Charlie goes to Medical School

Gonna kick back and relax for a minute.

Andreas Vesalius - De humani corporis fabrica (On the Workings of the Human Body) Huntington Library. Detail of the Anterior Aspect of the Bones of the Human Body Assembled Together. From the Description in the Huntington Library. Picture by Brewbooks.

Thank you…thank you very much.

For starters, today’s exam was rough. I think I did pretty alright, but it was a clear demonstration of what I know and what I am unsure that I know and what I don’t know.

I spent the entire weekend reviewing stuff from class, but clearly I’m getting to where I might benefit from a bit of outside help. These aids tend to highlight high-yield subject areas as well as some specific topics that not every school will get to.

I started with a clean white board for my physio review…it was filled after cardio and pulm. This meant kidney, GI and endo all were off in on note cards and legal pads.

We are going to need a bigger board.

However, the exam was much past this with a lot of the questions geared more towards practical application of this knowledge, so memorizing is no longer enough. You have to know how to apply all of this stuff. This really was the same as the approach to the anatomy/dev exam…it was just harder with physio.

Biochem is my last exam, and after I will officially be done with my first year of medical school. I don’t really have a strong plan in place for what I need to get done with all the free time that I am about to have. But needless to say, I’ve put off enough stuff that summer is going to be pretty busy.

Any of my free time needs to either be directed at relaxing or studying for Boards. However, my day job is going to be research. Maybe I need to clear the white board after biochem and use it for the “must do” list for summer.

I can't draw for crap.

I’m pretty tired. I need to start studying, but I was up late last night…the last three nights. Studying for the Anatomy final exam which went pretty well, but I wish I had started studying on a different tack than I did.

I’ve been saving my flashcards which has been somewhat helpful, but not as much as I would have liked. Ultimately, I made them too all inclusive, and what I’ve been needing are the highlights. I did use them to cover stuff from the fall once before moving to the high-level review, but most of the cards I didn’t have time for.

I mainly concentrated on the clinical correlations that were given to us throughout the year. The result is that the granular study early on and going back over stuff from the fall (especially the muscle compartments of the limbs) made the clinical correlations really stick. Half of the questions on the exam I answered in less than 10-15 seconds.

Where I really wish I had taken more time to review was some of the development which was also on the exam. Overall, there were a couple of really tough questions that I had to really guess on, but I don’t know that I ever would have known them.

One thing that sort of helped was drawing and scribbling a few notes on my white board. I wasn’t entirely successful at determining what should have been on the board, but it did help me out more than a few times. My drawings are all awful. You should see some of the other students in our class. It amazes me that medical professionals who universally have awful handwriting can do some of the best illustrations.

I’m feeling better about this subject now that I’ve taken the test. I was pretty unsure about things going in, but I think that was just because I did such a high-level review…although sometimes that is all that is needed.

Old Microscope by Flavio@Flickr

Today was the cumulative lab practical exam for our histology component. Histo has been a lot of fun, but I think everyone is glad to start sloughing off the responsibilities associated with each component of this curriculum. I’m one step closer to summer.

We also handed in our scopes and slides today, so I am no longer responsible for the equipment which happens to cost way too much money.

I was actually bragging to Wife over the weekend about how well done the histology labs are. The first year class is split into four sections in four different rooms, with our class taught over video conference while other instructors facilitate inside the room after the demonstration video.

The great thing about it is these demos are recorded and we have access to all of them. Most of the past few days, I’ve been intently reviewing the lab demonstrations…at around x1.5 speed. During this process, I discovered that our instructor starts each video with the phrase “Today’s Lab Session is on the…”, so that’ll be a catchphrase here soon.

I also spent some time reviewing electron micrographs, the last edition of our textbook and a set of histology flashcards that I bought. Had I to do over again, I would have spent an extra 10-20 bucks and bought an extra old histo book or two to cut up for flashcards instead. The other thing I do for these practicals is spend some time just looking at the words and saying them over in my head. There have been more than a few times where I know exactly what something is during its name…except for its name. Apparently “that thing next to the other thing” is not an acceptable answer.

The lab exam was mostly the same as every other practical exam we’ve had. It seemed to go pretty well.

