Tag: MS1

Life As a Medical Student

Hello hello.

Whether you are a premed interested in what your future may look like in medical school or you’ve recently been accepted, finding out what a day in the life of a medical student looks like is often something searched. It is usually difficult to find, and for good reason! Every school, curriculum, and student is different. Making a “day in the life” of student hard to capture.

I am going to be honest here: I was not usually on top of my shit as a student. Despite what the medical school youtubers show you and what the over-achieving instagramers say, most people are not on top of studying or have it together in medical school. It is completely common to be far behind, too tired to finish, or often run out of time in the day to do what you need to do.

Because of this, I spent a lot of time NOT going to class, learning at my own pace, and sleeping. Majority of my classes were not mandatory in person, and they were recorded so we could in essence “re-watch” them later. What that really meant was most students didn’t go to class and just watched them later on their own time.

Year 1:

Year 1 is all about that learning curve. In case you haven’t read a previous post, I went to a school that was known to have a difficult curriculum. They also had block scheduling, and the curriculum taught the “normal” first year and the “abnormal” second year. So that meant first year you would have anatomy, physiology, biochem, immunology, histology, and embryology for each section. The second year was mostly pathology and pharmacology. So you would have GI 1 in first year covering the basics, and GI 2 going over disease and pathology. They would definitely throw in common diseases to be tested on in first year though; they make great test questions. The idea was that you would have the ability to see it twice; as more repetitions = more likely to get into your brain.

Because the school was proud to have a “tough curriculum”, it also meant that you did a lot of self learning. I won’t go too into details, but you would have your lectures/reference books, but a lot of it was not easily put together for you. You did have to hunt to find important information. First year did hand you a bit more, but by the time you got to second year you did a lot more hunting…

It definitely made it frustrating as a student as most of us wanted to spend them time just learning and understanding what we needed to know, but it is what it is.

I wrote a lot of blocks on my classes in first year. But a schedule typically looked like this:

  • Class from 8 am to noon most days of the week. Occasionally we would have lectures in the afternoon, but most of the time we didn’t.
  • Lab usually from 1-4 on 2 or 3 of the days in the week. First year would have PCM, OS, and anatomy labs to fit in during the week depending on the block course you were in. OS and anatomy labs were 2 hours, PCM was only 1 hour.
  • Any additional time spent off was in the lab or studying for your courses.

This meant that you either had to pre-read/review lectures before class and try to learn a chunk of it during class, or do most of your reviewing  later in the evening. I am more of an evening person, so most of my studying occurred at night.

For most labs, you did not have to prep. But for some you did. This obviously took up some of your review time to make sure you were prepared. There were a lot of long nights and most of my weekends were spent trying to catch up simply because of this. As time went on, I stopped going to class to sleep in or try to start studying and just went to campus for labs. For anatomy, you spent most of your time trying to dig and find your structures, but you didn’t learn them well until they were cleaned out and you were able to see them and their relationship in the body. If I would have prepped more before going into lab, I probably would have gotten more out of it.

Our school has something called Mediasite, which is where our recorded lectures would be. They would show up as soon as the in person class was finished. We could speed up or slow down the lectures, so you could get through lectures pretty quickly if you wanted. Other schools I know utilize just voiced over powerpoints, which you cannot fast forward through…

And that was how my first year went. A lot of lectures, doing questions, trying to learn the anatomy, etc. There were some classes that I utilized a lot of additional resources besides my notes, and some where I didn’t need to utilize much. Because I had previously had plenty of exposure to the subjects taught, I knew how to study for them and how to approach them. It was just learning how to accept, study, and understand the large amounts of material in a much smaller amount of time.

Overall I would study an average of 10-12 hours a day first year.

No, I didn’t really work out. 

Yes, I had a lot of anxiety and there was a lot of stress burrito-ing happening and cuddles with my kitty. 

Year 2:

Honestly, more of the same. Except the focus was on pharm and path. I utilized Robbins path and pathoma the most, in order to help me understand and organize the material better. But honestly, you just have to see the material many times in order to understand path.

We didn’t have anatomy second year, so our only labs were OS and PCM. Most of the important skills we actually learned in first year; so a lot of it was review or integrated with some fine tuning. Since we had exposure to how they tested for different scenarios for both courses in first year, it wasn’t as stressful second year.

For our schedule, it was similar:

  • Classes 8-12 (or less depending on the day)
  • and lab/simulations about 2-3 days out of the week. We rotated in smaller groups for more things, so the schedule would look more hectic than it was.

Again, I chose to sleep in during the morning and get a later start to classes/studying than go to class. I simply didn’t learn in class. And if I did go, I could only pay attention for about an hour before I needed to switch. Plus, a lot of our path/pharm lectures were flown through simply because there was so much material and not enough time to teach it.

I’d say I utilized more outside resources consistently for second year, such as Truelearn for questions, or sketchy/pathoma for help with path understanding. So instead of multiple books, youtube, paid resources, etc, I just used the same 1-3 sources. First Aid can also be utilized as well to help organize your thoughts for path.

Then towards the end of the year you start gearing up for boards and dedicated. See my other posts for that information.

