How to succeed In Third Year of Medical School

   When I began my third year of medical school last year, everyone's advice to me was to "show interest". At the time, however, I didn't really understand what that term encompassed. Did I just have to listen to what everyone said and know what was going on with patients? It goes a little further than that. 

     As a third year, your shadowing days are over. This is your time to get your hands dirty, do procedures, talk to patients, write notes, and learn. In certain specialties, however, the residents are so busy, they often neglect students. They may have you following them around doing nothing, which is a really frustrating waste of your time.  However, there are ways to make them notice you and still get a good evaluation. Success doesn't happen accidentally. You have to put your mind to it. Here are a few tips to keep when mind during your clerkships:

1. Be professional: This is the minimum required to do well, but it's still worth mentioning. It implies being on time, doing the assigned reading if given, complying with dress code and behaving respectfully around your colleagues.  While it sounds simple, precisely because it is simple it can affect you significantly if missed. The worst name you can call a medical student is unprofessional. You will not honor a clerkship with the "U" word on your evaluation. Some schools will even make you re-mediate the clerkship.

2- Know everything about your patient: This goes beyond asking all the right questions on an H&P. Know their story, where they're from, who is their support network, insurance status, how long they have had a disease, how was it diagnosed. Know which room number they are in without having to look down at a paper. Attendings will be impressed by this. If they ask a patient-related question, you should have the answer. 

When you're on wards, read notes other health professionals have written on your patients. Whether they are consults, nursing, PT, PCPs, doesn't matter, read it all. Read any new information that pops up on the EHR. Follow-up results from the work-up that has been ordered. Write down all the labs and vitals for that day even if they are normal. The attending does not want to hear "normal" if he/she asks you. They want a number. If you are in clinic read notes from past visits to get acquainted with what has already happened. Patients get annoyed when you ask them questions that can be answered by looking at a chart. If you're in surgery, don't just read about the procedure. Try to find out why they are having it done in the first place. Many surgeons are known for kicking students out of the OR if you are uninformed about who the patient is, and why they are there.

3. Take ownership of your patient: remember that one day you will be a doctor and be responsible for patients. Put it in your mind that patients assigned to you are YOURS. Don't let the resident present for you. Step in in any situation where your patient comes up. Especially rounds. This also implies calling other services to get things moving. Blood cultures pending? Call the lab for a preliminary read. Need to consult another service? Page them yourself. Follow-up with what their plan is. Don't just act as a messenger between the patient and the resident.  Talk to the nurses about how the patient is doing. Make sure the patient understands everything that is going on. Because they are your patient,and it is your responsibility.

4. Come up with your own assessment and plan. This will be hard at the beginning when you don't know enough, but at least take a stab at the basics. If you don't know specifically which antibiotics they will need at least mention that you think the patient needs them. 

When writing in patient progress notes, always ask yourself what are the patient goals for the day and what do they need to be discharged. Don't just copy and paste the plan from the day before. Read through it and change it along the course of the hospital stay.

When in your primary care rotation, keep all of the preventative care in mind and find out if your patient meets criteria for any vaccinations, cancer screening, etc.

 5. Read about diagnosis: You will remember things a lot better if you put a face to a diagnosis you have to study. This part is centered more on the disease than the patient. If, for example, your patient has pancreatitis, read about which criteria for pancreatitis does your patient meet. Are the amylase and lipase elevated? Do they meet ranson's criteria? How severe is the disease? What caused their disease in the first place? What are the complications of the disease? Look at the imaging, labs, past work-up. What are other things on the differential diagnosis? Read about management. How long do they need to stay in the hospital? Does this patient need outpatient follow-up? Learning by doing is the best.

6. Don't just accept a diagnosis. Ask yourself why. Going along with #5, the answer to why is usually hidden in your first and second year education. Why is the potassium low? It has to be going some where. Is the patient peeing it out? Is it inside the cells? Don't just treat with potassium replacement. If you bother asking why, you can possibly find what's really causing the hypokalemia and by correcting that you won't have to replace the potassium anymore. Or the answer can tell you that it will correct on its own. Asking "why" changes your management. And that's what an M.D is all about.