Sorry this post is pretty short. I’m moving on to the next subject. We have a review tomorrow, and I don’t want to go in cold for it. So off to study!

Quick post to say that I took the one and only test for the last module for the year. I wish I could say I felt better about it, but I usually feel this way after tests.

Tomorrow starts the review sessions for our shelf exams. We actually do a bit more in the cumulative exams department than most schools, but it is pretty good to get a solid check point this year…because next year the end of year tests are much more important.

One bit of feedback that I got this week: I need to learn how to relax.

365::62 - moments so quietly gone by brdwatchr1

I was going to call this something else, but this picture so perfectly says it.

I still have review sessions and tests left, but today marked the end of lecture for Phase I, my first year of medical student.

We marked the end of class solemnly by throwing pies in the face of one of the course directors (it was part of a fundraiser). The throwers were picked out of a box, so I naturally started a movement to “nominate” one of our friends to do the throwing. Alas, it didn’t work.

We have a test on this module coming up, followed by shelf exams. Shelf exams serve as a checkpoint at the end of the first year, so students can gauge their retention of knowledge for second year when we have to take the step 1 boards. The lecturers in charge of the relevant subject areas are nicely putting together review sessions/materials to help us study.

These tests aside, I’ve covered all of the material from the first year of medical school. I can’t remember how much I’ve written about our curriculum, but medical school is basically broken into four parts. Roughly, the point of each year is as follows: The first year covers how the body should work. The second year covers how things can go wrong (and pharmacology). The third year is how you treat these disease states. The fourth year sort of continues the third, but with more of a focus on what you want to do (and where you are going to go…Match!).

So with Phase I nearly complete, I should have a fairly comprehensive understanding of how the human body works. I guess I’ll get to gauge that over the next few weeks as I take my shelf exams.

Non Sequitor (This gets just a tad graphic…and sad, so be forewarned.): So last night I had a pretty weird moment. I ran out to hit an ATM to deposit some checks and deposit some checks. On the way back, I swerved to miss a cat who had been hit. It wasn’t until I passed by that I realized that the cat was still moving. The cat rolled over on its back and onto the other side, clearly writhing in pain. By the time I pulled around and got out of the car, the cat had died (or seemed dead enough without me risking exposure to something like rabies). At the time, I remember feeling pretty powerless seeing as how my initial reaction was to actually ask the cat if it was okay. I whistled a few times and checked to see if it would respond, but there was enough blood on the pavement to rule out this cat’s survival. I was fairly sure that I could leave and be satisfied that the cat wasn’t hurting any more.

Of course, at the time my head reeled thinking about what actually was going on with the cat. Even moving the cat would have probably resulted in the cat’s death. I don’t really have much else to say about it. When I got home, I wound up staying up really late because I didn’t feel like going to bed or studying with those thoughts in my head.

Jean-Auguste-Dominique Ingres (1780-1867), Study for Phidias in the Apotheosis of Homer, 1827. Courtesy of the San Diego Museum of Art.

One of the more laughable attempts that New Scrubs made at demonstrating a first year medical event was their “Thank You” day episode. In fact most of this new series has really been based around 5th grade skit versions of what I have been calling “medicine camp”. When I told some of my friends that I was going to speak for our group at our Cadaver Memorial, the one piece of advice I got was to not go with Lucy’s speech or really anywhere near it. I don’t really think the writers really understood what went on in Anatomy Lab.

Last night, our entire class and the anatomy faculty gathered to pay respect to the donors who gave their bodies so that we could learn and to their families as well.

Unfortunately, we didn’t get to meet with the families of the the donors last night. I really would have liked the chance to show my appreciation directly to the family. The school and some representatives of our class will be holding a memorial just for the families in the near future. I suppose an event with the entire class might be a little too much for the grieving families.

The entire class attended the event last night. At this point, it is definitely hard to wrangle the entire class together. People often take the day off from lecture to work on their own, so the class is hardly ever gathered in the same spot except for tests. Plus, at this point the energy level was really low. I know I’ve been a little snowed under with my research write-up for IRB. In spite of all this, the entire class showed up and we had a really great memorial service. In spite of everything, everyone was present and in the right frame of mind last night to pay respect to those who are making our education…our new careers and lives possible.