Overall, I would study maybe 6-8 hours a day consistently for second year. Partly because I was burned out, and partly because I would avoid my duties due to stress. It is what it is.

No, I still didn’t work out. I did hang out with friends more though. We would call it “study group” but only about 1/2 the time was spent studying… 

Year 3:

Well, I’m just starting so I don’t have much to offer yet!

But my site is doing what they call the “2+2” method. It is where we are in clinic for 2 weeks and then off for 2 weeks. But when we are on, we are on. In my first rotation this meant I was on straight for 14 days. Anything that was on call that my provider called me for meant I needed to be there. It was a bit exhausting by the end. I didn’t really get a “day off” until my 14 days were done. 

I know in the future, my schedule could be any combination of weeks on/off. It just so happened that my first rotation was one off, two on, one off. Because of this program, we have more work to do than our classmates. We all have some online work to do (and by we I mean my class as a whole), but my site has more additional projects that count towards our grade. This includes case presentations, powerpoints, standardized patients, and virtual reality. 

On my weeks off, it would usually consist of doing the work assigned for a grade, flash cards, and practice questions. 

For my first rotation, my scheduled looked like this:

  • 6am Rounding: As a student I would go before clinic started. I would usually run into my attending as I was finishing up so I could present. Then we would go see the patients from there. If I finished beforehand, I would look up the first few patients in clinic for the day so I had their information handy if I was sent in to see them.
  • Clinic from 7am-4pm (which always ran late).
  • I was on call the whole time, so if anything next door on the floor was called in, I would leave clinic to go be with the attending that was dealing with that. Sometimes it was the attending I was with, sometimes it wasn’t. Weirdly, I was usually with the attending in clinic that was on call that day. So it worked out in my favor. So if a baby was about to be born, we would leave clinic and go deliver and come back.
  • Some days we would have scheduled surgeries mid-day. So usually over lunch?
  • After clinic, we would visit patients on the floor. Usually started sometime after 5 pm. We would check in with any mom’s that needed to be delivered, or anything that was admitted while we were in clinic.
  • I would usually leave anywhere around 6-7 pm. 
  • On the weekends I would be there from 6/7am-7pm. I think there was one night where a case went haywire and we were there pretty late. 
  • This was a mix of inpatient and outpatient.

And that was mostly how my first rotation went. I only had enough time to shower, make food, and eat before passing out during the 2 weeks I was on. And since it was my first rotation, I hadn’t learned how to work in studying yet and hadn’t gotten used to the physical exhaustion yet. Hopefully my next rotation I will be better with this!

All I know is my next rotation is peds. I’m off the first two weeks and on the last two. I believe this rotation is just inpatient, so I’m expecting to be doing regularly scheduled 12 hour hospital shifts, but will let you know!

Cheers!

 

I got a Nudge From the Universe Today…

Hello!

This is going to a bit more unusual of a post than what I normally post. So let me set the scene for you, and I’m just gunna jump right in…

A few weekends ago I was sitting in my favorite coffee shop in Joplin. I had just arrived and was starting to unpack all of my books and notes. I had a test the next day, and as always, was hoping to get in a few hours of productive study time. The mountain felt high, but I was hoping to chip off a little bit before the exam. Let’s call it extremely hopeful.

Yes, yes… I was that: hopeful.

I was still in good spirits, but also still feeling like I was drowning. Which is the usual feeling in med school.

In hindsight it probably didn’t really matter if I studied at all that day. But I digress.

While opening up my books, a man who had set himself up at a table nearby was walking back. He politely stopped and asked me what I was studying.

Now, I sometimes forget how friendly people are in Joplin. In Michigan, most people aren’t this friendly. And you usually aren’t approached at a coffee shop unless you dropped something or some girl wants to compliment your dress/shirt/bag. So I was a bit caught off guard.

The conversation went something like this:

“Oh, I have a really big test tomorrow, it’s on all of the cardiopulmonary system and the kidneys.”

“Oh? I have lots of people that I know that work in healthcare. In fact, one of them is a nurse. She is on dialysis…”

Hmm…Okay. Not sure why that was important. In fact, I was wondering why we were even going this direction. But alright, it’s conversation I guess.

We got to talking and I later learned his name. But for now, let’s call him M.

M eventually told me the the had interstitial lung disease which is now causing him some depression. Ah! I’m thinking, I actually know what interstitial lung disease is! I don’t know it well (even though I was supposed to know it for my last test… but hey, I know it). And before you ask “Joyce, where the hell are you going with this story?” The answer is I’m about to get there. Calm your tits. Please.

Anywho, long story short and he tells me he thinks medicine is poison.

An interesting stance. One that I obviously do not agree with, but one that I’m sure I will come across more than once in my future.

But a point that I nonetheless wanted to talk about today.

As someone who does not have a chronic illness and as someone who lives a relatively healthy life without many restrictions; I clearly do not have the same hurtles, experiences, or struggles as someone who does. I do not know what it is like to have difficulty breathing. To be gasping for air or feel like you might be suffocating on a fairly regular basis or even all of the time. I understand depression, but my encounter with that illness is different from his experience with it. Simply put, I cannot put myself in his shoes because I have absolutely no reference to base it upon.

