February 2019 – Page 2 – We're All Med Here

Gastrointestinal Block

Hello MedHatters!

I thought I would try something different with this post this time around. If you are interested in my thoughts as I progress through the course, this will be in the first half. The second half will be detailing more of the course like the rest of my block posts have been.

Pre-Midterm Thoughts…

Hmm… This block.

This was has been a swift kick in the butt that said less “Welcome Back” and more “Are you off your ass yet?” type of course. But that’s okay. I really wasn’t sure why I was expecting rainbows and rose petals and all that jazz when returning to medical school from winter break.

I feel like I’m staying on top of things, but who knows!

I’ve definitely had a rollercoaster of emotions again (like I do with every block really…) while going through this course. Part of it was getting back into the swing of things, and part of it was anatomy lab was another balancing act to add onto my plate. The last lab component that we had wasn’t all that difficult in cardiopulm. In fact, it was pretty straight forward as there weren’t a shit ton of things to remember and dissect out.

This one is a little closer to how our musculoskeletal lab was. I think we have like 6 pages of structures to know? I’ll have to take a closer look before I take the practical as hopefully there are some repeat structures.

Anyways; I’m a bit cranky this morning. Probably shouldn’t be typing this up right meow. Will check back in on another day for more thoughts.

Post- Midterm thoughts, pre-final thoughts:

So. It’s currently MLK weekend and I have an extra day for studying. I have one more full week until my final happens and I have to really kick my booty into gear.

Right now it’s Sunday, so today and tomorrow I can try to fit some studies in. I have my cat ear headband on; I need to kick some butt today!

I have my coffee from my current fav coffee shop, have my smoothie, and am all set up. Currently, I’m set up in our mock patient rooms. It’s a nice personal space that has a movable table, chairs, a semi-comfy patient bed that I can lounge on, and a nice big window! Anybody else love having a window to look out of while studying? It’s also not the “typical” study room, so I don’t have to sign it out.

AKA I can be here all day without having to move.

I’m glad I currently feel positive, but that may fade fast. I was really annoyed at myself for basically doing nothing the past 2 days. I went to class on Friday, but unfortunately for me I wasn’t in the mood to actually pay attention. So even though I was there physically there, I wasn’t mentally present. The rest of my Friday I hung out with E, doing coupl-ey things. Like date night!

And Saturday. oof. Well, I was having a day yesterday. I was angry that I wasn’t motivated enough to do anything even though I had a shit ton to do. I was mad that all I wanted to do was lie down in bed and play on my phone and cuddle my cat. And every time I attempted to look at something, I would just get distracted and get more angry at myself for being distracted!

Yesterday was a mood for sure. Hopefully today won’t be one. Will check back later.

[Later]:

It is freaking freezing in this room. How do I change this temperature? I’m gunna turn into a snowman. And not a cute one.

[Mucho Later]:

Welp I definitely didn’t get through nearly as much as I wanted.

Merp.

At least I got through two anatomy lectures. I half-assed my way through part of a histology lecture and did some physiology reading. But really Joyce, I wanted to do more. Will try again tomorrow!

Weekend before the final exam:

Ahh. It’s hitting me now. The panic is setting in. The performance anxiety. The ‘do I know enough’ anxiety. The ‘will I actually get a higher grade than the average so I look smarter than everyone’ anxiety. ~~Actually scratch that.~~ All the anxieties are setting in right about now.

I can feel my stress level about to bubble over. I’m not feeling super motivated to do much; but at the same time feel like I’m drowning in material that I still need to learn/master. I feel like I have no time given that the anatomy lab component of this and in general, the way our schedule has been this past week hasn’t left a ton of time to review or learn material. I feel like even though I’ve gone over a lecture 2+ times, I’m not retaining any of it.

Me trying to get at that material. (Giphy.com)

Joyce has gotten on the struggle-bus to struggle-town and she’s not sure when she is getting off.

It’s definitely interesting when medical students and pre-med students post on the internet all of the amazing things that they are doing/experiencing and all the positives. Positive is good. But positive is only a fraction of what actually happens in medical school. And since I’m a realist, Imma show you the real shit. Like now, when things aren’t rainbows. Because honestly feeling inadequate and stressed and overwhelmed and not smart is a really large chunk of what you go through in medical school.

I’m also writing this right now because I’m in a really down mood, and letting this out is weirdly therapeutic for me.

[The next day]:

In case anyone is curious how my day was going, I put my scrub top on backwards.

No. Not inside out.

Backwards.

With the front “v” and pockets on my back. Maybe I should just go to bed early tonight and cut my losses.

Post Final exam:

Well fuck.

Ugh.