7. Take it to the next step: Once you are staying on top of things, reading on your patients, coming up with differentials and your own plan, you will probably be above average from your classmates. This is still what is expected of you, however. If you want to really impress people, do MORE than what they ask you to do. Or at least do it before they ask you to do it.This is hard to do in rotations that you dislike or that you know you don't want to pursue. If you know you want to pursue it, you have to make sure they remember you. Don't wait until someone asks you  if you want to do the discharge summary, start it yourself. If you already did two admissions, but another one comes along, volunteer to do it anyway. Update the sign out sheet every day; learn how to put orders in; go watch your patient's procedure if they have any. Bring in research studies to share with your team that are relevant to your cases. If you go out of your way to do more than what they expect, you'll be able to ask for a letter of recommendation with confidence that it will be good.

7. Don't be afraid to ask questions: A lot of students are afraid of looking dumb in front of their superiors because we work in a culture where we are expected to know everything. Often enough we feel like we know nothing the more information we learn. But by asking questions you are showing that you are present. That you are thinking about the information given to you in a critical way and you are not just accepting what is told to you. Take advantage of working with people with more experience than you. You can't find every answer you need on google or UptoDate. There are some questions only experience can answer. By asking questions you are also letting your superiors know what your level of knowledge is, that way the know what they can teach you based on what you already know.

8. Never EVER complain. About anything. This is medicine after all. It's hard. You will work long hours, feel tired, hungry, stress/overwhelmed, and sleep deprived all at the same time. This comes with the job. Surgery is the rotation you will want to complain the most, but it is the most important rotation in which you shouldn't. The residents have to do the same as you and more. One time in surgery I had a bad cold, pretty sure I was running a fever. However, my resident was sick as well. And if he had to stay and work, I had to too. I never asked to go home. Our attending knew I was sick, he could have sent me home without me having to ask if he thought I couldn't work. Doctors will be the first ones to tell you to get help if you really need it. If you don't complain, you look like a trouper. If you do, you look like a baby. Your choice.

9. Don't let yourself be intimidated by pimping. Some attendings just ask questions to assess the level of your knowledge so they know what they can teach you . Others like to stimulate discussion and critical thinking. I had an attending who would purposefully pick topics I knew nothing about and then he would encourage me to think about the basic physiology of the body or pathophys of the disease to answer the question. It's natural to feel scared under pressure, but don't let it get the best of you. Attendings will respect you more if you don't let them intimidate you. Strong personalities acknowledge each other.

10. Be confident. Or fake it. This goes along with #9. Don't let your fear show. Speak up. The way you phrase things makes all the difference. It's not the same saying " I think maybe it could be CHF?" than saying "His labs and physical exam point towards CHF". Don't give answers that end with question marks. It shows you're afraid of being wrong and hence you don't commit to a straight response. But one day you will be a resident on-call on nights and your decision without question marks could save a life.

11. Be receptive to feedback. People will tell you how you're doing in the rotation in different ways. We all like to think we are super awesome, but that may not always be the case. You are a student. Of course you have things you need to work on. It is important that when someone gives you feedback, you take it with a good face. Take note of what they point out and improve yourself. Don't try to interrupt them to explain yourself. Just shut up and listen. If you really feel like you need to explain a misunderstanding, phrase it carefully. You don't want to come off as immature and stubborn and stuck in your wrong ways. Improving during a rotation shows you have potential to be a great resident.

I hope this advice can help you in the future. It can all be summarized as "showing interest", as I mentioned before. Like my Internal Medicine Chairman said at the beginning of my third year, "Show up. And do your damn job".

Good Luck.

The Second Year of Medical School

     For the average medical student, the most dreaded year of all four is definitely the second year. This is due to what awaits at the end of it, USMLE Step 1. The United States Medical Licensing Examination is an 8 hour exam that tests you on all the knowledge learned during the first two years of medical school. It is different from the MCAT, in that, if you pass the MCAT, but didn't get the score you wanted you can always take it again. Step 1, however, is an all or nothing deal. You can only take it again only if you failed the first time around, though failing is not an option you want. Your Step 1 score is a measure of your clinical knowledge and it sets a threshold for the residencies you can apply to. The more competitive the specialty you want to practice, the higher your score has to be.

     The second year of medical school is entirely about preparing for this exam. The first year fun is over. And if you thought first year exams were overwhelming, you have no idea how much worse it can get. I am usually an optimistic person, however, this post is going to be more realistic than anything else. If you are looking to read a rainbows-and-puppy-dogs-message about Step 1 you should probably stop reading right now.

