This is one of those ideas that looks really great in theory, but has the possibility of sucking astronomically in practice.  And I’m sure that it’s worked out well somewhere, but GUMS hasn’t gotten it down quite yet.

I am perhaps not the ideal person to be critiquing the system.  Unlike many pre-meds, my “patient contact” before medical school was not confined to volunteering at an information desk and following a physician around for a day.*  I worked my way through undergrad in an actual hospital where I did actual things for patients that involved touch and bodily fluids and responsibility and occasional unpleasantness.  I kept my eyes and my ears open and put myself out there as someone who was willing to learn how to do anything and who was eager to stay late/come in early to see anything.  So I had a lot of opportunity to look and learn, and I took advantage of it to the best of my ability.  Therefore this whole early clinical exposure bit is perhaps not as exciting for me as it might be for someone who has never actually seen 4+ pitting edema or heard a heart murmur or looked at an infected incision.  However, none of my classmates seem enthralled with the experience we’re having, either, so I think it’s more than just me.

Our clinical exposure in the second year comes in a few flavors.  Every week we each are required to locate a patient in one of the approved areas of the hospital and do a history and physical (or, as much of the physical as we have learned up until that point).  We then write it up and present it to our attending mentors.  I think this part is a nice idea that fails in practice because, as big a hospital as GUMS is, there are only a finite number of patients who are suitable for learning how to do a history (i.e. it helps if they can speak and is even better if they know who they are and where they are).  There is also only a finite amount of time in which we are not in other classes.  The upshot of this is that you have a small army of medical students descending on the wards and practically arm-wrestling each other to get to the fraction of patients that are good candidates.  Invariably these saints get tired of suffering through question/exam sessions that take two hours (because we aren’t allowed to do a focused history and have to run through the entire ROS and because, let’s face it, we’re new at this) and don’t want to talk to any more students.  So the rest get stuck trying to get a history from someone who thinks it’s 1954 and is wondering where their pants are so that they can go home.  While this is not a horrible experience in and of itself (heaven knows we’ll need to deal with it at some point), it’s really not a great learning exercise when you’re not actually on the team and you can’t do any of the ordinary things like call up a family member or get the med list from the pharmacy or any of that stuff.

But that’s not the part I really have a problem with, as I think that even at worst it has the redeeming value of having you go through the motions.

The part I have a problem with are the “examination rounds,” in which we are supposed to go around in groups of four with a resident for an hour so that we can see patients with any interesting physical exam findings that the resident may be aware of on the floor.  This, again, is not a terrible idea in theory.  But in practice, since they are unable to find enough residents to handle us all, we get lumped together in groups of eight.  We then traipse in and out of people’s rooms in a white-coated conga line begging to see whatever abnormal finding they might have.  But because there are so many of us, in a show of amazing sensitivity, we only each listen to half their lungs or at one spot for their heart or what have you.

I would be more understanding about this if we were looking at really incredibly unusual things.  But, for example, in today’s hour, we saw three patients.  One had leg edema (which was 1+ if that) and ascites (we weren’t permitted to do an actual abdominal exam, however, because of how many of us there were).  One had crackles in the right base (so only half of us heard them, as the other half were listening to the left).  And the last one was… wait for it… pale.  To her everlasting credit, the poor resident whose job it was to chaperone us through this wonderland of excitement tried really, really hard to make it worth our while by telling us about how each patient was being worked up for their problems and what was being done to treat them.   But it was a sad waste of our time and her time, and she knew it.

More importantly, though, I think that it was really not worth doing that to the patients.   These were not people who were happy and excited to be a part of our medical education (well, except for the lady that was pale — she, kind woman, clearly didn’t mind a bit, but then again, we weren’t undressing her and poking and prodding at her).  These were people who were given less than half a chance to agree to our invasion and were clearly reluctant to be involved.  The glib answer that is given by GUMS to these concerns is that it is a teaching hospital and that all these people know that when they choose to come here they will have to deal with students.  Even if that were true for every patient (the idea of choice is laughable in many cases), I still don’t like it.  I think that if you are going to have parts of your body bared to a crowded room of eight rank newbies that the newbies should at least be getting something important out of the experience.

The only thing that I’ve gotten out of this experience so far is the conviction that, if I’m ever in charge, I won’t do things this way.

*It may seem here as if I am slightly scornful of the pre-meds who choose this path. I try not to be, but I suppose I am.  It’s really that I just don’t understand how anyone could make the gigantically life-altering decision to put themselves under mountains of debt and years of work to pursue a career of which they seem to have, at best, the barest minimum of comprehension.  I mean, it’s not like I had some incredible perception of what the life of a doctor actually is all about, but at least I gave it a bit more of a try.  I also received a lot of condescension from people who couldn’t understand why I would bother doing a job that actually required contact with urine and feces — they felt that such a thing would be so beneath them.  This obviously does not refer to all pre-meds — there are certainly valuable reasons to choose to spend your time doing research or teaching projects or what have you.  It does refer to the ones who were total dicks about it, however.

Now I have to put my money where my mouth is when it comes to picking a date to take the exam. This is a decision that I rationally understand is actually not that big of a deal, but the whole strategy aspect of it is one of those things that you can go round and round with forever. (And I have, pretty much, with my friends.)

