Breast Cancer Awareness Month

Cancer. Malignant. Metastases. Tumor. Survival rates.

These are terms many of us might be lucky enough to never hear in our lifespan. They are the medical terms that indicate our worst nightmare has come true. Hearing them once in a lifetime is one time too often than what is welcome.

My aunt was unfortunate enough to hear them over and over again during her life. She first heard these words when she was 42 years old and they would haunt her for decades as she bravely fought the breast cancer that had invaded her body.

My aunt was incredibly brave, beautiful and the most elegant person I’ve known. I was a little girl when I first found out about her illness and I didn’t really comprehend what it was. All I knew was the she kept changing her hair! She had a variety of wigs she wore and eventually her hair grew back totally different. I vividly remember stroking my fingers through her hair commenting on how soft it was.

She had gone into remission after being treated with chemotherapy and had been in good health for years only to find out she had a reoccurrence. This time it was more dangerous and this time she’d lose more of herself to her cancer. She underwent a double mastectomy and later breast reconstruction in hopes of ridding herself of the cancer. Her procedure was a success and she thrived in the following ten years of her life.

After ten years of being cancer free, she felt something on her sternum. I can only imagine the fear that set in at this point. She ignored the voice telling her to get it checked out. She didn’t have insurance due to her pre-existing condition (the affordable care act wasn’t a thing yet). She waited months. Those months slowly allowed the cancer cells to spread through her body, sending cells to her bones and later to her brain. When she finally got diagnosed she was told she had stage IV breast cancer.

The news was devastating to us and I don’t think she ever truly accepted that it had come back for a third time. It was as if her entire life was being controlled by her cancer. She fought for years and was very lucky to live with her cancer for years before things got bad. In these years she changed a lot and to be honest, I was mad at her for it. She was different. She often was cranky and didn’t take an interest in my life like she had when I was a kid. Her demeanor wasn’t soft and she was quick to get angry. I didn’t understand her.

The week of my USMLE Step 1 exam I got the news that she was in the hospital and she would most likely remain there until her death. She had a belly full of fluid, getting liters pulled out daily. I was overcome with guilt because I wasn’t able to travel to see her. Even though my parents reiterated that she wasn’t herself; she was a shell of herself and wouldn’t want to be seen this way. The night before my exam I spoke to her over the phone and told her to go to a better place, that it was time. She wasn’t able to respond because she was knocked out by various medications.

As soon as I walked out of my exam I started balling. Her battle was finally over. I was devastated that her time on earth came to a close, but I also felt a sense of relief. Cancer had truly stolen every ounce of her being. It stole her body and more saddening it eventually stole her elegance, happiness and inner beauty. Cancer had made her someone I didn’t want to spend time with.

For awhile after her death I felt guilty that I hadn’t made more of an effort to be with her in her toughest times, even though she made that nearly impossible. The more I think about it and the more I learn from patient care I realize that every person grieves and fights in their own way. My aunt didn’t do it the way I would have, but I have to accept her path. I try my best to remember the times that I felt she was truly herself. I’ve used her battle as a learning experience to help me care for my patients.

Her ‘end of life’ care wasn’t ideal by any means and in some ways I’m sure I couldn’t have changed that for her. This experience caused me to reflect deeply upon the subject of how we can help patients determine the way in which they want to die. It sounds morbid – but I’ve seen so many patients ignore the difficult questions, only to suffer in the end.

The moral of my aunt’s story is that:

#1: We aren’t going to ‘understand’ anyone’s cancer battle. We can listen, support and empathize, but we won’t really get it unless we have to go through it.
#2: You can’t make someone spend their last days the way YOU want them to. Sometimes denial can change the way people do things and that’s OK. Not everyone is going to see their morbidity as a chance to spend time with family and do the things they love one last time.
#3: End of life care matters and we don’t do enough talking about the topic. Ask your patients the tough questions early and often. Understand what is important to them. Do they want to be doped up on pain meds only to barely be able to say goodbye? Do they want chest compressions, intubation and other measures to prolong their life?

This piece is dedicated to my beautiful aunt Sam.

 

See the original post here on Medelita’s blog: click me.

6 ways you are making medical training harder than it needs to be

#1 

You are wasting time doing unproductive studying.

Restrict access to your phone, social media, etc during study time. Study in blocks and take 15-minute breaks as needed to reset. When your brain is fried, recognize that and do something else! No use in staring at a paper learning nothing when you could use that time to do something else.

#2 

You think in the past and future, not the present.

You did poorly on your last quiz or you are getting anxious about the next big exam you have. This energy can be refocused into productive work right NOW. The past is the past and the future is still not certain.

#3

You are making yourself unhappy by telling yourself medical training is “taking away your 20’s.”

You have time to build relationships, travel the world or learn Spanish if you MAKE it. There are plenty of people who do these things and more. How did they do them? Making a plan, moving forward and stopping the self-pity.

#4

You are resistant to change.

As healthcare providers, we know one way is not the way that works for everyone. Some people respond differently to treatment X but respond well to treatment Y. And both patients get better. Apply the same thought process to your journey. If the way you are studying isn’t working, stop doing it over and over again! Try something new. If you aren’t able to fit in all the things you want in one day, try another way. Reorganize your schedule, stay flexible, find an alternate path.

