Month: July 2019

Being a Paramedic Prior to Medical School

Greetings! I was asked by [Joyce] to talk about how my previous work experience as a paramedic affected my first year in medical school. It was my pleasure to do so, but let me say this out front: this is an opinion piece, and incredibly subjective. With that, let me get my resume out of the way: I answered 911 calls on an ambulance for seven years prior to medical school. I got my EMT-B (emergency medical technician – basic), and found a volunteer fire department and started answering EMS calls. And I loved it. Soon, I got my paramedic certification and started working 911 full time.

Small aside for those who are unaware, EMT and paramedic are different things. I include this because I was asked frequently about the difference between the two. An EMT is usually trained in the basics of life support, CPR, airway management, and treating trauma. Almost all firefighters are credentialed EMTs as well. As you get more credentialed, you can start intravenous lines (IVs) and give some medications (This was called AEMT for Advanced in Texas, but before that it was EMT-I for Intermediate, but we usually used the latter). Paramedics (EMT-P) are additionally trained in advanced cardiac life support and pediatric advanced life support. In Texas they are trained to intubate, perform pharmaceutically assisted intubation (ie, anesthesia), trained to read EKGs and identify STEMIs (heart attacks), and give more medications as appropriate, like narcotics. The idea is to emulate the first 30 minutes of the ER in the back of a fancy pick up truck. 

“The pay is better as a paramedic” is what I usually tell people in order to keep it short and sweet.

So I got my bachelors, went into EMS, and ended up teaching EMT and paramedic students. I had wanted to go to medical school since my sophomore year in college but forgot about it with all the fun I was having working 48 hour shifts every week, with some overtime here and there. Thankfully I broke my shoulder, had to take medical leave, took the MCAT, applied to medical school two years in a row and got in on my second try.

If you are applying to medical school as a first responder allow me to tell you this, if you haven’t figured it out already: No one in the academic or medical field knows what you do. Some doctors, usually ER docs, do have an idea from experience and working with EMS, but most do not. Academia has even less of a clue. I was told I needed more leadership experience by a pediatric neurologist on an admissions board, saying my job was just “epi or no epi, am I right?”.  This was the morning after I treated a pediatric patient presenting with drug resistant seizures in the middle of the night. 

“Now hold on there Dr. ‘rectal valium or no rectal valium’!”

I was told a lot by friends and family that I was a shoe-in for medical school over and over again, but this was not the case. They probably thought this because I would tell them stories about how I fixed this or that patient and how I recognized this rare condition and how exciting (but more often boring) my shift was. They told me how I would get in, no problem. Allopathic schools never called back and I had three interviews at osteopathic schools after applying to over 50 schools. Did I likely overextend myself? Yes, that is probably too many schools. But my point remains that being a nontraditional applicant, was and is, tough. 

My significant other said I could go to the fire academy only if I never got into medical school. She was diametrically opposed to me being a firefighter so I assumed she got me in somehow. 

Alright, let’s get into how being an EMT/paramedic helps and hurts your first year in medical school.

Having been trained in medical skills helps…

To my memory, we tried to knock out vital signs, IM (intermuscular) injections, blood draws, IVs, and intubations as skills in the first year: a paramedic’s bread and butter. I had a great time not worrying about this stuff, only so that I could worry about the basic sciences course. They may have a video for you to watch about how to do these things, or a chapter in Bate’s  and then they sit you down to test out in front of a doctor or a fellow.

Taking a skills test is a new kind of test taking that you may not have had yet. I entreat you to find the skill check off sheet or the rubric, and learn it line-by-line as if you are learning your lines for a play. If you say your lines, out loud, in order, then it is more likely that your hands will follow suit. EMT and paramedic training is months and years of skills tests offs. It gets less nerve wracking with time and practice. It’s all fine motor and gross motor movements, so repetition is key, and that’s what clinical time will help with. For you Type A personalities out there, failing to do an IV at first is what is expected. 

For those of you trained on this stuff, be ready to take over for a doctor who is tired of teaching the skill after doing it all day. Try to get a letter of recommendation out of it. Be humble, and watch as your classmates delight to hear at task explained in pure English rather than medical-ese. 

… But don’t assume you know everything.

I failed my first vital signs check off.

“Where’s that guy going?”
“Medical school is what he said.”
“Wait, that guy?”

