medical school classes – Page 5

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 is the Principals of Clinical Medicine course at KCU?

Hello MedHatters!

I’ve explained what PCM stands for in prior posts, but if you haven’t checked those out or you just forgot, it stands for principals of clinical medicine.

This is my “how to be a doctor” course. We started right out of the gate with this course because well, we are in medical school, so we need to start learning how to be doctors!

There were a couple of different elements in this course. Now, I’ve only gotten one semester under my belt so I’m unsure how other semesters will go; but, seeing as the second years still have of the same aspects I’m assuming it won’t drastically change.

If you’ve read my Testing in Medical School post, I did a pretty good job summarizing what this course entails (not to toot my own horn, but someone’s gotta do it!). But if you need a refresher, here it is:

There are several different components to this course. You have your regular lectures, you have labs, you have SP encounters, and you have HSPs.

Lectures are your standard a professor stands at the front of the room and talks to you for an hour or so with a powerpoint slide.
Labs include you doing hands on work with using tools, figuring out how to do the exam, etc with a physician or professor there to help show you how to do it and answer any questions.
SP encounters we have people from our community who are “acting” as patients. They are given a scenario to act out and respond via the different questions we ask, etc. This by far has made up a huge chunk of our PCM coursework in our first semester.
HSPs are human simulated patients and these are our mannikins. These are more or less robots that settings can be changed on to practice certain skills or to be tested on. We’ve haven’t used these much yet.

How it works:

Lectures were heavy at the very beginning of the semester as they were explaining what to expect for this course and we were learning how to chart and use our tools. Then we had several SP encounters to practice taking a history. We then had labs that were integrated as we were learning more information in our block courses (which go by system), so we could integrate learning to do exams on a patient with the system we were learning in our main class. We would then get an SP encounter to test doing the one of the exams and to continue to practice taking a history. For our systems, we would have a competency where we would either draw a card and perform the exam or they would expect us to do an entire exam (without a problem).

As time went on, there were less PCM lectures as we would only have one or two to go over how to do an exam for that area and different pathologies for that area of the body. Depending on the system (we’ve only had musculoskeletal, respiratory, and cardiac so far), would depend on the amount of labs we had as well. For musculoskeletal, we had several different labs to go over each joint. Versus for respiratory and cardiac, we only had one lab each.

The amount of SP encounters differed as well. We had more in the beginning to learn how to take a history. When we first started, we would split the 14 minutes up with a partner. One of us would get the elements of the HPI and one would get the social history. As time went on, we were eased into doing it completely by ourselves. Then we had at least one SP encounter for each subsequent system learned. So we had two for joint, one upper/lower respiratory complaint, and one cardiac complaint to address. In total, we had 7 SP encounters this first semester!

Each SP encounter is 14 minutes to take a history and do an exam, and 9 minutes to write a note. We have to stick to this time limit because that is how we are tested on boards at the end of second year. There are definitely times were it doesn’t feel fair, because we are still learning and royally tripping up on how to do things, but at the same time, gets you used to what you will be expecting on your boards.

After writing the note, we go back in and the SP’s give us feedback on our interpersonal skills and things that we missed. There is both good and bad corrections given here. We then head on over to a classroom and have a debrief with one of our professors where we go over the case in detail (to also see what we missed or connections that we didn’t make). They also tend to have high expectations for these as well, knowing that we won’t be able to do everything/obtain everything in the short time period. But again, they are doing it to prep us for boards.

The last component of this is we have to watch our recording! YIKES! I absolutely hate this part. They record you during your SP encounter, and after everyone has gone, they release the video and note for us to review. We fill out a reflection sheet on things we feel we did well and things we need to improve upon. No one really enjoys watching themselves; turns out I have a lot of nervous tics I need to watch out for!

The following table is showing the order of how we went about learning to integrate our PCM skills with the system we were on.

Order for our first few PCM SP encounters	Order for a systems-based PCM SP encounter (lets say joint exam)
1. Learning how to chart and what belongs in each section of the chart (lecture)	1. Learn about how to do an exam for a joint and different possible pathologies for that joint (lecture)
2. How to interview a patient and ask questions to get said information for your chart (lecture)	2. Have a hands-on lab learning how to do an exam and different speciality tests that go with that joint (lab; you do it on your classmates or an SP)
3. Practicing getting a history on an SP (first couple were with a partner; we split the duties)	3. You have an SP encounter where you take a history and perform an appropriate exam for their complaint/joint problem
4. Practice several more times on SPs (with partners)	4. Graded competency over doing an exam for this particular system.
5. Have an SP encounter on your own to take down the history

Competencies:

We’ve had a total of 3 competencies this semester. Which doesn’t feel like a lot, but each one had a fair amount of material in it. These are definitely graded and are a way for us to show that we can competently do an exam in this area that we learned. They aren’t worth a ton of points (thank goodness!) because we are still first years and still don’t know what we are doing half the time, but none the less, we still have to be tested to make sure we understand how to do them.