Maybe one day I will eventually walk away from taking a test and be semi okay with my score. But I guess this was another block where I was not. I’m getting really annoyed with myself and how different topics are being taught compared to how they are asked on the exam. I can’t really seem to grasp it how I want.

Which is weird. Because I was acing majority of the practice questions I was doing…

AND I had a super false sense of confidence and being positive while taking the test. Totes thought during the final exam that I was KILLING IT.

And then my score came back.

The worse part is I’m pretty sure most people did okay on this test or fairly well. I won’t know for sure until our scores are up and I can see the average, but I’m pretty sure I’m below average on this one. Which means I won’t get as great of a boost from the curve.

Whatever. (I’m not salty at all…)

Maybe next block will be my bitch. But really, it seems like every block is not my bitch. You know, while scribing I would cross off specialities that I knew I didn’t want to do. Like ER. Or family medicine. Or Ortho.

Why? Because I mostly didn’t like the environment. Or the content wasn’t as interesting to me. Or I was bored fairly easily or was jaded too fast while working in that speciality.

It also could have been the type of people but ya know, that is very variant on where you go.

So I thought to myself, “Joyce, when you get to medical school you will SURELY find topics that interest you! We will find other possible specialities to consider besides just neonatology!”. However, almost every block so far has also caused me to cross off topics that aren’t interesting to me.

I’m really really hoping that it’s just the way our curriculum is. Maybe second year when its more pathology I’ll be interested. Or maybe I won’t get a good feel until rotations.

Either way, I’m feeling very stuck and unhappy with my performances.

Merp.

Oh well. Guess I’m gunna go clean my apartment which I’ve been neglecting to do for a few weeks.

Block Breakdown:

Okay. There were a lot of different classes this block around. Different disciplines involved included:

Biochemistry– we had one biochem lecture this whole section. It went along with the physio lectures we were having. In pasts sections we had pretty easy biochem questions: they were obvious. This time not so much. So make sure you look at this.
Genetics– There is like one genetics lecture that we had. Again, it coincided with some of our physio lectures. But just like biochem, they were not as obvious as I was expecting.
Immunology– We had one lecture. It is different from the information that we learned in COB as it was more medically related and just focused on the gut. But in general, having Dr. Shynra previously in COB is always more helpful than those who did not have him.
Pharmacology- I really didn’t understand the need for this one. This is the same content (almost identical really) to the lecture and DSA’s we were given for cardiopulmonary. I also think we got a similar one in MSK. HOWEVER, don’t punt this bitch. It was like 9 some questions on my exam and I think I got all of them wrong…
Histology– There were a few histology lectures this time around. Majority of it we were tested on during the midterm. Less so on the final. BUT, we had histo show up on our lab practical.
Embryology- we only had one embryo lecture this whole section. We were tested on it on our midterm. However, there were embryo questions (that weren’t necessarily just from this block) that popped up on our anatomy lab practical. The practical wasn’t until the day of the final exam.
Physiology– So. Much. Physio. You will be doing a lot of physio in this course. If physio is for you; great. If not for you; pull up your bootstraps baby because it’s about to get wild.
Anatomy– There is also a fair amount of anatomy in this block as well. But honestly, there was definitely more physio to be concerned about.

Our lab practical also had not just anatomy on it, but histology and embryology on it as well (which is a mostly new testing breakdown for lab). They also upped the amount of stations from 50 to 60 questions in the lab practical (so more rest stops were taken away), AND everything for the practical itself was cumulative between the knowledge we learned in lecture for both midterm and the final.

But the lecture exams were not cumulative…

Midterm Breakdown:

23 Anatomy
7 Embryo
9 Histology
9 Immuno
14 Physio

62 Total

Final Breakdown:

26 Anatomy
5 Biochemistry
5 Genetics
5 Clinical Medicine
5 Histology
9 Pharmacology
37 Physiology

92 Total.

How I studied/What I found Helpful:

Well for lab, things need to be dissected out (just like what I’ve said previously) in order to actually learn them. Physically dissecting them out didn’t help me learn it. So going in like the half of week before once everything was dissected out (or mostly) was more helpful to me than actual lab time. With that being said, most of our GI sections were not embalmed well and so things were more difficult to find than say in MSK. And, that also means you do need to spend time outside of lab working on it just to make sure you can see the structures.

Remember, anatomy fellows will tag poorly if you don’t dissect out your bodies enough (or at least in our year they have).

For class, specifically physiology I read A LOT. A lot a lot. I know it helped somewhat since I didn’t miss a chunk of the physio questions, but you still need to make sure you go over that info several times. Do those practice questions. Unfortunately for me, I was doing well on the practice questions (in most disciplines) for the final but the questions on the test were not as clear/harder.