     Second year is hard.

     I finally understood why so many current doctors try to discourage pre-meds from going into that profession. This year will test you not just in academics, but in discipline, resiliency, balance, focus, and willingness to make sacrifices for your career. You have to push through the misery and keep your eye on the finish line. Believe that everything will be okay, but study as if everything will go wrong.

     In my medical school, second year exams are taken every three weeks but they test you on a minimum of 90 lecture hours of material. Think about it this way, if say you typical college class is 1 hour 3 times a week, and you take over a period of 5 months, that totals around 60 hours of material spread throughout an entire semester. In medical school you cover more than that over a period of three weeks. Other schools may vary on this, but at USF our second year ends two months earlier than other schools, so the course load per test is heavier.

     Needless to say all you do is study. At the beginning of second year, people are more likely to socialize and still go out maybe once a week for a fun time. However, the closer you get to Step 1, the less this happens as students crawl into their study caves for months.

         People will have many different approaches to balance and studying on this year, but the most important thing is to find out what works for YOU. 

         The most common mistake people do in medical school is compare themselves to their classmates, as if them or their classmates are setting a standard everyone else needs to follow. 

         Many medical students will probably disagree with this last statement, but you will discover for yourself that it is true. Comparing yourself to other in medical school is the easiest way to stress out and drive yourself crazy. You have to remember that each medical class is a collection of the smartest students around the country. While you may be used to being an A-student all your life, now you are grouped with 120 A-students as well. These students have different ambitions, different goals they want to achieve in medicine. So comparing yourself for example, to a students that is striving towards orthopedics while you want to be a pediatrician, is probably not a sane idea. Don't get me wrong, I am not saying that a pediatrician should study less. We all need to have a thorough grasp of medicine. But an ortho candidate may want research experience, consistent 90s on tests and a higher Step score, than what a future peds might want. So find out what you're striving for and what you have to do to get there, and try to compete only against yourself.       

     Even though second year has an insane course load, I discovered this material was much more interesting than in first year. First year focuses on anatomy and physiology; learning what is normal in the human body. Second year focuses on pathology, microbiology, pharmacology; what goes wrong and how to treat it. Every piece of information is clinically relevant and your inherent drive to learn will help you get through your 12 hours of studying a day. Anyone who lacks this inherent drive should probably consider another career path.

     During my second year exams, I never got higher than an 80%. Most of my scores were around 73% +/-4. However, I was focusing more on board relevant material, rather than lecture material. Unfortunately, these don't always overlap and lectures tend to have a lot more information than what we need to know for boards. My school has a pass/fail grading system and my A-student mentality had to adapt to be content with a 73% average. As long as I passed, I was okay. I studied hard every day and the only way to break out of my 73%-rut would be focusing more on lecture and neglecting boards; a price  that did not seem worth the pay. Focusing on boards paid off later when I started official Step 1 studying and my first NBME score indicated I would definitely pass.     

       As an MS1 (medical student year 1), I had the privilege of living with an MS2. I lived with her through her MS2 struggles, which prepared me mentally for second year and also gave me lots of advice in order to succeed in this terrible year. Not everyone has this privilege so I am passing this advice on.The following suggestions below are what worked for me; I can't guarantee that they work for everyone so take them with a grain of salt, and adjust them to your preferences.

     1-Mentally prepare yourself for what is to come. Think of it as sacrificing one year of balance and fun, for the stability of the rest of your life. Get ready to stay in on many nights you want to go out. Get ready to be miserable for a long time, but still suck it up and do your work.

     2- As impossible as this sounds with a 12/hour study day, try to stay balanced. Don't give up everything that makes you happy just to study. If you normally work out every day, continue to do that. If you are passionate about a specific sport, or another hobby, don't take it out of your life.

    3- Spend time with your family and/or significant other. This one goes along the same theme as #3, but it is significant enough to have it's own slot. You will discover there will be many times when your family and/or partner will feel neglected throughout the year. It's not that you don't want to spend time with them, you just can't dedicate the same amount you used to. Communication is the biggest way to overcome a fall out. Try to make them understand what you are going through and how important it is, but still dedicate some time to them on your schedule. This makes them feel appreciated and also fills you with those warm fuzzy feelings that cancel out any bad moods studying has induced.

