It’s monday and I’m bored

Summer is officially here. The sun is out and birds are singing. The temperatures have finally peaked above 20C. I’m in a state of recovery, but it seems that there are those who are already bored of the time off. In fact my inbox has been filled with messages such as this one:

“I hope your first couple of days off have been relaxing, I know everyone deserves it. Anyway, I’ve done the whole visit with the parents thing, cleaned the apartment, spent time with the girlfriend and now I realized I don’t have anything to do! Anyone up for anything? I was thinking beach volleyball, roller blading, some hiking, poker …. anything?”

You can almost sense the desperation. It’s actually kind of funny in some ways. For the past month I’ve been waking up at 8am and either going to class or studying until 11pm (and I know there are those who work a lot harder). Then it’s over and summer is in full swing…leaving one with this weird sense of guilt for not being so busy. The art of relaxation has been lost completely. For myself, I find the first week the hardest as I try to rediscover the joys of doing nothing (or less, I should say). For those in the same situation – I suggest a deck with some sunshine and a Corona, turn off the brain and let yourself be content in the moment. If you can do this – the summer is yours.

Re-entry

Finally – exams are done. The last of them were today and I am feeling the effects of “re-entry”, a phenomenon characterized by a lack of all social grace and skill. My ability to small talk is shot, and my patience for normal social conventions gone. I am confused by the simplest of conversations and my personal mannerisms, my tone, my affect are blunted. I’m not sure how to describe it but I know that I am not alone.

A friend of mine after the exams today told me that he had a family dinner on Sunday that he had to attend and all I could think was – you poor bastard, and the funny thing was that he was looking for the sympathy. I understand where he is at. This is not to say that he won’t have a good time, or that I wouldn’t love to see my own family, but rather we’re a poor choice for company right now. I can imagine my friend at his house, sitting with his family not being capable of decent conversation. It’s as though it moves too fast and the little clues, the gaps and spaces that normally allow one to take advantage and converse are gone. It’s like being autistic (or autistic as far as I can imagine it at this point). I should point out here that it’s not necessarily limited to medical students, in fact some of the worse cases I have seen are with those post-PhD defense. If you have the chance try and talk to someone who has just defended and I think you’ll notice the poor verbals skills and spaced look, much like I am wearing right now.

A positive aspect of the re-entry phenomenon is the feeling of once again stepping into the real world and remembering that there is more than school, and that there are other activities out there besides studying. Life goes on despite the little hiatus. I’m glad to be back in it.

post-OSCE

It was 2 and 1/2 hours of clinical testing and I’m thinking I did alright. I know that I didn’t do well on three stations but I definitely passed the rest so I’m not to concerned…I could get burned on the marking but I really don’t think that will be the case. It’s a relief that it’s over.

So from Saturday my predictions were pretty close to true for the physicals and the histories ranged from such scenarios as: worst headache ever, depressed patient with poor libido, man with constitutional symptoms and bloody stool. I had trouble with the same stations that everyone else did, which is reassuring – perhaps they’ll scale the marks if they see that everyone was confused by the instructions, but I guess we’ll see. Of course, after the exam the ‘war stories’ begin to be told – one in particular sticks out.

Preparing for the MSK portion of the clinical exam is perhaps one of the more difficult aspects because of the sheer number of tests for each joint. It becomes a real memory game as one tries to remember the name of the test (usually named after some European physician long since passed) and how to perform the procedure. Some students were betting that the OSCE would focus on either a knee or shoulder exam, as had been the case in years prior, and so some of my classmates had prepared to do only those two exams. A bit of a gamble but I understand what they were thinking. Time is of the essence here, you put as much time as you can into the areas you think you need to, and don’t focus on those areas which you think (hope) will not be tested. Sometimes it works, and sometimes it doesn’t. In this case the money was on knee and shoulder but the roulette wheel came back with ‘lumbar spine’. A bad gamble, but not be deterred one of my classmates who was in this particular situation walked into the room, turned to the examiner and stated:

“I’ll level with you. I prepared for the knee and shoulder exams but not the lumbar spine. So I’m going to try and muddle my way through it the best I can, but I understand if you have to fail me.”

At the end of the exam the instructor’s feedback was summed up as:

“Well, I wish I could give you points for honesty …”

…and now the fun starts

Today is the 2nd year Objective Structured Clinical Exam (OSCE), which probably means that…a) I didn’t sleep last night, b) I am peeing pure cortisol, and c) my shirt is dark blue from having both sweat stains meet in the middle. For those who aren’t familiar with this type of exam – the OSCE is meant to assess “clinical proficiency” and will use a simulated patient (read ‘actor’) in a variety of standardized scenarios to test this. Theoretically the OSCE presents a better opportunity to evaluate not only the student’s knowledge but also communication, professionalism and decision making abilities. Brown Medical School has a nice little write-up on their website here (http://bms.brown.edu/students/osce/index.html) with a little video which may give a better sense of what the exam is like. What you aren’t told is that the OSCE provokes fear in even the most stoic.

Today’s fun includes 13 stations, each 10 minutes long. There will be 8 minutes for the actual examination or history, and then 2 minutes given for student feedback. What I can expect is 5 histories (I have no idea what to expect here – could be anything from geriatric health to sexual medicine, or ethics – maybe all three combined? Little old lady hits on you doing a physical – what do you do??), 4 physical exams (I’m guessing 2 MSK, 1 Neuro and 1 Resp / Cardio), 1 PEP (post-exam question), 1 self assessment, and 2 breaks. I have prepared well for both the breaks and the self assessment, I know I can pass these, it’s the others that have me tense.

The last pbl session

Today was it. It came without the fireworks and cheers that I thought would accompany it. It came quietly and was over before I knew it. Today was the last day of classes for year 2 of medicine …

god loves good graffiti

this graffiti is

fleeting human contact

both of us lost

but for a moment

we’re lost together.

I wonder who you are.

(I found this scrawled on a desk in the BMB library where I study)

medical mnemonics

There are those naysayers out there that claim that creativity dies at this point in the semester as students desperately try to cram all the obscure factoids into already overworked brains in preparation for finals. I have to disagree with this. If you want creativity then look no further than the medical mnemonic. The simple memory aid becomes a work of art for some as they try and get the right balance of memory and verse. The mnemonic, in order to be successful, has to be catchy, not too long and (of course) easy to remember. A good mnemonic is well worth its weight in gold and can be a true Saviour in the time of need…here is the winner for this semester:

Here is the award winning (and clean) mnemonic for the suprahyoid muscles – thanks to Alex in the class of 2009:

DIG MY STYLe it’s GENIus

(Digastric, Mylohyoid, Stylohyoid, Geniohyoid)

Want more? Check out the link below for all your mnemonic needs -
http://www.medicalmnemonics.com/