But I can understand that he is struggling. That he isn’t happy with the cards he was dealt. And as a future physician, I need to be able grasp this.

This conversation lead me to multiple realizations:

  1. People want to be heard.

As a future a physician, it is our job to be able to lend an ear. Most patients don’t just want to be “fixed” or “cured”. They want to be heard. That their struggles are valid. That their emotions about their struggles are valid. Sometimes they just need to vent. And we need recognize that. Yes, you can say that they can be referred to someone else other than you for this. However, a part of our jobs are to have a human-human interaction. And sometimes, patients just need an our ear.

2. Perspective

I seem to be gaining a lot more of this recently. But perspective in the fact that we know what our lives are; we know our struggles, our obstacles, and what we have to do. But we sometimes don’t stop to think that our patients may have a much more difficult time doing the same things as us given their obstacles. It also reminds me that not everyone has a great experience with medicine. And with that, patients are scared, unsure, or may pushback more because of it.

3. It’s okay to disagree with our patients. Respectfully.

But it means we need to try to understand what is important to them. Their goals may be different than your goals. And sometimes as physicians we have to slightly re-align the goals to be more realistic. Other times, we just need to be on the same page.  Is their life meaningful? Can they do the things they enjoy doing? Do they still have the drive to do the things they enjoy? Can they work on accepting that it may take them longer to do a task now than it did previously? All of these are important. But taking time to just chat with your patient to get an idea of where they are at and sometimes gently nudging them or re-aligning their goals can help them immensely change their frame of mind.

4. And lastly and most importantly, we as physicians and as a medical culture need to stop being so afraid to allow death to happen.

This is the biggest thing that I think we sometimes all forget. Medicine can do many wondrous things. It can save lives, it can improve life and quality of life, and it can extend lives. But it can also extend life with the association of declining the quality of life. And that often times, we as physicians don’t do enough explaining or education that death is not necessarily something to be afraid of.

Do I want my future patients to die? Of course not! I want to give them a fighting chance when it is something that they want and it is within reasonable limits. But I also want them to know that it is okay to decline extra surgeries or procedures. It is okay to say no more. Especially if it may prolong their lifespan, but decline their quality of life.

There comes a point in someone’s life where the answer isn’t always a clear “yes, make me better so I can live longer”. When we are young or younger I should say, the answer is always make it longer. Give them a full life. But when you take someone who is chronically ill or elderly, the amount of sickness or chronic diseases start to pile up. I’m not sure our bodies were ever meant to live as long as we typically do nowadays. And as all of those start to pile up, the quality of life goes down. Sure, most of them are easily fixable on their own. Or if they had a perfectly healthy immune system getting something like pneumonia or a urinary tract infection would be easy to clear. But when put with someone who does not have a healthy immune system, it can seem like attempting to move a very large boulder that is constantly trying to squash you.

So too that, I think as a future physician myself and a lot of my future colleagues need to put our egos aside. We need to start having discussions earlier with our patients about their wants and wishes. So that when shit hits the fan, their family members who aren’t ready to let them go don’t contradict what the patient wants. Because not all family members will agree with what your patient wants. They may be selfish about what they want instead. And even just having that conversation early allows your patients to have the ability to take time and think about what they truly want. Because in some situations, it is better to grant their wishes or let them have a natural death to where they aren’t dying with tubes out of every orifice and hooked up to multiple machines. Or when their heart starts to give out, their defibrillator isn’t constantly shocking them, prolonging death and causing pain.

We also need to be better at discussing that death is not always traumatic. A lot of times, when chronic sickness takes over, your body doesn’t necessarily “kill you slowly”. A lot of times, you will go unconscious because your blood pressure is too low, or you are septic, your metabolites build up in your system, or your heart just gives out.

But it also leads me to this point…

I was sitting there having this discussion with M who I don’t know. This man who clearly wants to vent but also wants to be validated. I thought to myself: I am so wrapped up in my own problems that I forget I have a very fortunate life and situation.

As someone who just came back from Kenya, it is seriously embarrassing to admit that it only took 2 months to forget the perspective I learned while there.

But I also needed this conversation. Call it a nudge. Or maybe a little wind blew in my direction from the universe.

I needed to be reminded of where I was. That yes, this was hard, but that I was doing this so that when a patient like M walks into my office, I can have this conversation with them. That I can reassure them. Listen to them. Allow them that space.

Humans need to feel connected. In a world where we try so hard to be connected via social media, we don’t do a very good job of actually forming connections with people. I’m going to run into having patients who just want to see me to discuss that they are unhappy. To talk it out. For me to remind them or gently nudge them to find the things that they find pleasure in life with. And once that is gone, we should discuss where to go next.

I was at a crossroads in my life before this conversation. The universe gave me a little nudge to remind me that what I’m going through now won’t be the rewarding part. That what I’m doing right this second isn’t what it will be like in practice. That the conversations I have with my patients will be both heartbreaking and rewarding, but worth my white coat.

Just wanted to throw that out there today.