#5

 You are getting overwhelmed.

Take a breath. Break things down and make priorities. All you need to do (and can do) is put one foot in front of the other. Take the next step. When you are done with that one, figure out what comes next. You can’t do everything at one time, so how could you possibly think about everything at one time? Figure out the things that can wait and the things that can’t.

#6

 You are sweating the small stuff.

I often find myself fretting about the dishes that need to be done, that package that I need to mail or the laundry that I forgot about. In 1 week will you remember these things? Probably not. Focus on the big picture. Focus on your goals.

Third Year Gems

Well, my friends, I’m officially a fourth-year medical student. Honestly, it is still surreal to me. Time has literally flown by. It feels like yesterday I was freaking out about my physics final or waiting for my MCAT score to come in.

My first two years of medical school felt in many ways an extension of my undergraduate career. Yes, there was way more information to learn and the stakes were higher, but I felt at home in my studies. I was able to master much of the material and take exams with confidence. To say it bluntly, things were much more black and white. The correct answers were there in front of me.

Third-year has been so much different. They always say that, but you don’t really get a taste of it until you do it yourself. This year has been a year of growth for me – mentally, physically, and academically. I’ve had to do things that I did not want to do. I’ve had experiences that made me hurt so much inside. But, I’ve also gotten to do things that have truly made me so happy. I wouldn’t trade this year for anything. I’m going to save some of these reflections for later, but I wanted to be sure to make a post before the new third-years start rotations! Let me preface this with the fact that this post is going to be more “non-academic” things aka not information on how to ace exams. I will have a small blurb at the end for this. PS THIS IS LONG.

 

What should I have “ready” before my first day of clinical rotations?

So, to be honest, you could go in day one and be totally unprepared and things would still work out. But, if you are a planner like me and want to have a few things to keep you busy these are some things to think about.

  • Get your white coat all ready to go. Less is more, seriously. Your shoulders are going to start hurting.
    • Tools: stethoscope, pen light (and if you are on neuro reflex hammer, tuning fork, sharp safety pin)
    • Learning materials: paper, pens, +/- ipad mini  (some rotations I used my ipad, others I didn’t)
    • Snack (esp. if you are on surgery)
    • $$ (esp. if your team gives you minimal time to eat aka not enough time to run to your locker to get food)
    • pager/cell phone (make sure to exchange #’s or pager with your team on day 1, ask them how they want you to reach them if you need to avoid any confusion or irritating them!)
  • Get an H&P template ready if you want to really be on top of things. Basically, just write one out in your own format that works for you and then make a bunch of copies. You can just grab these each day and put them in your coat. Same thing applies for progress notes. This makes it easier when you go to present your patients. You can purchase these types of things also from Medial Basics.
  • Put your rotation schedule into your planner. Being late never looks good.
  • Make a list of “to do” items for your first rotation. For me, I started making a study plan in advance and that really helped me. This was basically figuring out all the things I wanted to do to study plus the rotation requirements and then splitting them up in the weeks that we had for the rotation.
  • Purchase any books you are going to need in advance. It sucks to get started late just because you are waiting for things to come in the mail.
  • Familiarize yourself with the hospital you are working at — aka the floor plan. Some rotations you will be in a small segment of the hospital, which makes it easy. But many other rotations like internal medicine your patients can really be anywhere!
  • Go shopping! Some rotations require that you wear dress clothes nearly every day. I definitely didn’t have enough prior to starting third-year and the last thing you want to do is spend extra time in the morning scrambling to find something to wear. Some of my go-to pieces are below.
    • Coach Olive Loafers like these. I have a few pairs that I found at TJMaxx for half the price. They are comfy enough to get me through the day and also super cute with minimal “breaking in” time.
    • J.Crew Lexi Pant – here. These are comfortable and go with everything. For $40 plus a student discount, they are worth it!
    • If you start with surgery check my post here for shoe tips.
    • For tops, anything not low cut and breathable works. I wore a lot of tanks so that I didn’t sweat too much and I always had my white coat on so it wasn’t “unprofessional” looking.

What can I do to stand out on my rotations?

There are lots of ways to stand out as a member of your team during your third-year. And no, this is not by gunning your other classmates. To be honest, this makes you look worse. I’ve seen students straight up throw other people under the bus in attempts to make them look good. Sadly, this just makes you look like a jerk. Don’t be this person.

If you want to ‘look good’

#1 Know your patients. Take some extra time to talk to the patient and the family to see what is important to them. Spend time looking at their chart and familiarizing yourself with their medications/diagnosis. If you have a patient on your service for a few days, take some time to find a research article relating to their care and present it to the team. It doesn’t have to be anything fancy, but you can tell your attending that you read an article last night about X and wondered if you could share the poignant information with the team. This will benefit everyone. Even if this information is something the attending already knows, maybe the intern doesn’t. If your attending doesn’t want you to share the information, this probably isn’t someone who values team-based learning (unfortunately).

