Accepting the Inevitable

All are in the mood of merrymaking, decorations are everywhere, I hear carols on the radio, even the TV is singing Merry Christmas, and yet here I am, with my handy dandy notebook, notes, highlighter and ballpen - STUDYING for my exams on the day our vacation ends.


It's not uncommon I guess for medical students to miss out on important events, be late on occasions or having no idea at all of happenings all around them. With the constant wave of exams and lectures, with the unending reports and case studies, it's easy to say that medical students cannot afford to care for anything else than studies. It may be depressing to think about it but it's the reality of being and wanting to be a doctor. In fact, it can safely be concluded that it would be terribly worse during internships, residency or even after practicing as consultants. 

The Art of Expectations in the Emergency Room

This article caught my attention as an intern once relayed to me his experience in the Emergency Room wherein the patient, after all that had been done for them, complained and maligned the interns and the staff of the ER. As unfair as it may seem, the disconnect between patient's expectations against hospital protocol may well be the very reason of this incidences. Or I may be wrong... nevertheless, this article is worth reading...


The Art of (Emergency) Medicine

Jeffrey Wonoprabowo, Medical Student

I had seen the patient. I had come up with my assessment and plan. I discussed it with a senior resident and now it was time to present it to the attending. As I wrapped up what I thought was a fairly decent patient presentation, my attending asked me what the patient wanted. I stammered. What the patient wanted? Wasn’t that obvious? They come in to the Emergency Department with a chief complaint and we’re supposed to fix it. Right?

Pre-Clerkship Exposure Duty Rotations

PhotoCredit: MedObserver.Com

          Our exposure duty this year had been extended to 6 months instead of the usual 3 months as a result, I presume, of the first ever student consultation spearheaded by our first alumni dean of the college. The purpose of which is suppose to orient us and make us be prepared for our upcoming internship duties in a few months to come.
          One thing I learned about these duties are they are basically WORTHLESS. Basically we don't do anything and instead we answer to the whims of the residents on duty. We do whatever they say in the absence of real work that may prepare us for the grueling work we will do as interns. It's good for those like me who had hospital experiences during our pre-medical course but for those who haven't, it's totally a purposeless.
          For the benefit of those who would otherwise learn from these experiences, I will try to give out some tips to make it a rewarding and a learning one:

Recovering from a Bad Evaluation

Question

I received negative feedback from my most recent rotation, and I'm trying not to freak out. What should I do?

Response from Alisa R. Gutman, MD, PhD Psychiatry Resident, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania

It's no secret that medical students are used to doing things right, so there are few things as difficult as being told that you've done something wrong. Even worse is getting serious negative feedback in writing. Here are some tips for learning from a negative evaluation without letting it rewrite how you see yourself.

Schizophrenia

PhotoCredit: Mindblog.dericbownds.net

Important Terms

• Schizophrenia
• psychotic mental disorder characterized by profound disturbances in thinking, feeling and behaviour
• one of the most studied, but remains one of the least understood of all the psychopathological disorders
• diagnosis is based on the presence of a set of signs and symptoms
• if patient is diagnosed with schizophrenia and is symptomatic then he is in a psychotic state; if there are no delusions/halllucinations then he is in remission.

Practice Tests: Cytology 2

1. Cells that predominate dense regular connective tissue

• Macrophages
• Fibroblast
• Mast Cell
• Trophoblast

2. During calcification of cartilage, Calcium is deposited in the

• Perichondrium
• Lacuna
• Matrix
• Chindrocyte cytoplasm

3. Which is the most important factor for stimulation of erythropoiesis by bone marrow

• tissue hypoxia
• Acute Blood loss
• Low supply of iron
• Low oxygen tension in alveolar spaces

JULY 2011 NURSING LICENSURE EXAM RESULT

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Practice Tests: Cytology

1. Period of human development after fertilization from the 2nd to 8th week inclusive

• a. period of zygote 
• b. period of embryo 
• c. period of fetus 
• d. none of the above 

2. When does the haploid # of chromosomes restored to 46 chromosomes

• a. blastomere 
• b. morula 
• c. zygote 

3. The fixation of fate in the embryo and the assignment of irrevocable structures of diff. forms for the future is

• a. differentiation 
• b. regulation 
• c. determination 
• d. destiny 

A Bloody Mess: How Bloodstain Pattern Analysis Works

Time to have a dose of Forensics Medicine. I still get a hangover of Dr. Raquel Fortun's talk about Forensics in the Philippines during the last Medical Student's Conference in UP Manila or rather the lack of it. I hope you enoy this post as I have mine.