A few of our classmates performed some nice songs. A member of each dissection table spoke, saying something about their experience and thanking the donors. I spoke for our table and said something about connecting with the body and with our patients in the future, trying to be that thing that some people want…a connection to other people to last beyond their years. Something that we have to live up to.

We also got a chance to celebrate the woman who directed the Anatomy curriculum. She will unfortunately not be able to make our teacher appreciation day, so we took a moment to thank her for everything she had done.

And the entire thing was put together by members of our class. It dawned on me later that this was one of the first non-social events that was put together by the class (possibly with some guidance from Student Affairs, but it was mainly our Curriculum VPs…so thanks to them).

Anatomy lab has been a huge part of this year. I’m not going to be a surgeon or anything. At best I will probably only be doing some minor procedures. However, I learned so much about medicine in the lab and it will start helping us next year when we start learning more about what can go wrong with the human body. In fact, it already feels like it is starting to help out when I go to clinics to volunteer and actually talk with patients. So thank you to our friend. Thank you for helping me in my first year of medicine.

Behold the Resplendent Anatomy of the Human Fry...by Futurama

So…

The end of the last module hit me much harder than I expected.  I managed to get through without any major damage to my grades or my ego.  Wife feels a little ignored and my caffeine twitch is a little more pronounced, but all-in-all it was a rousing success.

Musculoskeletal was a very interesting module because it gave me a chance to think about some specialties which I had not considered yet.  We did have a bit of lecturing on integument which meant that we also had a dermatology clinical lecture.  We also had a radiology clinical lecture, which was a jumping off point into the radiograph studies that we made use of in the gross anatomy material.  However, the majority of clinical correlations during this module had to do with surgical specialties, orthopedics and surgical oncology.  It has been interesting to listen to these clinical lectures, because I hadn’t given a lot of thought into surgery.  However, the major sticking point still seems to be that an early retirement age (or at least retiring from surgical procedures) means that I won’t get to practice as long as I would in other fields.

A lot of significant first occurred during this lecture.  Gross Anatomy Lab kicked off which we’ve already talked about.  We also started Histology Labs which I’d like to spend a post talking about.  This has also started a round of lab practical exams, which I should probably also include.

Mostly, however, this module has been a lot of grunt work.  Biochemistry has started covering a lot of metabolic pathways which means memorizing the pathways, the enzymes, the regulation and the clinical conditions associated with their dysfunction.  Anatomy is mostly memorization with a little bit of sussing out function (once you have the origin and insertion of a muscle, you can figure out what it does…and sometimes vice versa).  Histo is more visual memorization but basically the same thing as Gross on a smaller scale (if a cell has a lot of secretory vesicles…it secretes stuff, if it needs a lot of energy…it has a lot of mitochondria), but with some accompanying Cell Biology.  Some Physiology and Development were also in this module.

Neuroanatomy Lab...by Futurama

The Nervous System has gotten off to a slow start with some intro lectures…until today which was basically a four hour laundry list of structures that we need to memorize, the skull, the brain, the supporting structures and the ventricles (I’m going to go with the description “brain holes” for the ventricles).  We are wrapping up some of the muscular dissections with the neck and face and quickly moving into the brain next week.  We’ll also have a separate series of neuro anatomy labs.  This module is more lab-heavy than the last module.

Neuro/Psych is what people are considering to be the hardest of our first year (but I bet they say that about every module), so I’m going to be doing my best to stay well ahead.  Luckily both Thanksgiving and Christmas breaks occur during this module, so I’ll have a couple of chances to catch my breath…or at least study a lot without new material.

Futurama is a show that was on Fox but is now showing on Comedy Central or somewhere.  Go watch it or buy it.  Thank you.

When did your first notice that you were a clinic room? by Brittany G

Our first test is over with, and I am pleased with how it turned out.  We have moved on in our fundamentals unit continuing into topics having to do with biochemistry, molecular biology and development.  These classes are going well and I am comfortable with the material especially since I covered a lot of it in my post-bacc coursework.  On the other hand, our clinical course has gone into a field which I really don’t have any experience, interviewing patients.