    4- Find a study partner. Students have different views on this one, as many prefer solitude and confinement while studying, with no distractions. But if you are not one of those people, having someone to study with, to keep you accountable for your work, and to push your academic limits can make a huge difference throughout the year. When looking for a study partner, try looking for someone that is at your same level. I do not recommend studying with some one that is so far ahead that they will intimidate you and stress you out. I also do not recommend finding a friend to waste time with while you're  supposed to be studying. A perfect study partner is one that learns at the same speed as you and strives for the same academic level as you. A friend but also a colleague.

   5- I found that skipping class was a good way to be more efficient with my time. I would go to school at 8ish am. Studied until 5 or 6, then work out and have dinner/cook afterwards. It was the closest way to keep some sort of balance in my life, as opposed to being in lecture for 8 hours of the day to then start studying afterwards. Study hard, but also, study smart.

   6- Plan out your studying. Have both a short-term and a long term plan. The short term will be the one that leads up to each individual group test; while the long-term one will lead up to Step 1 itself. For every school test I made a list of all the lectures I had to cover with all the resources I wanted to use to cover them. I aimed to be done looking at all the material once a few days before the test so I had time to review and memorize little details. The long-term plan started somewhere in December and it included going over First Aid, re-watching Pathoma, and other things I will include in a future blog post.

    7- Be aware that life does not stop while you're in medical school. Friends outside of med school will start graduating, getting married, having kids. Actually, even inside medical school you or your friends might go through these stages. Starting a family makes balance so much harder, and I have the utmost respect for my classmates who did. Your family may have losses, celebrations, or issues that interrupt your schedule and keep things from going according to plan. You will have to adapt to these situations and evolve your focus so much more to be efficient with the time that you are studying.

    8- Do not undermine any particular subject because you feel you won't need it for the specialty you want to go into. Every subject is important to have a thorough understanding of medicine and to do well in your boards. The information you are learning now will potentially save someone's life in the future. You may want to do radiology, for example, and think you don't need to know immunology, but every subject in medicine tends to overlap, and especially if you want to do well in boards to be a good radiology candidate, you can't afford to neglect any subjects.

 I hope this came of help to some of you.Follow my blog if you are interested on my future posts which include Resources for Studying for Step 1, Making a Step 1 Study Plan, How medical school have changed me and many more. Please share with your friends!

50 Random Facts I've Learned About Med School Life

1- The meaning of the word gunner. A gunner is basically an overly ambitious and competitive medical student who is always ahead of everyone else. It's like your typical nerd times 1000.

2- The hardest studying you have ever done in your life is still not as hard as you will study in medical school.

3-Caffeine withdrawal gives you awful headaches.

4- Some people think women who go to medical school are actually nursing students.

5- Physical therapy students will be better at interviewing patients than medical students will.

6- Most doctor's have an unconscious tendency to be less friendly towards their obese patients because they cause their own diseases.

7- Cadaver lab is cool on the first day; then it gets old REALLY fast.

8- Having faculty members that truly care about their students makes a huge difference.

9- Most  gunners don't identify themselves as such.

10- The class' averages on tests will be ridiculously high.

11- Going to class is considered a study break.

12- You will never look or feel more badass than when you wear your white coat.

13- Showing cops your medical school ID (or white coat) can get you out of speeding tickets (unofficially).

14- Plexuses suck.

15- It's really hard for family and friends to understand how busy we really are.

16- Human flesh looks like steak.

17- Most patients will truly trust your advise as a student even though you are not an official doctor yet.

18- Speaking Spanish is a huge asset in the medical field.

19- You have the power to start making a difference as a student. Whether it is through a research project, a mission trip, saving a  life on your free time, or through an organization, making an impact starts now.

20- Two weeks in regular time equals a month in med school time.

21- You will have REALLY LONG DAYS every single day.

22- There will be a fair portion of your classmates that are already married or engaged.

25- Starting med school in your thirties and/or being pregnant during med school is not uncommon.

26- The alternate definition of "pimping": when a med student gets singled out to answer questions by a resident or attending. Depending on the extent of your knowledge you can excel or be humiliated.