Created by: Forensic Nursing

Dumbest Midnight Calls

Emergencies can arise at any time; this is exactly why there are doctors on call through the night. However, many inconsequential, obvious, and downright bizarre telephone calls can come in the small hours. In a recent discussion on Medscape's Physician Connect (MPC), an all-physician discussion group, doctors discussed some of the weirdest and most memorable of these consultations.

Pediatricians bear the heaviest burden when it comes to fielding what some of them have termed "sleep-wakers." Parental concern, of course, is laudable: A parent with an obvious question during daytime hours might be considered thorough, but a father calling at 3 AM asking whether his 5-month-old son's breasts are too large is something else entirely. The pediatrician who handled that worried father commented, "I had to put the phone on mute while I collected myself. I've never laughed so hard at 3 AM. It took me forever to convince this 'manly man' father that gynecomastia is normal in male newborns."

Weathering the Storm

It was July 1—my first day of fellowship. I was assigned to the cardiac ICU at Hopkins Bayview, the same unit where I had taken my first call as an intern and where I had run my first code.

Moments after receiving sign-out, an overhead page sounded, "CICU fellow, pick up line seven-five."

It took me a moment to realize that the call was for me. I picked up the phone.

"I'm calling from the emergency department. You need to get down here, stat. We have a patient in VT storm."

"VT storm?" I asked, with a squeezing sensation in my stomach. "Are you sure?"

New Physician Jobs Feature Hospital Employment

Primary care physicians remain in high demand, although the majority of job openings are for hospital employees, not in private practice, according to a new survey by Irving, Texas–based national physician search firm Merritt Hawkins.

For the sixth consecutive year, family practice and general internal medicine were the top 2 most-requested physician search assignments. They were followed by hospitalists, psychiatrists, orthopaedic surgeons, emergency medicine physicians, obstetrician/gynecologists, neurologists, general surgeons, and pediatricians.

Reimbursement cuts and declines in elective procedures have reduced the volume of search assignments for radiologists, cardiologists, and anesthesiologists. Those specialists, which were among the most requested searches 4 to 5 years ago, are now ranked 17th, 18th, and 19th.

Could Facebook Get Me in Trouble?

Question:

Like many of my friends, I enjoy using Facebook, Twitter, and YouTube. How can I keep my online presence professional and in accord with patient privacy rules?

Response from Megan L. Fix, MD Associate Residency Director, Emergency Medicine, University of Utah, Salt Lake City

Facebook, Twitter, and other social networking Websites are fun, and your online identity can be informative to future employers, patients, or colleagues. But involvement in social media can also get you into trouble if you aren't careful. Here are some suggestions for safeguarding hospital and patient privacy and your perceived professionalism online, both as a student applying for residency and as a medical professional.

Catching the ID Bug

In medical school, I was planning to pursue primary care when I landed in an infectious diseases (ID) rotation at the Veterans Affairs hospital in Portland, Oregon. The cardiology rotation I wanted was full, and looking at the elective list I thought, "What the hell, I'll try ID." All too often in my life, serendipity has led to life-changing circumstances. (Sometime I will tell you the story of how I met my wife.)

As a medical student I was amazed by the pathology in ID. A patient with mitral valve endocarditis caused by Staphylococcus aureus required acute valve replacement. A person with Pseudomonas meningitis from urosepsis died. I remember, like it was yesterday, the thin green slime of bacteria and pus covering the patient's brain at autopsy.

As a student, I was also impressed with my attending's breadth and depth of medical knowledge. Unlike my other attendings, who often seemed slightly bored and were going through the motions, the ID doctors were fascinated with medicine. ID doctors, then and now, get excited about a great case. I was hooked. As an intern I did an ID rotation and my addiction was confirmed. ID was the life for me, and I have never looked back. Including my fellowship, I have been an ID physician for 24 years.

To Cry or Not to Cry

Considering the tragedies that occur daily in the hospital, there are plenty of reasons to stop and cry, but should you? After talking with colleagues about this and being in many difficult conversations, the simplest answer is that if crying fits for you and for the situation, it can be positive in its ability to strengthen existing bonds. If tearing up in public is not your thing, don't go there.

As a palliative medicine physician, I encounter many sad, difficult, and trying situations that test my emotional stamina daily. In fact for some physicians, it may be that visceral connection to another human that attracts us to medicine. I was surprised in residency when I first discovered that ''breaking bad news'' and ''compassionate honesty'' led to praise and gratitude from patients and families who would cry, be angry, and eventually come to a certain peaceful but sad acceptance of dying. Using my medical knowledge to guide patients and families through this was personally rewarding and occasionally emotionally difficult, but I never cried in these meetings. But then, I also am firmly planted in the second half of the answer above: I don't cry in public.