#2 Ask how you can best help the team. If you aren’t busy you mind as well see how you can help the team. Some people may not need help, others may want you to go see a consult.

#3 Always be open to trying new things. OK, I’m kind of a scaredy cat, but this year I forced myself to ALWAYS say, “I’ve never done that before, but I’d love to try!” Inside my head, I was scared I’d mess up stitching the fascia or pass out while helping place a PICC line. But, you know what, you don’t know what will happen until you try. And people know that you are not a pro at any of these things. Don’t be that person who looks like they are “too good” to do something, when they may just be nervous. Go for it!

#4 Ask questions. The best way to learn the material is learning it with your patients as examples. Yes, you can probably learn things from the book, but they stick better in real life. And, no you aren’t annoying. Just find the right time aka when you are walking from room to room during rounds to ask questions. I wish I had done more of this early in my third-year. Often I didn’t want to look dumb because I didn’t know what an abbreviation stood for or didn’t know the generic of a brand name drug they kept name dropping. JUST ASK! It takes two seconds and it shows that you are interested. ESPECIALLY, ask when you feel like something isn’t adding up. If you feel like you read X, but now the team is doing Y, ASK!! Seriously, there is always a reasoning behind things and you don’t want to miss it! If it doesn’t seem like your attending/residents have time that day, jot the questions down and look them up in the evening. If it still isn’t making sense, ask the next day for clarification.

Any other gems?

Advocate for yourself! Every school is different, but I realized early on that it wasn’t easy to form connections with attendings because I often had the same doctor for less than a week! I knew for family medicine I really needed to have some good mentors. I e-mailed my course director and asked if I could be put with the same attending for a longer period of time. They were happy to help me out. So, if you aren’t getting what you need- ask for it!

Keep in mind that you will need letters of recommendation. Try to build some relationships with attendings in the specialty you want to go into and also some others that relate to yours.

Get used to not being able to have an exact schedule all the time. This was a hard transition for me because often times you don’t know what time you are ‘done’ for the day or you just stay until the doctor says you can go. You don’t have as much control over your schedule compared to 1/2 year, but at the end of the day, it is what it is. Take advantage of any days off or half days to schedule any appointments you need (or just do this before you start rotations).

There will always be someone who is smarter than you, scores higher than you, or sutures better than you. Don’t determine your self-worth based off someone else. Comparison is the thief of joy. Aim to do your personal best.

HAVE FUN! Seriously, third-year is amazing. Yes, it is very challenging, but it is also rewarding.

Don’t sacrifice your happiness for anything. This year has been difficult, but I’ve managed to be the happiest I’ve ever been in my life. I get emotional just thinking about it. Happiness has always been a ‘journey’ for me in many ways. As I’ve gotten older I’ve realized the things that truly matter to me and this has been a beautiful thing.

Obligatory information on studying for rotations

Find out what works for you and stick to it. For me, I primarily used Case Files, Online Med Ed, UWolrd Q’s, and NBME exams to study. This was a little bit different for some rotations like internal medicine I used Step Up to Medicine and for family medicine I used Q’s from University of Virginia and AAFP. Get an early start on reading and then have the time closer to your exam more question heavy. The shelf exams are more difficult than exams during 1/2 year because the right answer generally isn’t as obvious. Practice dissecting the questions and looking for what they are really asking about. Know the “next step” in any workup and how the book/exam answer differs from the real life answer. For example, in the ER sometimes they order a bunch of things all at once. The exam will ask you what the next best diagnostic test is.

Told you it would be long. Feel free to e-mail or message me any other questions you have! I’m happy to help!!

X/O A

Advice through the Years

So as many of my followers know I’ve been doing a lot of “video blogging” on my Instagram video feed in lieu of some real writing mainly because I’ve been super busy with school! I finished up my family medicine rotation and kicked butt, thankfully. I’ve decided on my specialty and am so proud of myself for successfully retaking my surgery exam and kicking butt on my family medicine shelf. {pat on the back}. I just started my psychiatry rotation this week and have been getting a flavor of what this rotation will be like, more to come soon. In the meantime, I wanted to give you guys some advice through the years and reveal some embarrassing pictures.

The Highschool Dayze

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You can laugh, but hey I thought I looked good. Okay, but in all seriousness, if you are a HS student and are thinking about medicine here’s your advice. #1 priority is to have fun, yes you read that correctly, HAVE FUN! It is so important to your growth to meet new people, try different things and laugh, a lot. #2 take some science classes if your school offers them, I recommend anatomy. I was lucky that my HS had an anatomy class in which I got my first introduction to dissection and surgery {saw an open heart surgery hehe}. #3 find someone who shares your passion. See this chicky in the photo – she’s going to be an amazing doctor. She’s currently attending Emory’s med school and thinking about going into Urology, can you say inspirational? She was my HS buddy who shared my nerdiness and love of science. It’s important to find friends who have as big of goals and dreams as you do. #4 Do not worry about getting into medical school. You have time to worry about this later. Focus on determining if medicine is what you are passionate about and focus on gaining entrance to a college that has a major that can support that passion.

