Tag: medical school

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:
courtesy of giphy.com
  • 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:
courtesy of giphy.com
  • 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!

What is Osteopathy?

Hello Medhatters!

For those of you who did not know, I am currently (as of 2018) an OMS-1 student at Kansas City University. As an osteopathic medical student, this means I am not only learning all about medicine in the traditional sense, but also learning how to manipulate the body through osteopathic treatment and manipulation (called OMT or OMM) to learn to treat disorders of the body.

If you are looking into medical school and are undecided if you should go the MD or DO route, hopefully this helps clear things up a bit for you. If you are just curious or just starting out your research on medical school and medicine, I hope this sheds some light for you as well!

What is Osteopathy?

Osteopathy is the philosophy of knowing the structure and function of the body and being able to use this knowledge to aid in the health and healing of the body. This practice looks at the host, (or patient) as a whole, instead of individually looking at just the problem area. In combination of seeing the patient as a whole + treating the disease/illness = overall improvement in health. By using our hands to feel and use OMM, we can help accomplish this! And this is generally how osteopathy operates.

How is this used in practice?

According to AACOM.org, “Osteopathic medicine provides all of the benefits of modern medicine including prescription drugs, surgery, and the use of technology to diagnose disease and evaluate injury. It also offers the added benefit of hands-on diagnosis and treatment through a system of treatment known as osteopathic manipulative medicine. Osteopathic medicine emphasizes helping each person achieve a high level of wellness by focusing on health promotion and disease prevention.”

You can also check out the link above for more information on the American Association of Collages of Osteopathic Medicine's website.

So, we still learn how to do surgery (in residency if that’s what you choose to go into), prescribe medications, and learn all about disease processes just like MD students do, but we add learning how to do OMM. OMM is used to treat things such as tight muscles, to treat a fancy term described as somatic dysfunction (which is anything that is unequal or off from the normal for the patient that can be treated by OMM more-or-less), poor circulation of lymph or blood flow, etc. In my first semester, most of what we have learned so far is finding if one side is unequal to another, or finding a very tight muscle and learning to fix it or cause it to relax. (This has been great for my tight neck and back!)

Now, OMM doesn’t treat everything. There are many types of techniques that have both general and very specific contraindications (or makes that treatment inadvisable to performing it on that patient). There are also many different types of treatments that we learn. So if one doesn’t work, there could be many others that may work.

However, if none of the options are recommended to be performed on a patient, or they aren’t working/the patient cannot tolerate them well or isn’t understanding the directions well, we need to look into the more “traditional” method. In this scenario, an osteopathic physician would treat the disease itself (so your typical medical measures such as medication, surgery, etc) as the patient would be unable to handle OMM without potentially causing more of an issue. But as a whole, if we can integrate OMM in combination with medically treating the issue, the patient should overall have improved health.

Honestly, I think this has a lot of appeal. Think of how many patients who do not want to undergo surgery, take pain medications, or muscle relaxants when they can come get a few second to a few minute treatment on their problem area(s). Its much less of a cost, much less invasive, and has immediate effects if it is indicated and safe to do OMM.

As a side note; just because an osteopathic physician is trained in a more wholistic fashion, doesn't mean many of us are also well versed or trained in holistic medicine. Some providers will know a lot about supplements and alternatives in that sense. But we do not get additional teaching on this. This has to be a side interest for any physician to learn. 

Some physicians may also learn things such as acupuncture or massage therapy to help assist with OMM. But again, not every provider will undertake this!

4 tenants of Osteopathic Medicine

There are 4 tenants of osteopathic medicine that we abide by. They are brought up many times (at least during our first year) and are listed as follows:

  • The person is a unit of body, mind, & spirit
  • The body is capable of self-regulation, self-healing, and health maintenance (Meaning may leave it to fix itself. However if having a fracture & displaced arm, interventional treatment is needed to help itself heal)
  • Structure and function are reciprocally interrelated
  • Rational treatment is based upon understanding & implementing the other 3 tenants

History of Osteopathy

Osteopathic medicine all started with this guy ——>

A.T. Still.