 I walked in second in line like I was the big man on campus and they failed me on my first vital signs skill check off. Granted, they failed a lot of people that day. And there was quite a scandal when we found out the manikins they used to test us off on were all sent off for maintenance. But regardless, I failed. 

I tried to take it on the chin. My significant other and friends seemed more upset than me. I retested and passed. But this was not the last time I would fail some clinical aspect and had to retest. My reason for why this happened is because they didn’t want me to be a paramedic in medical school, they were trying to teach me to be a doctor, if you can imagine. 

This would continue in the classroom. A question would ask about a medication I had used or been around, or a condition that I had seen or learned about for my last job. I would use my experience to guide me when I had not had the time to study up on such things. I was right sometimes but wrong other times. I once made an ass of myself in front of a tutor regarding pulmonary embolisms arguing about necrosis or apoptosis. But you know what? If I had just shut up and sat down I probably would have learned more pathology than what they teach you to help grandma when she falls down and breaks her hip. 

However, working in true emergencies does help, in that…

You should have a good idea of the stakes…

There is a lot of stress with medical school.  There is no way I could think to phrase that in a way that convey just how stressful it is. But right now, in year one of medical school, no one is dying. I said that to myself often.

“Wait, what did he just say?”

It helped remind me of what was important. Some people may have figured how to study every day, all day, but I could not be a medical student for 168 hours a week. I needed some time away from it to stay happy and sane. 

 A lot of that is how you are going to manage time. At the community college where I got my paramedic training from they handed me an Excel sheet that had a cell of each hour of the day in rows, and each day of the week in columns. Then they had use fill it in; Sleep, meals, work, exercise, school, commute. 

Your education specialist or adviser may do a similar thing when you start and it’s a good thing to do at least once. Just like taking out the correct amount for student loans (my biannual nightmare), you have to budget each hour. In paramedic school it was because almost all of us were working one or two jobs while in school full time. I worked two jobs and I was single, and I can still say that was a really hard year. Most of the married people in my class were separated or divorced by the end of our year long training. 

When I got out of training I worked my tail off with overtime, trying to make money for the first time in my life. A lot of first responders do that, especially if they are starting families. And then burn out happens. Your empathy takes a nosedive. You forget why you wanted to be there in the first place. You resent the people at home for trying to sympathize but also for not caring enough about what you’re going through. You probably drink too much. Your passion is all gone. 

Beware of the burnout. 

I don’t have kids, but one of my close friends in medical school does and I know several who do. Some industrious young men had their first children in year one of medical school. And those people, your family or the people you bring with you to medical school, need you to spend at least some time with them. I know you are busy, but they help ground you. I have a significant other, she always gets my Saturday morning. We did not do a lot of dates last year. Sometimes she would let me off the hook from cleaning the house Sunday morning if there was a test on Monday. But for the most part I did not leave her hanging to cook, clean, and help pay the bills. Plus, I love my SO, so hanging out with her decreased my stress and helped me focus when I did study. Working on those boundaries between time and emotions and school took effort. 

For those coming to medical school by themselves, you will not be alone. I know a couple of guys have a board game night one night a week in the cafeteria. I haven’t seen them miss a week, even in the most hellish of test weeks. Do something like this. Make plans, go out once a week, be a human, not a med student for a handful of hours. Back to the board game guys, as a fan of board games and tabletop RPGs I walk by them slowly, hoping they will feel that I am psychically reaching out to them, wanting to be invited… but alas …

At least you have your real world experience!

Man oh man, I wish I could remember more about my patients so I could write them thank you letters when their exact situation showed up on a test question. Mostly you, poor older woman with a candida infection under her breasts so bad we needed towels to even get close to doing a 12 lead EKG. Who could forget you when my pathology professor wanted to teach my about fungal infections?

When you get to cardiology, find someone who worked as an EKG tech or a paramedic or a nurse. For whatever ungodly reason, our school spent an hour or two teaching us how to read EKGs, gave us a book written by some cocaine-addled pedophile old doctor (you’ll know which book when you read it) and then had a bunch of test questions about EKGs. Not cool.

The Wikipedia page for that author is eye opening.

I asked the EMS academy I worked for if I could borrow some of the material we used to learn EKGs as paramedics and it was great for helping teach my classmates basic EKG interpretation. This was a nice because …

I did not have a solid science background.