Here comes the collegiate 

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I was really just a freshman trying to survive dorm life. What are your goals freshman year? First off, survive — college is hard and is a huge transition. Stay healthy and sane. Next, find at least one club/extracurricular that you are passionate about. It doesn’t have to be medically related!! Second, start volunteering and stay consistent {and pro-tip keep track of all your hours, they ask this on your app}! This will help you out junior year when you are freaking out about your med school app, trust me. Sophomore year? Begin to expand your #bosslady and #futuredoc community. Join a medically-related community. That could mean pre-med club, a research position or start a pre-med frat like me. See these lovely ladies below? Both attending medical school at Wayne & Loyola. They are both huge parts of my success within college. I cannot express how important a support system is at basically every point in your life. Lastly, start thinking about applying to medical school. I said think, calm down. Just try to begin talking about what things you need to apply {classes, letters, MCAT, etc}. When do you want to take the MCAT? Are you considering a gap year? All good things to start getting in motion.

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Junior year, this is a big one. For me junior year brought a lot of my hard-core science classes I needed for medical school. Do well in these courses and maintain a good gpa. Hammer down your plans for studying for the MCAT and applying to medical school, especially if you don’t want to take a gap year like me. Make sure you have a good advisor and are continuing to do all the right things — volunteer, shadow, get letters of rec, etc. A good advisor can REALLY help you out. Also, start saving money for those expensive applications. {sorry, reality sucks}.

Senior year — this will be different for everyone based on their path, but for me I had already submitted my application and was into my interview season, which was hectic! Try your best to balance your current coursework and your interviews. My best advice for interviews is to just be yourself. Why? You are awesome. You got this far and absolutely deserve a spot at the best medical school. Believe in yourself. When you’ve successfully gotten admission to your medical school, make sure to graduate {don’t flunk those easy classes like the Aliens course I took senior year} and CELEBRATE! If you are taking a gap year start thinking about what you will do in that gap year to improve your chances of getting into medical school.

Welcome to the best and worst days of your life: future doctor land

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M1 year: Treasure all of your firsts. Your white coat ceremony, that first awkward meeting with your soon to be best friends, your first OSCE, the first time you feel legit when you use your stethoscope. These are all important moments that you should be thankful for, because hell you worked so hard for them! Next, don’t be too hard on yourself. Some of the smartest people I know barely passed a few exams in the beginning or were met face to face with their first failure. It’s OK. Buckle down and get back on track, you can do it. Find something you are interested in and pursue it. Very much like your freshman year of college you should find some activity that you enjoy. For me, that was my involvement in AMWA. And lastly, start building connections with physicians you meet!

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M2 year: Don’t get complacent, but also don’t be a looney. What do I mean? Studying is important and may come easier to you now that you are a seasoned pro, but don’t forget you’ve got Step 1 coming up. The harder you work through the year, the easier your Step 1 study period will be. That being said, don’t forget that you need to have a life and maintain your relationships. These will come in handy when you see the stress of Step 1 & M3 year. Don’t stress out too much about your M3 year. After Step, you will most likely have no idea what is happening, but it’s okay. You will get the hang of it, I promise.

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M3 year: Be okay with being bad at a lot of things and not knowing a lot of things. Easier said than done, but there will be a lot of situations in which you really feel like you don’t know what the heck is going on. Be on time, it’s important. Work on reading something every night — that’s what all physicians say is the key. But really, working all day is difficult and then studying at night?! It’s just something you need to practice and it will get easier. Pay attention to what you like and don’t like. Pretty quickly you will get a feel for whether you like inpatient work or if you enjoy outpatient clinic. You’ll figure out if kids are your thing, orrrrr not. You’ll begin to see the differences from specialty to specialty and that’s important for when you make your M4 schedule.

M4 year: TBD 

OK guys, I think I’m all typed out. I hope this was useful to someone out there and if you have more questions don’t hesitate to comment below or shoot me a DM on my Instagram. Hope you all have a wonderful week and stay tuned for a fun giveaway on my Instagram soon. 🙂

X/O A

4 Must Haves for your Surgery Rotation

#1 Comfortable shoes – It goes without saying that surgery has some wild hours. For the first four weeks of my rotation I worked 75-80 hours/week and was on my feet constantly. I honestly couldn’t have survived without my variety of shoe choices {and Epsom salt soaks at night}. I stuck with my Dansko clogs, Grey’s Anatomy clogs, Nike running shoes and fuzzy crocs. My clogs kept my feet happy during my day shifts and I interchangeably wore my crocs and Nikes on the weekends and night float. Scroll to the end of this post for a review of the Grey’s Anatomy clogs!

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#2 SNACKS! As a result of crazy hours and long surgeries, there are many times where you won’t be eating at regular times or even at all, unfortunately. I stocked my coat full of snacks like granola bars, fruit leather and even some candy {there goes the healthy diet…}.

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#3 Essential oils — say what?! If you are someone who isn’t the best at dealing with some of the gnarly smells that come with hospital jobs, just do what I do! Always have a bottle of essential oils on hand. Mine came into EXTREME use when I scrubbed into a necrotizing fasciitis case {worst smell ever}. I just dab a small amount on the inside of my mask and voila you cancel out the large majority of the smells. I personally purchase the Young Living brand!

