Tag: OMS1

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. 

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.

 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.

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.

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.  

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.

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.