Most of you will. Most of you didn’t finish their degree in history with a minor in biology like me. But some of you did something similar, or some of you got older than 22 and now your brain isn’t as fast as it used to be. 

So thank goodness of the all the other people who were TAs in anatomy, or were scribes, or actually liked biochem and microbio. Because I needed each and everyone of those people as I struggled to tell which was a nerve or an artery on a cadaver, or how to write a note like a doctor (not a paramedic), or learning about how a cell works. Just anything about a cell. They remain mysterious, complicated little things, to me.

So really, by teaching some people EKGs, I was returning the favor. Paramedic training is not nearly as zoomed in on cell function, as they are mostly concerned with the air going in and out and the blood going round and round. Also, paramedics love emergencies, (I certainly did and do) but not everything in medicine is an emergency, which is easy to forget when you are paid to ride an ambulance around pretty fast for a living. To the first responders, I entreat you to remember all of the 911 calls you got that were not actually emergencies, and realize that you are going to learn how to help those people the most during the first three or so years of medical school. All that advanced cardiac life support? That is run quickly through at the end of year 2 for us, then on to family medicine rotations. Which can be frustrating because you probably like dealing with real emergencies if you worked with an ER. The good thing about that job experience is, no matter what that one pediatric neurologist said that one time…

You probably have leadership skills!

Hurray! So I would encourage you to get involved in student government or a club and serve in some capacity as a leader. It is a useful skill when you are good at it, and something you need to work on if you suck at it. You likely are applying to or have been accepted to medical school, and it is incredibly likely you will be in charge of stuff and people as a doctor. I hope I am not the first one to tell you that.  

“Alright, I hope y’all know what you’re doing because I’m not good at telling people what I want or accepting feedback in a way to helps us function as a team…”

A couple of words of caution, however, to the former military and first responders and future leaders …

Your classmates are not your former coworkers.

I had several students who were veterans at the EMS academy who had trouble with this one. They would come home from Iraq or Afghanistan, and enroll in our courses to work in a familiar field to treat acute trauma and have a command structure with lieutenants and captains and chiefs. They were smart and passionate, but constantly bewildered when their way of speaking to a classmate, coworker, or patient was somehow hurtful or seen as insensitive because they, as veterans, were not used to talking to civilians. 

I have a filthy mouth, as I was reminded today while riding my bike next to someone in their car with the window down, unbeknownst to me. I asked in many different, colorful ways what they were thinking, and they in turn revealed that they heard every choice word by yelling back at me.

“Where are you going with that mouth? Oh. The medical school?!”

Medical school frequently asks that I behave professionally, and I try my hardest. But man, I have written some apology emails. I was so used to living with my coworkers. My last partner and I lived one third of our lives together because of our shift schedule. We worked in a fire house with four guys and nothing was off the table, conversation-wise. You know what isn’t the same thing as a fire station? A medical school. 

I know you likely did not read a blog about medical school in your free time to be reminded to behave but I had a hard time learning this lesson. Or at least keeping my mouth shut AND learning this lesson. 

Speaking of learning, if you were a paramedic I bet you want to get into medical school and go on to residency because…

You just want to be an emergency medicine doctor

It’s fun, exciting, and you get to fix all the problems that a paramedic leaves you with. Chest tubes, levophed drips, then send ‘em up stairs, on with the next train wreck. “The ER is where it really happens,” you say, “that’s where death gets showed a thing or two!” Boy howdy, you may even want to go back to your old service and be the medical director. I know I do. It’s comfortable, and you would probably be good at it. You see all these urgent cares going up, you are already used to shift work and long hours. There is not a whole lot else you want to be when you grow up. But please …

Don’t drop anchor on emergency medicine this early

I never shadowed a physician prior to medical school. I didn’t know how to set it up or didn’t want to. My job was my clinical experience, and medical schools should know that (now we know they don’t). I did recently and he showed me so many new things that medicine does. I saw procedure in the OR and he worked in internal medicine in a cancer hospital. And every day I saw something new, I wanted to do that for a living. 