27-Fourth year is the easiest one. It's kind of a scam for students to pay tuition to go interview for jobs around the country.

28- In a second year exam, you will be easily tested in at least 90 hours worth of material.

29- One-on-One teaching  is the best learning method.

30-Physician professors are the best lecturers.

31- Your one official free day will be the test day after the test is done.It's wonderful.

32- Comparing yourself to other people's grades and/or study methods is the best way to drive yourself crazy.

33- Third year students are like myths...everybody has heard of them but no one has actually seen one.

34-Neuro block is an entirely different language.

35- First Aid USMLE Step 1 is the medical school bible.

36- Whether you have a life or not in medical school, is actually your choice.

37- There is never a "best time" to get married or have kids in this career. Just go with life as it happens.

38- It will either be raining or really cold on your free days. Murfy's Law.

39-Your circle of friends will change as school progresses.

40-You will forget what it feels like to be normal.

41- 8 hours of studying is not as much as it sounds.

42-Pushing through being miserable is the hardest part.

43- Even though you constantly feel stupid, you actually know more than you give credit for.

44- There are plenty of people, and plenty of sources with tons of advice about board study prep. One size does not fit all for USMLE prep. Find what works for you.

45- Having a mentor you look up to helps you keep motivated.

46- Non-traditional students have a tough time adapting because they've actually had a life outside the library.

47- The lady at Starbucks will know you by name. She'll notice your hair cut when your friends don't.

48- Friends are high yield.

49-Good enough is good enough.

50-You are stronger than you think you are.

Time Management in Medical School

     It has been about 10 months since my last post to this blog. I intended to keep it going all year around, thinking I would make time to write about my first year of medical school; keeping my memories fresh for you guys to enjoy as I went along. However, here I am on the eve of my second year with memories going stale, forcing  words out of my mind, and wondering how I can enlighten you with my experience.
     You might be guessing the reason I have not written in 10 months because I was busy studying. Well, yes and no. The first year of medical school provided more free time than I thought I would have. I thought I would be studying day in and day out as part of a nerd herd that slowly becomes less human with every test. Don't get me wrong. you will find people like that in medical school. But becoming one of them is a choice. A choice I decided not to make.
    It is possible to have a life and do med school at the same time. It really depends on the kind of person you are, however. If studying day in and day out is not a problem for you, the keep doing what works for you. If you are the kind of person that needs to balance all aspects of your life: physical, mental, family, spiritual, love life, then time management will be golden for you.
        Set up a designated time to do the things that are important to you, and then accommodate your study schedule around them. Leave room for freedom and adaption in your schedule. Find out what works for you and organize yourself accordingly.
       I, for example, like to go running at around 5 or 6pm several times a week. So I fit my studying before working out, this way running came as a good decompressing break. Running tended to turn into a 3 hour break sometimes, considering I have to shower, cook, eat, and do dishes afterward. By 9pm I would be  too tired and/or unmotivated to study. Any studying I did after this time was unproductive. So I tried to change it up to see what worked best. I tried working out later at night. But then it felt like I was not enjoying daylight or it felt heavier because my stomach still had dinner inside ( I usually run before eating).
          Then I tried working out in the mornings before my 8am class. This meant waking up earlier and then by noon I already needed a nap. Where there's a will, there's a way. Running is important for both my mental and physical health. Not doing it because I had to study was simply not an option. So instead I decided to run whenever my mind needed a break the most, whenever that may be, so the benefits would outweigh the costs.
        I know some of my classmates have done similar things. For some of them, Church on Sunday is a sacred time in their week and will be prioritized regardless of whether there is a test on Monday or not. One of my married classmates never studies on Friday night, because that is her date night with her husband.Another fiend likes to study while tanning by the pool. Some of my friends skip class entirely (luxury due to recorded lectures) to do everything they have to do in their day before they start studying. Many people take several days off after a test day, to recover and re-balance. People also get involved in many organizations and clubs available in medical school and then dedicate their free time to meetings, events, and activities related to these clubs.
      You might be wondering, if there is such a thing as free time in med school, why did I not write? Well I was too mentally drained during this time and I wanted to use it to do something fun and relaxing, instead of exerting my brain some more. An advice that I recommend anyone in this field to do. It's important for me to feel like I am still a normal person and that I can still hold a conversation with someone that doesn't know what ptosis means. That is why this summer I have done nothing but chill by the pool, hang out with my friends, work on a research project, and enjoy myself. When second year begins the course load will be a lot heavier and the mental demand more taxing. But this just gives me more reason to prioritize balance.