A week ago, we had our first mock interview session.  The school of medicine here has its own patient rooms which are specifically designated for teaching the students in a simulated clinical environment.  Our first mock patient interactions were with classmates acting as the patients.  The purpose was not to actually gain any information from the interaction, but to practice building a rapport with a patient.

The lesson from lecture earlier that week dealt with the techniques involved in putting the patient at the center of the interview and allowing them to drive the conversation, and we were getting a chance to do that.  A  doctor must facilitate the conversation in such as way that he can document a patient interaction methodically while still putting the patient at the center of the conversation.  This is done in part by starting with very broad questions and getting around an issue (clarifying, describing) before drilling down with more detailed questions (the specifics).

Sometimes in this conversation, silence is your friend (as the doctor, not the patient).  And sometimes, all it takes is a slight nudge to get a patient into a place where they can describe what is going on.  At the very base of this interaction is a rapport that must be built quickly that can enable the conversation to happen.

This week, our clinical lecture actually started getting into the information that doctors use when diagnosing a patient.  So what is the information that a doctor gets?  Well, I’m going to hold off on that until a later post so I can focus a little more on the specific data that is to be gathered from an interview.

I will tell you that for each encounter between an doctor and a patient, it will depend.  Experienced doctors working with a specific patient concern may not go into every part of a full history.  As a student, however, I will be expected to go into full detail with each patient and the present the entire history to a physician before they perform a physical exam.  With experience, you learn what pieces of information can be important while diagnosing a specific concern.  However, all of the information is relevant.  If you go into the doctor’s office with a cold, you might not be asked for a full history which is why you should have regular physicals done to cover everything with your doctor.

I’m looking forward to more training and practice, but I do have a lot of work to do in preparing for interactions with our standardized patients (i.e. actors) and with actual patients in the hospital.  Lecture and classwork has always been easy for me, especially since in science the grade is always objective.  Interviewing patients on the other hand is much more subjective and will require an amount of work on my part to get proficient at them.  I’m really looking forward to it.  Until then, I can always practice in front of the mirror.

http://www.flickr.com/photos/brittanyg/ / CC BY 2.0

Well, I’ve survived my first week of medical school.

So far, I’ve learned about amino acids, proteins and enzymes.  I’ve learned about lipids, membranes and membrane transport, specifically glucose and amino acid transport…so far.  I’ve learned about nucleic acids and nucleotide base metabolism.  And, I’ve learned about professionalism, in the context of case studies involving ethical situations/dilemmas and in the context of an oath that I will swear in a month.

I’ve been asked a few times what classes are like.  First off, they are four hours long.  Sometimes, they are six to eight hours long if you include afternoon activities two, three days a week.  And you don’t care.  You learn about a semester’s worth of material in about two to four weeks.  What I learned this week would be a major test’s worth of material in an undergraduate course.  And it seems completely normal…and I know it is only going to get faster.

The difference in the material coverage, is that the focus is less academic.  The tests we will be taking are based on recent updates to the USMLE Step 1 Exams.  The updates to the boards are based on the reality that everything you learn in the classroom during the first two years of medical school must eventually be applied.  So, the course covers the bulk of the material needed (biochem, molecular bio, cell bio, physiology), but the lessons are completed through vignettes and case studies which demonstrate the topics that we are covering both on the tests and in the lectures.

The first day of class, we learned about amino acids and their role in determining the structure and functions of proteins.  This past Friday, the CDC MMWR released a dispatch which demonstrates the resistance to antivirals.  This resistance is believed to be associated with a substitution of an amino acid on the neuraminidase surface protein of the Novel Influenza A (H1N1) Virus.  The structure and function of this surface protein was altered by the substitution of one amino acid resulting in a drug resistance for the virus.

And so, I’m 5 schools days into this.  I’m also halfway through the material for my first test.  I’ve already started making flashcards (eventually, I may not even have time to do this).  Next weekend will be primarily purposed for booking it, and next Monday I’ll be tested on what I’ve learned so far.  This week, I will be preparing and making sure I properly cover the lecture material from this week.  In a week, we will see how I am doing.