Did you know a radiological oncologist basically crunches numbers and hands them off to some PhD to actually deliver the radiation therapy? They are paid handsomely for it. There are combination residencies. There is an endless cornucopia of future jobs you could be happy with, and you likely will not see them during your clinical internship/clerkships. So I hope you shadow someone soon or between your first and second year that’s outside your comfort zone. Or just don’t decide on day one what residency you are applying to. Be an open vessel. 

KCU 1st year: 12 General Tidbits on Studying

Okay. I know I’m all over the place when it comes to reviewing textbooks. I also know that what I used to help aid me in studying is never consistent. I never figured out how I studied best before arriving to medical school. And I certainly haven’t had time to figure it out since! But if I had to look back and condense some things, then this is what I would have to say.

But, before we begin I want to say this: No matter how much advice you get, at the end of the day, you need to decide and figure out what works for you. What works for me doesn’t work for E, or for some of my friends. And just like that, it may not work for you. It’s great to find many different view points as a starting platform to help yourself find a direction to go in. But remember, just because it worked for someone else doesn’t mean it will always work for you!

1. Class versus no class.
Well. At first I was very gung-ho about class. Why? Because I was in a great headspace, not overly stressed, didn’t need to cope by sleeping more, and was really gunning to be a great medical student. As time went on I realized that personally, being in class didn’t always help me. You can look back at all the blocks I wrote about this first year and see the ebb and flow I had when it came to going to class. And you really do get used to fast-forwarding lectures. Sometimes it’s hard to remember that you can’t fast-forward a conversation in real life only because you get used to that option when watching lectures!

But I will say this: You need to at least watch the lectures. Or most of the lectures. Some professors really do just read off their slides. Others put mostly pictures or vague text on their slides which means you know you have to attend or watch their lecture. I suggest at least attending each professors class once to get a feel for how they are before making your own judgements.

If getting up and going during lecture time works for you and you’ve trained yourself to pay attention during that time, then go. If you need to sleep, or prefer to watch lectures on anything other than 1x speed, then watch them. But you do need to build it into your day. It will be easier on you if you can watch the lectures the same day as when they were originally scheduled only so you have time to study them. But if you can’t, no worries. I still passed my first year with mostly B’s and wasn’t on top of my shit.

2. Textbook versus no textbooks.
I know people who never really cracked open a book and did fine. I know people who need all the textbooks even if they don’t use them frequently (cough *E* cough; looking at you). It really just depends on how you study. If you need to read the original paragraphs for the figures they use, you will want access to the textbook. If you are like me and your brain can’t cope with your professors removing a handful of words to make the concepts fit on the slides, you’ll need access to the textbook. If you do just fine with slide studying, then you don’t really need it.

Some professors use their required textbooks pretty heavily and others don’t. Again, it depends on what you are feeling from the slides that professor gives you.

How to go about textbooks? There will usually be *one* copy of the required textbook in the library at KCU. If it is checked out then oh well. You didn’t get there fast enough. They also tend to have a portion of the textbooks as e-books through KCU’s website, which you can easily access with your KCU login info. For a chunk of the textbooks, E would buy the hardcopy and give me the e-code because I don’t mind not having an actual textbook in front of me. If you have a tradeoff with someone like this you could do that as well. There are a couple of other ways to get textbooks, but I will not be discussing that here.

3. Review books/books I used throughout different courses.
Okay, there are a couple of books that I most definitely found helpful in a chunk of my courses. Some of them are required, some of them are recommended, some of them are neither.
– Moore’s * Only because it is an anatomy book and you will need it for every anatomy course. They will test you on blue boxes from this book. So if nothing else, try to make sure you can get your hands on the blue box material. If you were a COBer, you needed this book for Dr. Anderson’s class anyways.
-Gray’s Anatomy Review Questions. I used this book to test my anatomy knowledge for every single section that had anatomy in it. Some sections it greatly benefitted me to use this; others they tested less on the stuff I happened to focus on. It happens. These questions will be hard and there will be things in there that you are not required to know yet. You don’t need to do all those questions, but some will help you. Use this to help guide where you need to go over. Also, there are embryo questions there!
– BRS physiology. This is a REVIEW book. It will go over high yield topics and has some questions at the end of the chapters. The questions are not very hard, especially if you follow the review book. If you want the full textbook to explain the concepts more, you need to use the other Costanzo book (the big one lol). This is another great place to help you either baseline understand or review some high yield stuff and you can use the questions to help narrow down where you need to focus your studies on.
-*BRS anatomy. I did not personally have this textbook, but I know of some classmates who used it to help with anatomy as well.