#4 Pocket items. Within the first few days of your rotation, you’ll figure out what your residents want you to have on hand. Stock up and have things handy like lubricant, cutting shears, a suture kit, gauze and surgical tape. This makes things a lot quicker at the bedside when your residents need supplies!

 

 

 

5 Ways to Cope with What Feels like a Huge Failure

Anyone who has been following me on my Instagram @medicineinmichigan knows that I recently had a hiccup in my third-year. I recently found out that I failed my first exam in medical school – my surgery shelf exam. I was incredibly disappointed when I saw my Christmas break crumble before me. After a few days of recuperating I’ve put together this post for anyone who is going through what feels like failure {emphasis on the feels} right now or maybe needs this in the future.

Anndddd I have no pictures for this post, so here’s another adorable picture of my puppy.

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#1 – Talk to someone you love. When I first found out this news I called my fiancee and promptly started crying to him on the phone {maybe this is dramatic — but, at the time I was really upset}. After, I talked to my mom over the phone. There’s something so comforting in hearing things from those you love. My mom’s continuous pitch is that she is so proud that I’m getting out there and at least trying something that is SO difficult. She always tells me even if I made it to the day before graduation and then quit, she would still be so proud of me for giving it my all.

#2 – Let the emotions pour out. Sad? Mad? Downright angry? Let it all out. Emotional catharsis I think can be a good thing, but with a time limit of sorts. I told myself I’d be mad/upset/pissed for one day before I re-organized. I’m a believer in the fact that sooner or later it’s all going to come out and, personally, I’d rather have my mini-meltdown sooner, rather than later.

#3 – Reach out for support. There is NO shame in needing help. I met with several academic support folks at my school and they were nothing short of amazing and understanding. I also reached out to several friends and colleagues for advice. You don’t have to do things alone. In fact, medicine is about collaboration and sometimes we all forget that when we are in test mode.

#4 – Try to change your mentality. I told myself this was unfair, that my break was ruined, etc. One of my friends in college made me a sign that read, “You can’t have a positive life with a negative mind.” Positivity isn’t always easy — it definitely doesn’t come easy to me always. I’m trying my best to reframe this “negative” event into a positive one. Although I’ll have to work hard over break, studying now might give me an advantage down the line when it comes to overlapping material and step 2. This is also an opportunity for me to really show how hard I can work and my perseverance.

#5 – Lastly, remember why you started and what the end goal is. Between the studying and gruelling hours, there are the patients. The ones that make you laugh, the ones who make you cry and the ones who make you wonder how the hell they figured out how to become super-human. Those are the people that I started for and the people that I’ll finish for.

 

X/O A 

{Pediatrics, Updates & More Step 1 Tips}

{Updates}

Happy Halloween my friends! I started my surgery rotation last Monday and man was my first day a whirlwind. I got to see a laparoscopic cholecystectomy {when they take the gallbladder out}, a level one trauma patient, an incision and drainage of a hematoma and even put my first foley catheter in.  By the end of the day (730PM) my feet were aching and I was starving! I made a quick pit stop at Target and grabbed a bucket and Epsom salts LOL! Surgery so far has been grueling, but exciting. Yesterday I got to scrub into a wound vac for someone with necrotizing fasciitis! It was exhilarating but super smelly!

I just finished up peds and I absolutely LOVED it and wanted to give you guys a peek into my daily routine and post some tips! BUT, first — engagement pictures, because I miss seeing my hubs with my long hours on surgery. We are still deciding on wedding plans, more to come soon!

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{Pediatric Clerkship: Typical Day}

The set up of the pediatric clerkship is the following: 2 weeks on inpatient floors either in Royal Oak or in Troy, 4 weeks in an outpatient clinic, 1 week in the NICU, and 1 week on a sub-speciality (peds cardiology, GI, infectious disease, heme/onc, etc). 

Inpatient floors: This entailed showing up to the hospital by 630 AM and prepping for rounds. We’d get up to date on all of our patients and then round around 8AM unless we had grand rounds. During the day we had the chance to go to some of our patients’ procedures and keep an eye on the kids on the pediatric floor. We also had noon lectures!

Outpatient clinic: My day started by going to a case review — a lecturer presented a real case and we worked through it as a group. During the case, we reviewed high-yield principles, lab and diagnostic studies. This was SUPER helpful for the shelf exam. Afterward, I headed to the residents’ clinic and saw patients until noon. I’d take a break for lunch and listen to another lecture given by the residents or attendings. I really enjoyed a few of these that covered child abuse and were given by one of our child abuse specialists. I spent the rest of the day in clinic taking care of some adorable kiddos.

NICU: Rotating in the NICU was one of my favorite parts about my pediatric clerkship. We got to be part of the OR team during deliveries of high-risk premies, twins and emergency c-sections. I learned all of the important things to check right after the baby is born including APGARS, getting them all warm and toasty and, obviously checking for the ABC’s. Although there were a lot of sad things during this week {babies born to moms addicted to various drugs}, I also learned a ton about fetal medicine. During this time I learned the newborn exam and completed a tested encounter on one of the adorable new babies. My days on the NICU went from about 6AM-3/4PM.