Studying for Med School Exams

      During my med school orientation one of the deans mentioned that the information you study in undergrad is like drinking water from a water fountain, but in med school, it's like drinking water from a fire hydrant. At the moment it seemed a little dramatic but after having taken two exams in medical school, I know he was right. The material itself is not intellectually harder, there is just A LOT of it. Every two weeks or so we get tested on 25-30 hours of lecture, excluding anatomy (from the lecture hour count, not from the test). Exams are multiple choice, two questions per lecture hour. Being a science major was of MUCH help. A lot of the material they start with is advanced genetics and biochemistry with clinical correlations, so if you have a good foundation of those, you shouldn't be too overwhelmed. Professors will not break down or dumb down the material piece by piece for everyone to digest peacefully. They have 50mins of lecture and if you didn't get it, go to their office hours or ask a friend for help. Professor's are not rude regarding questions, but their lecture is being recorded and they only have so much time to get it all into the tape. Plus, this is the big leagues now. People are good about learning things on their own without a professor.
      Even though I have always had good study habits, after the first exam I had to make some adjustments to adapt. Re-listening to the lectures, and going over my notes a few times was not enough. There is so much information that by the time you finish going over all of it, the material from the first few lectures is already slipping out. I found ways to organize information so I could process and understand it faster: flow charts, YouTube videos, pictures, tables, outlines, dirty mnemonics, you name it, I've done it. Group study was also of tremendous help. People find different ways to teach each other important material, and once you talk about a certain topic, you will not forget it. My class is a great team when it comes to helping each other. We have a Sharepoint account where we upload notes on unrecorded presentations, practice quizzes, summarized anatomy, etc. We also have a Facebook page where we post links to helpful videos and websites. My peers have been my teachers as much as my professors have, or more.
         A week before the exam, the  only balance you will have in your life is the one between food, sleep, and studying. Nothing else matters. Dishes? Pile them on the dishwasher. Hamper? Overflowed. Bathroom? Dirty. Phone rings? Ten missed calls; from mom. Again, having a science major is a good prep for the type of life style you will find in med school. Studying in a group also helps you keep your sanity. People tend to make jokes or just start a conversation and that time can loosen up the tension and help you keep going. I have never been able to study at home for long focused periods of time, so I basically spent my weekend in school. As long as I have my student ID  I can go in any time I want. They have a lounge there with fridges and microwaves, so I went prepared with lunch, dinner, snacks, and coffee for the day. Saturday I went in at 8am and left at 10pm. Classmates that came in later, say noon, stayed up until 3am. Of course, we took breaks. Usually to eat, take a small walk, talk to other people studying at school, but anything more than one hour is a luxury we cannot afford.
         In an optimal study plan, the weekend is just for memorizing and developing a good grasp of the information. By this time you should have finished re-listening to lectures and writing notes. For both of my exams I woke up feeling confident about them. But when I took the test I felt like none of the important information I had studied was there, and I struggled to remember little details I knew I had studied but was not 100% sure  I remembered correctly. Talking about the test afterwards makes it all worse because everyone has different answers and they all have good arguments for each of them. It seems like any answer would be possible and the only definitive factor is what the professor says is right, because the professor says it's right. Even though, I felt awful after both exams, I did better than I expected for both, scoring in the high B range. The average was also in the high B range, but fortunately for me USF has a pass/fail policy and the average does not factor into my grade unless everyone has scored poorly.
         The day after an exam is my off day, and I use to catch up with life. Get everything in order and call everyone I haven't talked to in days. You just get one day though, because even though you just took a test you already have more information to study before it piles up. It is a stressful process, however, the nerd in all med students secretly enjoys what they are learning. But I would advise to anyone who is not passionate about medicine to stay away from it. It is the passion that keeps you going through all of it, knowing that this information could potentially save a patient's life someday. If you are still a pre-med, try to get yourself out of  a path in medicine as much as you can, and if you can't, then you know it's for you.

