6 weeks to finals and counting…

Today marks the start of the 6 week countdown to finals.  I don’t think I have ever before in my academic career looked so far forward to an oncoming set of tests. With medical school I know that if I don’t keep an eye on what’s ahead I’ll be in trouble come exam time. The reasoning for preparing now for exams, to be held over a month away, is purely for stress prevention. With the workload increasing and promising not to let up before I write, it will be hard not have stress build. The key is to keep the stress constructive – keep it as a motivating factor instead of a debilitating one. I think I definitely work better when under a little stress, but also understand that there is that fine line between when it is constructive and when stress becomes overwhelming. With a little luck and some foresight I’ll keep my stress levels under control and go into exams well prepared.

Blogging about blogging

Why blog? It’s a question that has come up more than once, asked by family, friends as well as myself. It’s something I asked a good friend of mine, J, back when he first started his blog years ago. He had several reasons why he personally blogged, and felt that there was a lot that he got out of the process. For J it was a way to practice writing, a skill lost if not used. It was a new world for him to explore (in a way). I got the sense that it was therapeutic for him, a form of catharsis. For myself, I’m still unsure of why I want to do it but there are definitely similarities between my friend’s reasons and my own.

The reasons of why I started this blog were brought to my mind a week ago with an article published in MedScape called “Why Medical Students Should Have Their Own Blogs” by Nicholas Genes, MD, PhD. In his article Dr. Genes states that there may be a certain benefit to using blogging as a type of expression and that the format forces one to communicate at times when communication may be at its hardest. I think this is true. I also desire to use this space to communicate a little of what I see now as a matter of record for myself so some day I can look back and remember what it was like in medical school. I would also like this space to be a way to communicate with family and friends so that they are a part of my experiences even if they separated from me by time or distance… And maybe someday it’ll be a form of therapy (maybe someday I’ll need it! That is to say more than I need it now). For the time being it fills a much needed niche.

How to choose a speciality…

(Source: British Medical Journal)

Friday afternoons

I think I may have mentioned my med courses already in this blog but hopefully (without meaning to be repetitive) I will just briefly mention again how they are organized. The majority of classes I take are divided into lecture and problem based learning components which teach systems and pathologies. There are also a number of other unrelated classes that I take, which include: a “patient, physician, and humanity” course (the touchy feely aspects of medicine), a clinical skills course (i.e. how to use a stethoscope, or where to stick an otoscope) and a family practice placement (out in a real live doctor’s office). It is on Friday afternoons that I get to go out to a local family physician and spend the afternoon in the office learning tricks of the trade. It is perhaps one of my favourite courses given that it is outside of the classroom and gives me a bit of a break from the books.

This past Friday I was in the doctor’s office as per usual, seeing patients every 10 to 15 minutes, taking histories and conducting physical exams. Toward the end of the day I had the opportunity to meet an older woman who had come in to have her pain medication increased and who had a little extra time to answer some questions. For this I was glad because she represented a type of patient I haven’t had much exposure to yet.

This particular patient was terminally ill with unmanageable colorectal cancer unresponsive to treatment. She had been through surgeries and bouts of chemotherapy only to find that her cancer was still there at the end of the day, still growing. Since the disease could not be treated any further and there was no hope of remission, she was forced to simply treat the pain and symptoms until her eventual demise only 6 to 8 months away.

She told me that she was angry with the medical profession for diagnosing her disease too late, and angry at her body for betraying her. She was sad that she was dying and sad that she didn’t have more time with her grandchildren whom she was close to. She was also uncomplaining and open to discussing what must have been hard for her. She answered all my questions on how long she had to live, what plans were in place after she was gone, what had she been doing in the time between diagnosis and the eventuality of her death. In one story she told me that as a bit of reward to herself, she had cashed out some savings early and had spent the money buying gifts for those she loved and on a small trip for herself and her partner. It was fascinating to talk to talk to this woman who showed such composure and I appreciate the time she spent with me.

It was hard to leave the room without feeling more than a little sad. This woman is tragically having her life cut short by an insidious and cruel disease and there is nothing that can be done about it. Yet she was upbeat, happy and willing to answer my naive questions. I would have liked to have spent more time with her but I was already behind in seeing the next patient. Once outside the door I had to change gears quickly, from sorrow and compassion, to more of a friendly face. I opened the door to the next examining room and before me was another challenge of a different sort. This one consisted of two little girls aged 2 and 5 with running noses and a distrust of a rumpled med student with a stethoscope.

the “shotgun” approach to teaching medicine

There are several problems that I am beginning to notice with medical school. One in particular is the “shotgun” approach to teaching systems and pathologies. By this I mean that the instructors hit us with as much general information as they can in the shortest space possible with the hopes that a few of the details will stick for the long-term. For example, this past week, which was week 2 of the “Blood and Lymphatics” block, was on both bleeding disorders and malignancies of the blood (leukemia, lymphomas and myelodysplastic syndromes). Learning the basics about one or the other would take at least a week, if not more, and to be expected to learn both in one week was simply overwhelming.

The reason why the instructors pile on the information and expect so much from the students is that they are trying to make as best use of the time that they are given. Our curriculum is divided into system blocks such as cardiovascular, pulmonary, blood and lymphatics, etc. Each block has a certain amount of material that they are required to teach the students about, and certain amount of time given by those who set the schedule to do it in. Unfortunately because time is limited, and the schedule packed, there isn’t much room to maneuver. Therefore if a block needs more time to cover the material there isn’t any space available in the schedule to do so.

A problem that arises out of the shotgun approach is that the information that we are given tends to be very general in nature, and covers only the most common diseases or syndromes we’d expect to see. This can have the effect of marginalizing some pretty major diseases which significantly affect individuals. For example, in the Monday lecture the instructor remarked that we only needed to know that Marfan syndrome exists and we can disregard the other details. This was perhaps a poor choice of words because there is at least one individual in our class who is affected by Marfan syndrome and was no doubt devastated that we, as future physicians, were not taught anything about it.

I could go on as there are other examples (such as the concepts of nutrition being covered in one lecture) but I won’t. I understand to some extent why the classes are taught this way. There is an incredible depth to the material we are expected to learn and little time to do it in. We need at least a basic understanding of systems and their pathologies in order to begin to practice medicine and we will no doubt build on the base that is provided in these first few years. It is disconcerting to me and I hope that despite the limitations of the system I will have the tools to become a competent physician.

time precious time

I like my schedule these days. It’s a good mix of lecture, clinical skills, and time off. Most days we’re worked 9 to 10 hours at school, and others we simply go in for the afternoon. In comparison to first year, I don’t feel quite as rushed and because of that I’m less stressed overall. The mornings off that are scheduled into our workweek are used by me primarily to finish homework that I have from the day before. Other students, use this time to shadow physicians or residents in the wards (something I hope to do more of once I get the chance), and then there are those who use the time to catch up on their daily routine (i.e. the chores and errands that tend to collect). Now that I have the experience of first year, I am beginning to see the value of the little time we are given between our classes, and I don’t think I have squandered it as much as I may have in the past. In fact, I have tried to stay on top of the work load and have even been able to start a couple of new projects (like this blog). In essence one the biggest things I have learned from last year is time management, and the importance of those precious few moments.

12 types of medical students

A cartoon of the twleve types of medical students. Apparently a friend mine already identifies with #7…