Subspeciality: I spent a week with the infectious disease team and rounded on lots of little sick buggers. Some had serious infections {even a case of atypical Kawasakis}, while others had minor viral illnesses. It was super interesting to spend time with the ID docs because I got to round on the floor and spend time in their clinic at Beaumont as well!

One of the topics from Grand Rounds!

One of the topics from Grand Rounds!

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How adorable are the pediatric floor doors?

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On our first day of peds we did a scavenger hunt that included finding as many Beau the Bears as we could!

{Step 1 Tips}

  1. Nail down a schedule as early as possible. Below you’ll see a snapshot of three weeks of my schedule — don’t be intimidated. Just make something that works for you and ensures you will hit all the topics and questions you need to get through. Keep in mind I also prepped before my dedicated time by trying to study my weakest subject areas — immunology, biochemistry, and pharmacology. Don’t forget to pencil in any dates that you can’t study {personal events, etc} and time to exercise, eat and sleep!

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Link to my full study schedule: step1studyschedule

2. Pick your “golden” resources and stick to them. DO NOT try to use tons of resources during dedicated study time because you will very quickly get overwhelmed. Stick with what has worked for you over your first two years of medical school and don’t get intimidated by what your classmates are doing — remember, everyone has a different way of learning. For me, my main resources were UWorld, First Aid, Pathoma and Sketchy Micro.

Well, that’s all for now lovelies. Stay tuned for a giveaway soon and some more life updates during my time on surgery!

X/O A 

{Internal Medicine}

WOO! Folks, I’m {almost} officially done with my Internal Medicine Clerkship. I’m still waiting on my OSCE score, but I got my shelf score back. I definitely didn’t do anywhere near as well as I want, but I kind of expected that. I had SO much going on during this clerkship as a result of moving into our house and, on top of that, internal medicine is just so FREAKING all-encompassing, AGH! I’m proud of myself for successfully transitioning from second to third year. Honestly, it was harder than I thought it would be. People always tell you how much different the non-clinical years are from your clinical years — and they are right.

During my first and second year, I heard upperclassman and professors talking about how amazing clinical years are, but I didn’t really know what to expect. I’m here to give you a little preview and then some pointers based off of my experience.

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{Internal Medicine Clerkship: Typical day} 

This is hard because there weren’t really any “typical days.” The clerkship at OUWB is broken up into three parts: night float, outpatient clinic and inpatient floors. I’ll forgo explaining night float since I already posted about it, here.

For clinic: I spent two weeks at the resident’s clinic, which is located in a building on the Beaumont hospital campus. Some of my other classmates went to locations more off-site for their outpatient clinic, ranging from 5-40 minutes away from where most of us live. My clinic hours were about 8AM-5PM depending on how many patients were scheduled for the day.

[630AM]– WAKE UP! [7AM]– head into the hospital, I’m lucky & have a two-minute commute [7AM-745AM]– review patient cases for the day, catch up on any misc. things [8AM]– clinic duties start [NOON]– grab lunch & attend noon lecture w/ the residents [130PM]– afternoon clinic duties start

Clinic responsibilities for me really changed based on which resident I was working with that day. Some residents let me go see/interview/examine patients on my own and then present the case to the attending after discussing with them. Other residents had me more in a shadowing role. I was writing notes on patients and looking up various topics on UpToDate in my spare time between patients. I really enjoyed clinic because I felt like I had more time to talk to each patient than when I was on the floor. My *tip* for the clinic is to try to look up your patients at the start of the morning so you have a little bit of time to look up any weird medications or diagnoses on their chart. I always felt more prepared when I did this.

For inpatient floors: I spent four weeks total on the inpatient floors {for those of you who don’t know what this means, it’s just seeing patients who are staying in the hospital vs. outpatient clinic is more like a walk-in doctor’s appt}. During this time I was put on a team with one intern {first-year resident}, one senior resident {second or third-year resident} and one sub-I {fourth-year medical student}. I really enjoyed working with the same team because it meant I always knew what to expect and there was a lot of consistency.

[545AM]– WAKE UP! [620AM]-commute & head up to the floors [635-7AM]– read up on patients’ events overnight [7AM-9AM]– check up on old patients/take history & physical for any new patients [9AM]– morning conference {all the resident’s & students & some attendings go over an interesting patient case from beginning to end} [10AM]– table round w/ attending on old patients {this means we talked over each patient and their updates over the past 24 hours} [11AM]– visit old patients w/ attending [NOON]– grab lunch and attend noon lecture {lecture w/ residents on various topics} [130PM]– table round or bedside rounding w/ attending on new patients *Our rounding schedule varied based on the attendings schedule. Most days we were done rounding no later than 3PM {except for long-call we rounded from about 5-630 PM}. But, every team functions differently. After rounding, you have time to finish up all of your patient notes and see if your intern/resident needs any help. For the majority of my classmates, I’d say our floor hours were about 645AM-430PM on any day except long-call.

When you hate waking up early, but know surgery will be way worse.