The White Coat Ceremony

    On August 17, 2012, 163 first year medical students of the largest incoming M.D. class ever at USF MCOM, received a white coat. It was a two-hour ceremony on a rainy afternoon. We still had class from 8am-12pm, but many students skipped to receive the family members that would attend the ceremony. My family is a 3-hour plane ride away, so they could not be present, but my best friend of 11 years now came to see me, so it was as if I really had family there after all. All the excitement and commotion usually present at graduations was there, except we were starting a journey instead of ending it. Dressed in our business-best, ready for the marathon of camera flashes that would come our way, we marched in the ballroom behind a man playing bag pipes, in our respective alphabetical order. We sat facing the crowd, with gleaming faces; in the melee it was hard to tell who was bursting more with pride, the students or the families.

    Dr. Stephen Klasko, CEO of USF Health and dean of the Morsani College of Medicine, proceeded to give a speech about the meaning of the white coat. Without the coat, he is a regular guy, but as soon as he puts it on, people look at him differently. They show respect and trust because he is representing something more than himself. Receiving the white coat marks the start of our professional life. It still blew my mind to think that the 163 students around me WOULD be doctors one day. It was a certainty and not a possibility anymore. 

        Dr. Brownlee, professor of medicine and 2012 recipient of the Leonard Tow Humanism in Medicine Award, spoke about the dangers the white coat can bring. Illusions of power that interfere with patient care and about the importance of taking the white coat off every once in a while to just be human.  Simple things like saying "I'm sorry" to a patient can be the most humanistic and hardest thing to do for a physician some times. Alicia Billington, a third year medical student at USF MCOM and president of the Student Council, spoke about humanism in her experiences as a student. She encountered a three-car crash on the highway once and stopped to help the victims while an ambulance arrived. At that point in her academic life, however, the most she could do was give CPR if a victim's heart stopped, and there was not much she could do without equipment to aid her. She spoke about how she sometimes felt she had been clinically right, but she still felt she had failed the patient. “Please don’t forget to smile and touch your patients. Don’t for forget to be human,” Alicia said. I surprisingly enjoyed each of the speeches. I expected them to be monotonous and boring but they held everyone's attention the entire time. l also loved how they emphasized the advantages and disadvantages of the white coat; like they're about to raise you on a pedestal, but they ask you to remember to step down and level with everyone else at the same time.

       Then the official coating began. Members of the faculty coated the students as we walked to the stage in groups of four. The coat had the school's seal on it, as well as a gold pin in the collar that read "Humanism in medicine". Theoretically, it should have had our names embroidered on them, but the order was not done on time and we had to return the coats after the ceremony was over.When everyone had been coated, the class was presented. The audience's exhilaration swelled our chests even more. We proceeded to pledge the Oath of Commitment, USF's modified version of the Oath of Hippocrates. In it vowed to practice medicine honorably and morally; to improve healthcare in our community; and to recognize when our abilities reach their limits, and seek assistance when that happens. We also made a commitment to life-long learning and respect of patient confidentiality.

       In a way, the White Coat Ceremony felt like a marriage ritual. Even though we get a coat instead of a ring, we still promise to practice it faithfully for as long as we shall live, and it still marks first day of the rest of our lives.

Short Video of Ceremony-Tampa Bay Times

Article by USF Health on WCC: http://hscweb3.hsc.usf.edu/blog/2012/08/18/a-commitment-to-humanity-in-medicine/#.UDPfQrGgvIQ.facebook 

         

      
     

Medical School Week#1

       Even though it's been a week already, it's still surreal to think that I'm in medical school. Getting into med school is a long term goal and you work hard on it for so long that it almost seems unreachable. There are 120 core M.D. students in my class, plus 40 in a special M.D. program called SELECT. Surrounded by 160 people packed in an auditorium, and ALL of us becoming doctors, makes me realize how blessed I really am. I knew a few people already because we had done undergrad together. Familiar faces on a first day full of new ones definitely enhance the experience.

        The first week was nothing like I expected it to be. I thought I would have homework and quizzes by the second day at least; and that most of my classmates would be know-it-all-snobs or anti-social nerds. I'm glad to report  neither was true. Although most of my classmates have extremely different life stories, when talking to them I can tell we have all been carefully handpicked and polished from a thousand others because of similar traits. Everyone seemed very well-rounded, approachable, with a good sense of humor, good social skills, and of course, smart (No more awkward silences after making a science-joke!). 