-An anatomy atlas. Any one will do. Whether you use Dr. Olinger’s textbook (his has drawings AND cadaver pictures) or Netter’s or whatever you like. Either a book atlas or an online app. It will always come in handy.

-First Aid: I’m hit or miss on this one. It is great at helping with certain figures or mnemonics to help you remember things. It is NOT however going to give you in-depth detail on anything. I think this helped with some people in our neuroscience course. But a good general overview if you have it or need a place to start.

4. Paying for additional help services.
So, I have mixed feelings about this. I’ve mentioned sites such as Boards and Beyond, Osmosis, etc. Some of their content you can get for free, the rest of the access for it requires you to pay. In general, I would suggest trying some of the free things they have to offer first. If you like how they teach (specifically if they have videos that can help explain topics or flashcards/quizzes made already) and you are jiving with it; then sure. It’s *your money, you decide how you want to use it best. I do NOT recommend you spend your money on 12 different ones and then never really use them. Make sure you are getting some benefit out of them before paying for it. Oh, and don’t just hop on the bandwagon because one site works well for a friend. Make sure you to test it for yourself first or it is highly recommended by a professor for a specific course.

5. Youtube
Use this as an extra tool. I have listed some sites throughout my time in first year that can be helpful. But you will have to do some digging to find one you like or to find several different videos on the same topics. You do not need this tool for everything, but it can greatly help.

6. Flashcard sites
I have been off and on with flashcards. I used to write them out last year in COB, but I also had 5x more time than I did in medical school to do that. I also had time to write my own review questions in COB. That ship sailed hard in medical school. If you prefer to write flashcards out, then you need to set a time limit on how much time you are spending writing them out. If you are writing them out but never truly studying them, you are wasting your time. Writing them out will only start the process of you learning. It will not cement it into your brain to the extent you need to know for the exam.

Online flashcard services is what I have been sticking to this year. There are many. Use whichever one you like best. But really they all do the same thing. I decided to stick with one that I could also use on my phone via an app, so I can test myself while waiting in lines to get coffee, groceries, or while taking laps around campus. Same thing applies here though: don’t spend an ample amount of time making them and then not studying them. And honestly, don’t notecard everything. That won’t be helpful to you either.

If you happen to get pre-made notecards from a second year on one of the flashcard sites or a classmate shares their notecards with you, this is just time spent less on making them and more on learning them.

7. Notes
Hand writing them, making outlines, filling out objectives, making flow charts, drawing. I have tried almost all of these methods for getting concepts into my brain. During the beginning of the year I had more time (should’ve savored that while I had it), and could hand write out most of my notes. It took forever, but was really great at getting information into my brain. As I moved along I would try outlining my powerpoints. Personally I didn’t get much out of that.
I tended to stick to filling out learning objectives, making flow charts, and drawing. I know E could just look at most of the powerpoints and be fine. I could not. Just know that even if you are a note-taker by hand, it will take you a large chunk of your time. You will need to decide if that is how you should best be allotting your time in medical school.

8. I stand by my 3x rule.
I will continue to say you need to see the material multiple times to get it into your brain. In COB, you could literally learn most of the concepts by reviewing them the night before as long as you had either gone to class or looked at your notes at least once before the exam. And you could cram a lot into your brain at that time, and would have time to do nothing for a couple of weeks after exam week.
You don’t get that luxury in medical school. At least not at KCU. So, you need to make sure you can build in time to go over the material as many times as you can before exam day. You will remember tidbits better, and will be able to make more connections to other lectures/topics this way.
Unfortunately, you will not have time to do this for every lecture or for every block. Do what you can.

9. Do NOT start studying for boards your first year.
Don’t make me jump out of this computer and slap you.

Don’t do this.

Just don’t.

You will have plenty of time to worry about boards in your second year. And honestly, not a ton of shit from first year ends up on boards anyways (or so I’m told?). Learn the foundational material in first year and work on passing your courses. The better you learned it the first time around, the easier it will be to re-learn it by the time you visit it for board studying.
Don’t stress yourself out with this yet. You will be too stressed trying to adjust to passing medical school and learning to play the game your first year. Worry about this in your second year.