544AM when you hate waking up early, but know surgery will be way worse

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12PM grand rounds lecture

Finally, heading home after long-call.

836PM finally, heading home after long-call {we have 13ish hour long calls}

My floor schedule was very variable based on what “day” we were on. At Beaumont Hospital internal medicine has several different “days” that indicate how many patients the team will take on. For example, on Admit 1, 2 and 3 days our team would take a different # of new patients. For teaching day we wouldn’t take any new patients, but we would present different topics to our attending that we researched the night before. For night float pick-up we would take two new patients who were seen by our night team the evening before. For long-call, we would take 5 new patients and be on the CPR team, which meant any adult codes that occurred in the hospital our team would be running the code. You can see that the day to day schedule can be highly variable based on which day your team is on.

*Tips* for floors include: 1) Always ask your team how you can help them 2) Learn how to write a good note, it will serve you well for other clerkships 3) Practice your oral presentation skills- you are constantly presenting to different attendings during the medicine rotation 4) If you can look up interesting research that pertains to your patients and present this to your attending when rounding {my attending told me this advice at the end of the clerkship, LOL thanks} 5) Start questions as early as possible, but seriously don’t procrastinate

Internal medicine was incredibly challenging because of the volume of information. I personally wish I had started on UWorld questions earlier on {there are literally 1300 lol} and would have tried to dive deeper into my patients’ cases. Friends who did well on this clerkship really learned a lot while they were on their clinical duties. Sometimes this is just luck of the draw based on how much your team is willing to teach or how often you ask questions!

At the very least, internal medicine definitely helped me reach my step goal everyday!

At the very least, internal medicine definitely helped me reach my step goal everyday!

Pros & Cons 

So, an upperclassman told me that since I’m technically undecided on what speciality I want to go into, I should keep a running list of pros & cons for each clerkship that I can reflect on next year when applying for residency. Thought I’d do that here so we can all benefit. Overall I really enjoyed my first clerkship and it was WAY better than sitting in class all day. I had no idea how much learning the residents still do {they attending at least two lectures a day}, on top of all the learning they do just with each patient case.

PROS: Huge patient population giving you tons of variety // Lots of fellowship options to choose from if you want – cardio, GI, endocrine, etc // Interaction with lots of different physicians due to consultations w/ dermatology, infectious disease, cardiology, etc // You treat patients for some of the most deadly conditions in our nation aka cardiovascular disease

CONS: Numerous social issues to deal w/ in the elderly population such as hospice, palliative care, etc {not necessarily a bad thing, just difficult to deal w/ in this day and age because of insurance issues} // You refer out a lot to specialists, so sometimes it feels like you really aren’t helping certain patients because you need a specialist to deal w/ some of the complex issues // You deal with a lot of very sick patients, many of whom are non-compliant {in comparison to pediatrics where the many of the patients do very well}

Well, I hope this was informative for those of you who haven’t done this clerkship yet & gives the M1s/M2s/pre-meds a little inside look into how a clerkship runs. I’ll be doing a little review like this for all of the clerkships as I go. 🙂

PS stay tuned for my #giveaway later this week.

X/O A

{How to Study for Anatomy}

Hi, everyone! Hope you are all having a lovely day. In Michigan, it’s quite a hot one today! I will be spending some time studying on my back porch in the sunshine! I was super lucky and got done with my floor patients around noon today, holla! I recently got some questions about two specific courses at OUWB called AFCP and BFCP. These courses are basically an anatomy course and a foundational science course. I gave some advice to a friend, so I thought I’d share with everyone my tips on how to study for anatomy. This advice will probably be applicable to any school that has a course dedicated to gross anatomy and works with cadavers.

A little background — I worked in a cadaver lab for three years at the University of Michigan and really enjoyed my time there. This sounds crazy to anyone not in medicine, right? Who likes to spend time with corpses? Well, for me, I learned a lot about the donation process and donating your body to science. I have such respect for the people who are selfless enough to give their bodies to science to help us learn.

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LOL, this is from before my MSK exam. My friend fixed him, don’t worry. On that note, let’s get started.

#1 & #2

You really need to have a great anatomy atlas to refer to. When I took anatomy we were given the Netter’s atlas, which I highly recommend and basically is a little mini-bible for anatomy. Find a copy here. The second item that is super key is the  Grey’s Anatomy Review questions, which can be purchased here. Honestly, I would say these two books [or two similar books] are absolutely essential and worth the $$.

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#3 In regards to anatomy lab

Don’t waste time in the lab! Many schools, including OUWB, spend extensive numbers of hours in the lab dissecting. Some people complain and say they don’t learn in the lab, BUT you need to set yourself up to learn. I recommend coming prepared to the lab so you get the most out of it. For me, this entailed looking up all the structures I knew I would be dissecting/looking for that day. I would use Netter’s and highlight away and even sometimes black out terms and write them in myself. I would look up anything I wasn’t sure about including muscle actions, bony processes, etc. The more familiar you are (you don’t need to know them by heart), the more you will get out of the dissection. Secondly, some schools, including mine, have several students dissecting each body. Meaning some people aren’t necessarily dissecting every time they go to lab. My lab group had these “extra” people pull up lecture notes and quiz the group on key concepts or, if everyone was clueless, that person would try to teach the information to us while we dissected. This was super helpful because many questions came straight from lecture notes on our written exam.