For anatomy, you just have to draw shit out. I watched both lectures (on KC and Joplin’s) campus for anatomy. Draw, draw, draw.

For genetics, Dr. Staudinger’s blue boxes are what you need to know. For biochemistry, Dr. Zaidi highlights things in red. You don’t really need to read outside of their lectures as they provide majority of the content you need in their powerpoint slides.

For Dr. Kruse’s lecture (pharm), IDK. IDK what to tell you man. I didn’t understand this shit and not sure I will ever just on the level they want us to. Pretty sure next year’s pharm is not structured the same way. But, with that being said, you actually have to spend a decent amount of time with this material too. It’s hard stuff and not always logically easy to get.

Sites that I found helpful:

For physio, this KUMC.edu site is a list of terms and some processes. It’s not pretty but it definitely helped me the first time around for the midterm.

For biochem, my professor gave us links to Handwritten tutorials which are a few minutes long and Osmosis. They were pretty concise and easy to follow.

For Histo, I’ve used Blue Histology , Histology Guide, and Chapman’s 3 minute Histo youtube videos. Chapman and Blue Histology were also recommended by my professor, but so far it looks like Chapman’s videos are mostly GI related. Not sure they would work well in other sections.

Teach me anatomy is a favorite of some of my classmates. And no, you don’t really need to login to get the information. I was able to a access what I needed without that. There are plenty of websites though for anatomy and anatomy apps. If you’ve found one that works previously for you, stick with it!

Lastly, There were some classmates who used online notecards from Brainscape or Anki that were made from previous years. Couldn’t get my hands on them. BUT, make friends with previous years, they can usually give you pre-made resources that will help cut down some time for you.

And uh yea, that’s it. I would apologize again for the long post but I think this is becoming the norm. I bet I could blabber on long enough to write a book at this point! See ya’ll next week.

What Still Makes Me Nervous in Medical School

Let’s talk about mental health today…

Mental health and the ability to overcome your fears and anxieties in medical school is a major component to deal with. Well, I mean really its a component in almost every aspect of life if you think about it. Depending on your personality, how you deal with/face things, and what hoops you decide to jump through can all affect your mental health and anxiety in life. But in medical school it gets amped-up. Like, x10.

Why you might ask? For those of you who have not had the ability to experience some sort of graduate schooling or advanced medical schooling such as nursing, PA, or medical school, it’s a whirlwind of information hurled at you that you need to at least somewhat master. Call it mental Olympic gymnastics. And just because you may not be getting gold, it’s still hella hard.

You need to be able to understand all of these complex ideas and master several skills that you will eventually apply onto real humans (gasp!). And, with the want to do well (or the need in some cases) in your courses and to master the material, along with trying to master these skills and learn to deal with humans in complex and unpleasant situations, it can be a lot for one human to handle at one time.

I’m not saying it cannot be done. Obviously it can be. Think of the hundreds of nurses, PA’s, and medical students that graduate each year in the US. (Or is it thousands? IDK. Fact check me please). But throughout the schooling years (and even in the training years such as residency) anxiety is real. Needing to be on-top of your game is a big deal. You are after all dealing with human lives.

But until you’ve learned to deal with it or simply master the type of medicine you are working under, it can be a hell of a lot. Even if you aren’t prone to anxiety; it will find you at some point in medical school.

And if you are someone prone to it, this will most definitely be added to your hurdle pile (like myself).

I’ve gotta say, medical school has both improved and worsened my anxiety all at the same time. I would be lying if I claimed that I wasn’t nervous for how medical school would affect my mental health at the start of the year. But I am pleasantly surprised that medical school so far hasn’t wrung me out to dry completely. I mean so far, anyways. We will see by my second year…

What I Still get nervous about:

Anything that requires a performance.

Right now this includes things such as right before an SP encounter or right before a PCM competency. SP encounters (or practice doctors’ office encounters with an actor) are used at my school to help us master interpersonal and communication skills with our “patients”. I’m usually really calm right up until an hour or a few minutes before I have to walk in and actually perform.

Could be because I’m having to talk to another human and sound confident while still being able to start working on my new doctor knowledge. Could be because I have to verbalize everything I do to get the points on a competency. Could be a lot of things.

Lab practicals.

I never know how bad it’s going to be. We’ve had 2 units that have had labs so far and will have at least another 2 units if not 3 next semester. Sometimes they are fairly straightforward tags but I psych myself into thinking that I put an answer to quickly and think I failed. Sometimes they are actually really really tough tags. It’s a draw and you never know what they are going to tag and how bad it’s going to be. Also, you have to remember exactly how they have the structure spelled and named on their list (that you need to memorize). So even if you know the common name (but it’s not what they want you to call it) you get it wrong. A lot of pressure for me on these.