10. Do not schedule yourself down to the last minute. 

I’m so guilty of this. Like slap a giant red guilty stamp on my forehead guilty of this. I’m a planner. I feel less overwhelmed when I plan or list out things that need to be done. With that being said, I also tend to write too much on my list of things to accomplish in a day or over-schedule myself.

It doesn’t really matter how you schedule yourself. Joplin’s Student Services have giant blank weekly calendars that you can block off when you have class, lab, etc. You can go in and fill in the rest if this works for you. They even have many different colored markers to make it pretty!

If you’d prefer to do it electronically then go for it. I tried many different types of app planners. I didn’t like any of them. Which is why I use Minimal List (still not a plug). Mostly because if I write it down on a piece of paper I usually lose that paper… But really, doesn’t matter how you make a plan, just make sure you have a plan on what you need to tackle so you can try to fit everything in before exam time. But please, for the love of whoever you believe in, don’t overdo your scheduling or list. If you have too many things to accomplish on your list, you will feel like shit for not getting to them. Same thing if you over schedule and don’t have time for everything. You may need 4 hours to digest and slightly understand that physiology lecture instead of the 2 you originally planned for.

And if you are one of those people that just wants to make a GIGANTIC list for several days or for the whole block and then slowly chip at it, you can do that too. I personally find that more stressful though.

Extra Tidbits; Not study related:

11. Be Professional. 

It feels like I shouldn’t have to say this but you’d be surprised at the amount of people that aren’t. This is a professional school. This means that in all aspects you need to act professional and respectful. Yes, you can thoroughly vent to your close friends when life sucks because medical school is hard. That is not what I’m saying.

  • I’m saying don’t be arguing with professors. Especially in class. If you do need to argue a point, do it one-on-one in their office or over email. And make sure you are arguing respectfully. Not accusatory. Not like you know everything under the universe and they don’t. Because at the end of the day, they give you a grade. If you have an honest argument there and do it respectfully, chances are you will get that point back.
  • Don’t be making super sarcastic comments during class to your lecturers. Although most students will likely get the sarcastic reference, that doesn’t mean your professors will appreciate it or find it appropriate behavior.
  • You should also be dressing fairly modestly. No super short shorts. No super low cut shirts or dresses. No crazy slogans or logos or sayings that are controversial on your clothes. Why? You are there to learn, not make a statement. You don’t need to be dressed professionally everyday. That would be awful; we aren’t LECOM over here. You can wear scrubs or sweats. But also remember that this isn’t Cochella up in here. Cover your butthighs. Please. I don’t want to see that either.
  • Lastly, this is a personal pet peeve of mine. Don’t ask irrelevant questions. If it is not pertinent to clarifying something the professor said or is related to what you are learning/the professor is teaching, don’t ask it during class. Please go out on your own time to ask it. Why? Because you are literally wasting the time of ALL of your fellow classmates by doing this. No, you don’t look smarter for asking that question. If it isn’t related, please don’t ask it. And if there are too many questions like that, your professor won’t have time to finish the lecture and either not lecture the material OR rush through it. No one is happy when that happens.

12. Get a book stand if you want to use actual paper books.

I know. Weird. Actual paper books? Gasp!

But really, you will be either looking at a screen via laptop or iPad or a book for pretty much 10 some hours a day or more. Your neck will be happier if your book is not lying flat on a table. The stand will help keep your head/neck in a position that is more neutral and cause less ouchies later. I promise.

Here is the one I got off amazon: Reodoeer BamBoo Reading Rest

It held my larger books well, is super lightweight and fits in my backpack, folds easily, and has page holders. Edwin got a similar one but much smaller and I have to say, I definitely like mine because its a tad bigger.

Some people also got laptop stands or got iPad cases that helped with this as well. Again, so their neck wasn’t at a weird angle. you find what works for you but I definitely recommend getting a book stand at some point if you are going to be carrying around textbooks and actually using them.

And honestly, I think that covers majority of the major study tidbits I wanted to cover. Hopefully this helps all you incoming 1st years a bit, since most of what ya’ll ask second years is how to study for a course. You will figure it out, especially what works for you. Remember, you can try something and if your first quiz/exam score doesn’t come back well, that is when it is time to change how you study. But most of the time, you will have an idea before you get there.

Good luck!