#4 In regards to the lab practical

Many schools require students to take a lab practical that entails walking up to a body, being prompted with a question (and usually timed) and then you answer and move to the next body. We had roughly 50 questions on our practical for each midterm/final for anatomy. For this what you want to do is be sure to see as many bodies as you can in the lab. For our school, there were about 20 bodies that were fair game for the practical. Once you start dissecting you will see quickly that everybody is SO different. The general pattern is the same, but you will want to be oriented to as many bodies as you can. Outside of lab time head into the lab and practice finding structures on a few bodies that you didn’t personally dissect. This will help immensely! I always went in with friends who were in different lab groups and we would quiz each other on the bodies. Also, if your class is willing to work together to set up a mock lab practical, that’s what my class did!

One other tip for being successful on the lab practical is to make sure you know which structures are fair game. For OUWB pretty much everything is — we get questions about muscles, nerves, muscle actions, bone landmarks, radiology images, etc. DON’T FORGET THE BONES! Bones are such easy points if you’ve looked at the images even just a few times. But, remember to try to orient yourself to each bone in several views. For example, I got a scapula on a tray once and they asked what a specific bony prominence was, but the scapula was rotated in a way that wasn’t exactly “normal.” I had to re-orient myself to realize what they were asking me!

I hope these tips help; feel free to comment any other questions below!! Oh, PS always study anatomy in the beautiful sunshine, because most of the anatomy labs have no sunlight {except OUWB, #humblebrag}! Wish I had my sunny porch during 1/2 year!

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X/O A

Advice for the Noobs {aka M1s}

Wow, the past four weeks have been an absolute whirlwind. I spent two weeks on night float, another two in the resident’s clinic and now I am working with the internal medicine team on the inpatient floors. Aside from my crazy school schedule I’ve been attempting to study, moved my entire life into our new home and finally am starting to feel settled! I will post pictures of our house soon, I absolutely love it! And more on finances, etc in medical school and how in the heck we managed to purchase our first home in an upcoming blog post.

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On to the REAL topic of this post! So the new OUWB M1’s just started Monday (yay!) and I thought it’d be a good time to get some tips out there for how to start with your best foot forward. I can’t believe my first day of medical school was two whole years ago — time seriously flies.

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As much as I tried to prepare myself for what was to come, you can’t ever truly be 100% ready. There are a lot of unknowns in medical school and sometimes you never see what you could have done better until after you’ve made it through the storm. So, I’ve got some tips for the newbies now that I’m post-step1 and in clinicals.

  1.  Be very careful about what you triage. Every exam is going to have a very large amount of material on it and thus some inevitably gets triaged to the side as “less important.” Although I think this is OK and sometimes necessary, be cautious when picking and choosing what to triage. I can confidently say that nearly all information from years 1/2 comes back either for Step 1 or in clinicals. Focus on getting a good understanding of each disease, it’s pathogenesis and some of the high-yield facts about it. In addition, focus heavily on nailing down microbiology and pharmacology and you will definitely not regret it!
  2. If you are struggling in one organ system get the help you need sooner, rather than later. Organ systems tend to build off of each other so understanding each section is important. Obviously, some topics you will feel weaker at. For example, I have a tough time with renal, but I still tried my best to understand as much as I could.
  3.  Make an impact in at least one student organization or within research. First and second year is really the best time to do this as your involvement may gradually decrease due to the business of 3/4 years. Plan to really invest some time in at least one extracurricular activity that you are very passionate about.
  4. I’ve said this before, but I’d recommend getting some type of long-term study aid. A lot of people I know use Anki cards or Firecracker. I think this is much more important during 1/2 years than clinicals. It’s really hard to remember things when you aren’t seeing patients, so sometimes having a reinforcer gives you that extra time seeing material that you need.
  5. Reach out to your elders {cough, cough me or any other upperclassman}. Seriously, we have been through exactly the same thing you are going through and honestly, we have better advice than advisors who never actually went through medical school. Find a few people that you trust and go to them for advice as much as you need! Don’t be afraid to reach out via Facebook, text, etc we won’t bite!
  6. Don’t stress out  too much. I know this sounds nearly impossible, but just try to keep in mind that school is school. Although it is incredibly important, it is not the end of the world to do poorly on an exam or even fail something. Everyone has a different life path and what matters most is that you are doing the very best that YOU can. Try not to pay attention to other classmates, just do what works for you. I can personally say that one thing I absolutely do not regret is taking time for myself during 1/2 years. Maybe I got a little bit lower grades than other people that put in more effort, but I had a very enjoyable experience (up until step 1 — more on this later). Try to start each day with at least one positive thought and remember that you were chosen to be at your medical school. If all else fails, here is a link to the best motivational clip ever. I watched this right before I took my Step 1 exam: Here.

 

Well, I’m back to studying for my internal medicine shelf. Stay tuned for my synopsis on a typical day on internal med!

X/O A