         At USF COM, the second years have a peer advisory committee and they prepared a week's worth of activities for us to socialize and meet each other. Starting with a park mixer the Saturday before the first day of class, where we had a barbecue, played football, and other ice-breaking games. At first it was a little awkward to randomly introduce myself to different people over and over, but everyone else was in the same boat, and I soon got used to it.Sunday night the class was split into groups of 7-10 for a welcome dinner with 3-4 second years (MS2s). The MS2s were full of advise and very supporting toward the year ahead. In my group we went to a Mexican restaurant and clicked so well, that we were there for 3.5 hours. The MS2s were so normal and fun that suddenly the first year was not so intimidating. No one was left out of the conversation, sure at times there were about three different conversations going on, but we did take the time to get to know each other as a group. Monday night (after the first school day!) we had trivia night at a pub. Yes, you read right, med students went drinking :O hahaha. I met more people there but by this third event I began to see that the same group of people were the ones going out to have fun. Not that the rest don't like fun, but there was a fair amount of classmates that were married, had kids, or were engaged, and as such they had pressing priorities.

          Tuesday night the American Medical Association (AMA) at our school had a social at restaurant-bar. I met a lot more people in the social and saw their true fun colors when the official meeting was over, the lights went out and the music began. The first day everyone seemed so serious and professional in their business clothes and med school mode, but that impression melted away when we all sang "Call me, maybe", "Titanium", and "Wild one", while busting out crazy moves in the dance floor. If anything that's when I really started to think I was dreaming and not in med school at all. Wednesday night, we went to a local baseball game, Rays vs. Toronto. While I don't follow any sports, I went anyway for the sake of having that experience with my classmates. I barely payed any attention to the game, but I did learn a few things about teams and plays from everyone else there. At this point people were naturally falling into groups of those they had the most in common with. Finally, Thursday night, we went to a small theme park Grand Prix to go-kart race and play miniature golf. There was free pizza and chicken wings as well as really cheap beer. I had a lot of fun during this first week, but all MS2s say, the first year is the "easiest" relative to the other years and the time to enjoy yourself is now. I room with an MS2 ad while I've been going out every night she has been studying non-stop, taking breaks only to eat or drink coffee.

          Academically speaking this week has been very orientation and mostly an introduction to our courses. We had lectures on the health care system and how Obamacare will change insurance. We also had several lectures discussing the importance of  professionalism, ethics, and cultural competence. Now that we are medical students we represent the health care system as well as our career and who we are anywhere we go. We were warned about how things we post online and how we conduct ourselves in our social time can affect our careers. We also discussed the importance of team work in health care. As doctors we work with pharmacists, physical therapists, nurses, and its important to value all of the members without demeaning either of them. Our first year lectures are shared with physical therapist students so we will be practicing this inter-professionalism starting now.
            Our curriculum runs by body "systems". Our first course is the musculoskeletal system and it is about 8 weeks long. In those 8 weeks we will learn everything related to that system from development, anatomy, diseases, etc. After that time we take a test and move on to the second system and so forth. Monday, Wednesday, and Fridays will be our science days while Tuesday and Thursdays we have ethics, humanities and Doctoring. In doctoring we are divided into smaller groups directed by an attending preceptor and an MS4, and we learn communication and history taking skills. Already in our first week we paired in twos and had to take the medical history of a standardized patient (actor) in a simulated clinical environment. The patients are not allowed to voluntarily give information just clues here and there, and as "doctors" we have to dig deeper on everything they say. Patients don't usually relate their symptoms but think of them as separate issues, so they may not mention other symptoms because they don't think it relevant to their pressing concern. In addition to Doctoring we also got CPR and AED certification this week. It was a four hour training in one and two-rescuer methods on adults and children.
          The week ended with a student organization fair. The COM had various interest groups for any occupations that students were interested specializing in their residency. National medical organizations were also present such as the AMA, Medical Students for Choice, Project World Health, AMSA, and many more. All of this offer volunteering opportunities, international mission trips and national conferences. Membership in any of this can enhance your residency application and also provide you with hours for the 80/hr volunteering requirement in the first two years.
           The science courses will be starting next week. Subscribe with your gmail account to follow up on how the med school heat builds. Hope you enjoyed this post :)