If I chose to take my test on the last day before third year begins, I would have slightly over seven weeks after my last final to study and prepare. I know a large number of my classmates who are taking this approach, and more power to them, but I don’t think that it would work for me. I think it’s all about knowing yourself, your strengths, and your weaknesses. I have often been told that procrastination is my middle name, and it’s sadly true. I think that if I gave myself seven weeks I’d waste about half of that time. I also think that if I go from Step 1 directly to third year without passing go and collecting two hundred dollars, I might possibly end up in jail. Because I’d probably explode, and there’s likely some sort of law against that.

So, clearly, for multiple reasons, I need some time between the exam and the start of third year. But how much?

My initial instinct was to shave 14 days off. That’s five weeks for studying, two for relaxation, and it seems pretty balanced to me. This was, however, before I started this semester of classes, back in those halcyon days when I mistakenly thought that I might have a spare moment for boards studying during the semester. Ah, the folly of youth. Also, when I told people that this was my plan, they looked at me as if I was utterly nuts. (Usually, they look at me as if I am completely crazy, so you can see that this was an upgrade.)

So, perhaps one week off? It seems so short and unsatisfactory. I’d actually like to go somewhere, and spend some time there, and this doesn’t seem adequate (I haven’t taken a real vacation since school started). Also, 6 weeks of studying still seems pretty procrastination-prone.

So now I’m not sure. My gut is still telling me to go with the 5/2 plan, but I’m questioning my sanity. I need to make this decision soon, though, in order to be able to schedule the appointment.

Hmmmmmmmmmmm.

This semester is going to be great, it really is.  It’s exciting, it’s fun, it’s interesting, and if I survive I’m sure I will look back on it fondly.  The pace is just insane — and it’s not like we were moving slowly through material before.  But this is what I signed up for, and I’m going to give it all I’ve got.

My boyfriend, who shall here be known as Bubble Boy (he’s possibly the most atopic person I have ever met), asked me what my New Year’s resolution for this year is.  I semi-jokingly replied, “To be a gunner.”  Of course, I don’t intend to start defenestrating my classmates or anything, but I am ramping up my effort to the 150% range.  I struggled with motivation at times in classes like biochemistry, but that’s all history.  I’ve already suffered for my resolve — I have a bruise on my thigh from rolling over Robbins when I fell asleep one night while studying and I broke a fingernail when I tried to pick it up out of my backpack with one hand, misjudged how heavy it was, and dropped it.  I guess that which doesn’t kill you makes you stronger.

I registered to take Step 1 and, I must admit, it was a bit nerve-wracking.  I feel like I have so much to learn between now and June, and so little time in which to do it.

Oh, well.  FORWARD!

Scientists for Better PCR 

If I fail out of medical school, I blame Dolphin Olympics 2.

http://www.washingtonpost.com/wp-dyn/content/article/2007/12/02/AR2007120201636.html (pops)

I’m grateful that I attend a pass/fail school.  I know myself well enough to realize that I am a competitive person, and I think that the competitive aspect of grades plus the worrying about grades on my residency application would have made medical school a much more unpleasant experience for me.  Here at Generic Urban Medical School (henceforth to be known as GUMS), I am supposedly free to concentrate on learning the art and science of medicine and on having a “life outside of the classroom.”  And it works, for the most part.  I’m posting on a blog during finals week, right?

I do think that it encourages (or at least permits) sloppy and/or evil exam writing on the part of some of the professors, though, and while I don’t go nuts about it the way some of my friends do, it is frustrating from time to time.   It is also an open secret that there are a few courses in the curriculum that, while you have to “pass,” have rather, shall we say, elastic standards for doing so, owing to the fact that it probably wouldn’t look good to actually fail the number of students who would deserve it based on the insanity rigor of the exams in those courses.  I don’t think that such a farce is terribly professional.  And we here at GUMS are all about the professionalism.  (Once upon a time I didn’t hear that word in italics in my head.  Now I have immense difficulty using it other than sarcastically.  This saddens me.)

While I have enjoyed some of the classes this semester, I am very glad it’s over and that I am moving on.  One more semester of being stuck in a classroom lies ahead, and it’s supposed to be a really good one (although based on the opinions of MS’09 about the rest of the curriculum, I am hesitant to trust that assessment).  While we have certainly learned an awful lot over the past year and a half, I don’t feel that any of it has truly been integrated or that I have learned anything about thinking like a physician.  I know that I have a ways to go, and perhaps I’m just overly jumpy, but I’m nervous about that.  One more semester doesn’t seem like it could possibly be enough to prepare me to take Step 1 and, more importantly, to perform on the wards.

I really hope I’m wrong.

Today’s video is “StudyBack,” a parody of Justin Timberlake’s “SexyBack.” I thought it was funny and well done.

Fortunately, amongst the various junk left here by the previous asshole renter (thanks, dude), there was a thermometer. So I am able to quantify my suffering. It’s 60 degrees Fahrenheit in my bedroom as I’m sitting here typing away. I shudder to imagine what it will be like once it actually gets cold. Methinks a post-holiday trip to the hardware store for some shrink-wrap window stuff is in order.