflow, and fund of knowledge. I’ve never worked as a temp, but I imagine this is similar. You walk into a new situation, cold, every few weeks. You rush to get up to speed, then head somewhere else to do it all over again. I’m not sure there is a solution for this in medical education, since medical students do need to rotate through so many fields. My goal is to do my best, to be as useful and helpful as possible, but also to give myself grace when I fall short of that goal.

Maybe as much as anything, this constant merry-go-round teaches us medical students to be flexible. In medicine, as I’ve learned so many times already, things often do not go as planned. You need to think on your feet, to be creative, to work with what you have and where you are. With that in mind, I’m trying to use these periods of disorientation to learn how to adapt to new and challenging situations. That can only help me as a physician.

Once I started thinking that way, focusing on how this frustration could actually teach me something useful, I started to feel better. This reminded me that attitude plays such an important role in education, as with anything else. You truly get out of it what you put into it — mindset included.

It also helps to know that I’m not the only one who feels like I’m flailing. Yesterday I was chatting with an anesthesiology resident shortly before a minor procedure on labor and delivery. He acknowledged that as a medical student, he too felt like he was in the way much of the time. He also said, with a wry smile, that he hoped my transition to feeling useful would be shorter than his was.

That would be nice. But I’ve realized that it’s not all about feeling useful. It’s great to be helpful, and I aim to be as much as I can. The truth is, though, that I just don’t know much of anything yet. That will slowly change, I’m sure. For right now, I want to go in every day with a smile, to be as valuable a team member as possible, and to keep an open, curious, passionate mind so that I can take it all in.

The pieces will fall together eventually. No matter how disoriented I feel in the moment, I have faith in that.

Nocturnal on demand

I’m hoping a pot of strong coffee will help prepare me for my first night shift on labor and delivery.

I can count the number of all-nighters I’ve pulled on one hand. All were in college. Tonight I will add to that number. Tonight, I start working nights on labor and delivery (L&D). It’s only for four shifts. But it will definitely be a growing experience.

I’m simply not a night person — morning is when I shine. Some people will stay up late to finish their work, then crash when they’re done. Not me. Back when I was in journalism, with a newspaper deadline looming, I would go to bed at 10 p.m., sleep for a few hours, then wake up at 2 or 3 a.m. to finish writing my stories.

But babies are born around the clock. So being a medical student on L&D means both learning what goes into a delivery and developing the stamina to work these long and sometimes awkward hours. The same principle is true for many other specialties too.

There doesn’t seem to be any good way to shift your schedule from days to nights. I got up as usual this morning, and then after lunch took a 2-hour nap. I made a pot of French press coffee around 4 p.m., which I’m drinking now. I’ve got lunch (if you can call your midnight meal that) and snacks packed, and more caffeine if needed.

Here goes …

What do I want to do when I “grow up”?

In a recent comment on my blog, someone posed a question to me. She asked whether I have a specialty in mind for the future. It’s a common question for medical students. So I’m used to fielding it. I think it’s worth explaining my thought process here.

The short answer is that I don’t really know what I want to do when I “grow up.” I’ll become a doctor of course, but what kind of doctor? I’m not sure yet. I think that’s the case for most medical students at my stage, pre-clerkships. We haven’t had real exposure to what doctoring is like. We’ve all shadowed various physicians, sure, and spent some time in the hospital practicing our physical exam and history-taking skills. But we’ve never been a true part of the medical team.

And that’s what clerkships are about. They’re an introduction to several medical specialties, a chance to try on the different branches of medicine, to see which one fits best. In order of my own rotations that start Feb. 13: ob/gyn, primary care (adult outpatient medicine), psychiatry, surgery, anesthesiology/critical care, neurology, internal medicine (adult inpatient medicine), and pediatrics. During clerkships at Cornell, we also get a 2-week elective block where we can try a field not represented in this list.

Part of choosing a specialty is finding the kind of medicine that interests you most. This is pretty obvious. Do you want a procedure-based specialty like general surgery or urology? Which patient population do you want to work with — kids, adults, pregnant women? Clerkships are designed to help answer questions like these.

I’ve also heard that part of choosing a specialty involves finding your kind of people. I’ve been told that different fields attract different personalities. Finding the right fit means finding where you fit in.

Clerkships still lie ahead of me. So I’m decidedly undecided at this point. My goal in the next year is to remain open minded. And there is so much overlap between the different specialties that no matter what I choose, having some experience with the other fields will benefit me — and my patients.

That’s my attitude. I hope that approaching clerkships this way will help me learn the most from each one.

Celebrate!

ChampagneI have two photos to share. First, the bottle of brut cava I just bought to put in my refrigerator for tomorrow. Not that I need an excuse to drink bubbly, but this is for a momentous occasion—to mark the end of my first year of medical school. I’m not quite there yet; I’ll be done in 24 hours. With all the hurdles I’ve have had to overcome to get here, finally finishing my first year—not only intact, but truly thriving—is surreal.

Rotation scheduleThe other photo, and another reason to celebrate: in February of 2017, I will begin my medical “clerkships.” This is where the rubber meets the road, so to speak. They send us out of the classroom and into the hospital to work with real patients (*gulp*). This photo is of my clerkships schedule, which I received yesterday. This will be my life, from February of 2017 to January of 2018: OB/GYN (6 weeks) → Primary care (6 weeks) → Psychiatry (6 weeks) → Surgery (8 weeks) → Anesthesiology (2 weeks) → Open elective time (2 weeks) → Neurology (4 weeks) → Internal Medicine (8 weeks) → Pediatrics (6 weeks).

Whew! So exciting. So much to learn. One day at a time …