At my school (and I’m sure at many other D.O. schools) we have to learn about what happens leading up to this main point, but basically after the Civil War (in which A.T. Still was a general in the battle of Westport; which is now a bar scene/district in Kansas City), he went back to his farm to live a “normal” life. 10 years after the war, in 1874, he “flung his banner into the breeze” (don’t ask me what that means because I still have no idea) which basically meant he decided to pursue his idea of osteopathy. At the time that he was a farmer, he was also the town’s physician and a Methodist church pastor.

When he spread the word and his idea about osteopathy, he was formally removed from the Methodist church and basically outed from his town. This is all still occurring in 1874.

Additionally in 1874 the first osteopathic technique was recorded. By 1875 A.T. Still officially moved his family to Kirksville, MO and he continued to work as a traveling physician in rural MO (since ya know, he was run out of his town and he had to keep making money).

Side note; Kirksville, MO ends up being where A.T. Still University (a DO school, obvi) will be in the future.

By 1885, Still coins the term “osteopathy”. Which doesn’t seem like a big step now but we use it daily in DO school.

In 1886 he becomes busy enough to stay in Kirksville and be the town’s physician.

It took until 1892 to open his first school, coined American School of Osteopathy (which will later become A.T. Still University). By 1900 it becomes the largest school of the healing arts.

Prior to A.T. Still passing away in 1917 he ends up publishing several books based on his research, his techniques, and his autobiographies.

How DO’s treat: the approach

Now, I don’t have a ton of practice in this yet and we haven’t really learned to integrate this into our PCM courses, SP encounters, or future patients. But so far in my first semester, we learn how to do an isolated exam and then to treat what we’ve learned so far (when in our osteopathic labs only).

From how we’ve been taught so far, it’s by far easiest to ask if there are problem areas for us to look at (because let’s be real, you don’t normally do a full body exam to find something. The patient tells you what’s bothering them!). Then we assess if its symmetric/even to the other side or not, tense, or more rotated/prefers one side.

Usually if you look hard enough though you can find something to treat. Or you don’t have to look hard at all. I mean, there is that too lol.

When assessing we look for TART. Which stands for tissue texture changes, asymmetry, range or motion, and tenderness. If there is any one of these, or more than 1 of these, it is worth looking into more to decide to treat. Then we pick a technique and “try” to fix the problem area with the limited number of treatment types we’ve been taught. I say “try” because 1) I’m a first year and I’m still trying to figure out what I’m feeling and 2) it may work for many patients but not be the best technique for that particular patient & their problem. Or 3) they need a combination of a couple of different types of treatments.

So far I have learned how to do soft tissue techniques (similar to some types of massage), lymph flow improvement, muscle energy, articulations, and I’m currently learning counterstrain! 

We will eventually learn how to pop (called HVLA), BUT, that is not everyone’s cup of tea. It certainly isn’t mine. But popping isn’t the only technique we learn or that DO’s use. In fact, I would say counterstrain and muscle energy would be more widely used to treat.

From my understanding, by the time we have boards we have to do a full “SP” encounter (for more information on my PCM course check out my What is the PCM Course at KCU post) and do an osteopathic examination/TART screening, and a treatment for that area.

Since we aren’t there yet in our first semester, we don’t have to worry about trying to do an osteopathic exam or a treatment for the person’s issue. I’m sure we will start to learn how to do that by the end of our first year or the beginning of our second year.

Again, we integrate OMM like we would with any other treatment. So, if you have an elbow that bothers you and a physician recommends rest, ice, ibuprofen, and reducing activity, a D.O. physician may also do an OMM treatment to help the body move healing along at the elbow joint as well.

Lastly, if you go into a specialty where OMM doesn’t really integrate well, or you choose not to use OMM, that is okay too!

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