The first competency was actually on an HPS for vital signs. More on that a little later; let’s just say I had a very interesting time testing with these mannikins.

The second was over all of the joint exams were learned. This included shoulders, elbows, wrists/hands, hips, knees, and ankle. I know we have more joints than this in the body, but this was are general joint exam. Everything else is a bit more specific. We had to draw a card for a pathology, and then had to perform a full exam and a specialty test (or multiple) to show how we would evaluate for that issue.

The last was a cardiopulmonary exam. This one we had to do a full upper and lower respiratory and cardiac exam, and our specialty test was randomly assigned to us while we were in the middle of doing the exam.

Overall, I’m surprised we didn’t have more competencies. But looking back, we really didn’t do enough to be tested on more. Either way, my anxiety is thankful I didn’t have more to be tested on!

HSPs:

Okay, these things. These mannikin things. Boy-oh-boy do I dislike these. They are really cool in theory, and I’m sure the residents who run scenarios on them find them way more helpful as they run a full code on the mannikins. But for me, I most definitely despise these things.

Why you might ask?

Well, I’m so glad you are curious. Because… Story Time!

We’ve only had one true competency/use on the mannikins so far. I’m sure we will use it again in our second semester; but I’ve had my fill so far with them.

I failed my first vital signs competency. Chalk it up to my heart was pounding way harder than I thought it was (as I think we got tested by the second or early third week of school), and I was most definitely feeling my own heartbeat through my fingertips instead of the mannikins’ simulated heartbeat.

Then, THEN, we received emails if we passed or not. I initially received an email stating I passed. But whoa, whoa, whoa, nope. Turns out they accidentally switched who was supposed to receive what email. So just as I’m thanking the gods for passing, I find out a few hours later that I had gotten the wrong email and actually failed.

The second time around, I had to tell myself to calm the eff down, so I wouldn’t feel my own heartbeat again. Now, when these things are on, you can tell they are on. When they breath it is pretty intensely audible. I don’t need a stethoscope to be able to hear if it’s breathing. In fact, its usually so loud that sometimes it’s difficult to take a blood pressure with the stethoscope because you hear a lot of breath sounds. But I digress.

So I walk up to the mannikin to first check for a pulse; this is so I can find it, pretend I’m counting it, and actually just take the respiratory rate *inconspicuously*. This also gives me time to find the pulse in case I’m at the wrong spot on the mannikin.

But there’s no pulse. I’m checking and checking, pressing a bit to try to activate the mannikin; nothing. I try looking at the chest and seeing if I can hear it breathe (maybe it was just on really low volume?), nothing. At this point I’m freaking out. Because if I say I think the mannikin is off when its not, I automatically fail.

Trying to compose myself, I take a step back, take in a deep breath, and try to calm down. Because I know that if I start freaking out, I’ll fail getting the pulse again.

I walk back to the mannikin and try again. Still.no.pulse. No breathing. The chest isn’t moving, I’m not hearing anything. I walk around to the other arm to check for a pulse as well, thinking maybe I’ll find it better on that side? But really I’m just freaking out and my 10 minutes to complete this competency is going to come up fast and I need to try to find SOMETHING.

So I take a step back again. Take a deep breath. Okay, I thought, If I don’t feel anything/see anything this time, I will say something. I’ll run the risk of them possibly failing me. But honestly, this thing IS NOT ON.

I try one more time. This time, I make it incredibly obvious that I’m trying to stare at the chest, feel for a pulse, and look at the damn window that the person controlling the mannikin is sitting behind. Oh, I stared for a solid 30 seconds. I’m unsure if it was because I didn’t have a professor running the simulator and had a staff member running it, but either way, after staring at the window, I finally heard that damn mannikin start breathing.

Thank the Lord Jesus. And I’m not even religious. I’m finally feeling a pulse and can proceed.

The rest of it went pretty smoothly actually and I ended up passing. Yay!

So yea, that was my experience with the HSP’s/mannikins so far. I hope ya’ll enjoyed the explanation of this course from what I’ve experienced in my first semester. Let me know in the comments what you liked, didn’t like, or what you would like to see next!