Procedures on live humans.

Now, I’m sure this will improve with time. And exposure. But for right now, anytime we have a lab that’s not learning how to do a physical exam I get a little nervous. I did get nervous for the first time using a mannikin part for learning a procedure, but turns out everyone in my group was struggling so it wasn’t too bad!

But overall, learning to do things on actual humans is a little scary. You could cause pain. You could cause harm. You could completely screw up. Or everything could go well.

Really it’s a draw right now as a first year with limited skills.

Giving tours

Now, I know you are thinking: Joyce, what on Earth does this have anything to do with what we are talking about? And you’d be correct in thinking that this doesn’t directly apply to medical school. But, I am a student ambassador. And as part of what I get to do, is give tours and mingle with potential hopeful future students during interview days, etc. Even though the tour groups can be small, I really hate public speaking. Not to mention the perfectionist in me (which has been hard to dampen at times) is terrified of messing up what I’m supposed to say!

Hit-or-Miss on my nerves:

OS competencies

Okay. Here is another lingo term that I will probably always debunk every single post. OS stands for my osteopathic skills course. Now these competencies are similar to the PCM ones, except we have 3 a semester and they are worth way more. Eek!

In these we are to complete 2-3 tasks in front of our grader. Then our partner does their 2-3 tasks (which are different from mine). The thing is, the first one we had I was incredibly nervous. Like had a full on panic attack just because I didn’t know what to expect. It was my first one! By the second one I didn’t really sweat it all. To the point that E was asking me if I was going to study or take it seriously…

Well unfortunately for me I lost a few easy points on that one but NBD. Life moves on. The third one I was a little nervous for solely for the fact that I had several other important tests to study for at the same time. I was nervous that I wouldn’t be able to give the required attention to studying for this competency. But thankfully everything turned out well in the end.

I’m hopeful for next semester that my worries or anxiety for this will get much much better.

What I Am no longer nervous about:

Prepping for anything PCM related

I kind of already mentioned this above, but in general when prepping for this course I’m not usually nervous. Most of the time everything hits me right before I’m about to walk in to do to the competency or interaction. But I’m cool as a cucumber before the anxiety of having to perform hits!

Lecture tests

I’m honestly shocked about this one. Last year in my COB/master’s program at KCU, I was pretty terrified before every test. Couldn’t really sleep the night before, had a hard time focusing during the exam, freaked myself out of answers, the whole 9-yards. I even had to bring in some “liquid xanax” to help calm me down right before the test (it’s a mix of essential oils people..don’t worry, it’s safe and doesn’t need a prescription). I would rub a bit of the mixture on my wrist or my chest, and when I started freaking out mid-test, I could always stop, take in a big whiff of the oils, and give it a few seconds to calm me down. I always get a comment from E that I smell like a grandma when I wear it but whatevs.

I’m proud to say that I really haven’t needed to use this before bed or on test day. In fact, I’m usually so ready for the test to be over that I can funnel my anger/frustration towards just taking the damn thing instead of wasting my energy on being nervous. I really haven’t had to employ any other techniques this year for test anxiety either. Yay!

Labs themselves

By this I mean before doing a physical exam lab on a classmate, going in for my osteopathic lab to work on a classmate, or going into anatomy lab. I was a little nervous at first for both the physical exam portion and the osteopathic portion, but those wore off pretty quickly. Mostly because no one was judging me for not knowing how to do anything…

As for anatomy lab, that rocks! I love getting in there (when I’m in a good mood anyways). Plus, I had a cadaver lab in undergrad and worked in an ER. Dead bodies don’t make me squeamish or nervous.

Writing notes/feedback/criticism

This one specifically applies to PCM and my SP encounters. As a dancer, I hated constructive criticism. As a cheerleader in high school I didn’t like it either. As a newbie scribe I hated it. Once I grew up and realized the world wasn’t out to get me and that I wasn’t perfect all the time, this was easier to accept getting criticism back.

As for notes, I can thank scribing for that. Note-writing for the encounters is my bread and butter. Bring it on!

I’m sure this list will change in the year or so to come. But for now, this is what I’ve been able to compile! Just know, that if you are feeling some anxiety or nerves, this is totally normal! Especially if it is your first time doing it. As time goes on and you get exposed to a situation or testing scenario, hopefully your nerves will improve. I know mine did in some occasions.

As always, let me know what you liked, didn’t like, or what you would like to see next in the comments below!