Is Ob/Gyne for you?

"Ob/gyn is great because it's some medicine and some surgery," many students say when they choose the field of obstetrics/gynecology. Certainly, this specialty is more than just medicine and surgery, and it is uniquely different from either one, but the statement is fairly accurate. Ob/gyn has a significant surgical component. The rate of cesarean sections for many ob/gyn practices is 30%, and this translates to a reasonable volume of laparotomies. Vaginal deliveries in many instances require cutting, control of blood loss, and tissue reapproximation. If you enjoy surgery and like putting your skills to the test, the obstetrics aspect alone should keep you mostly satisfied.

In addition, there are "operative deliveries," many of which include the use of forceps. Although fewer forceps deliveries are performed as the years go by, forceps are good tools to have when the need arises. In many cases, their use has been supplanted by either the vacuum device or good old-fashioned patience. Of course, there are also the more pure surgical procedures performed by ob/gyn specialists, including myomectomies, hysterectomies, and laparoscopies.

What about the medicine portion of obstetrics and gynecology? Treating classic medical problems such as hypertension and diabetes is a small but important part of obstetric practice. Although most general ob/gyns do not treat nonpregnant women for basic medical conditions, such specialists have become uniquely qualified to treat other types of significant medical issues. Contraception, for instance, can for some patients become a very challenging medical treatment process, and the treatment of menopausal symptoms is routinely an even more difficult endeavor.

Teen Self-Embedding Behavior: A New Challenge for Primary Care Providers

May 10, 2011 — Self-embedding behavior (SEB) in adolescents is a type of severe self-injury presenting a new primary care challenge, according to the results of a retrospective study reported online May 9 and in the June print issue of Pediatrics.

"[SEB] is an extreme form of self-injury involving the insertion of inanimate objects into the soft-tissues, either under the skin or into muscle," write Gregory H. Bennett, BS, from the Department of Radiology, Nationwide Children's Hospital, and the Ohio State University College of Medicine and Public Health in Columbus, and colleagues.

Metal staples are shown on the X-ray of a teenage girl. Courtesy RSNA.

"To date, no case series data on this behavior among adolescents has been described in the pediatric medical literature.... The goal of this study was to define [SEB], develop a clinical profile of adolescents who engage in SEB, and emphasize the importance of rapid, targeted, and effective identification and intervention."

Using a database assessing 600 patients who were percutaneously treated for soft-tissue foreign body removal, the investigators identified adolescents with foreign bodies self-embedded in the soft tissue and described their demographics, psychiatric diagnoses, and characteristics of SEB.

Increased Opportunities for International Medical Students

May 11, 2011 — As of April 15, 2011, only 12,200 H-1B petitions have been filed — a much lower number than in years past — indicating that H-1B visas should be available for international medical graduates (IMGs) through March 2012, creating increased opportunities in the United States. H-1B visas are a skilled worker's visa.

Employers "are not able to just offer H-1Bs willy-nilly," a US State Department official told Medscape Medical News. "They have to prove that the foreigner has certain skills that they cannot find in the normal employment pool."

A total of 85,000 H-1B visas are awarded per year to IMGs and other non-US citizens with professional-level credentials. H-1B visas enable IMGs to be employed in the United States for up to 6 years as trainees in their specific field. They are issued by the US Citizenship and Immigration Services, a branch of the US Department of Homeland Security.

Time is Right for Anesthesiology

I don't think there has ever been a better time to be an anesthesiologist. The role of the specialist is evolving, in part through the introduction of new technologies such as video laryngoscopes for airway management. The breadth of subspecialties, from critical care to pain medicine, has similarly mushroomed. As a result, research questions abound. Amazing advances, such as the imaging of nerve blocks and cardiac ultrasounds for noncardiac cases, have come about in the past few years and new developments are on the horizon. And, of course, guiding patients who are fearful about an invasive procedure and taking them safely from induction to recovery is an enormous honor and privilege.

Finding the right specialty will in many ways determine the quality of your life, both at home and in the workplace. Fortunately, within the same specialty -- anesthesiology included -- there are myriad types of roles, including teachers, researchers, quality managers, administrators, and mentors. There are also many different practice settings. That gives you limitless choices and opportunities within a particular field.

Keep in mind that your choice of specialty will be affected by chance events: the resident or attending who mentors you during your rotations; the location of your clerkship, whether it is an inpatient or outpatient experience; the patient population; even the condition of the physical plant where you are trained. For better or worse, these different experiences can transform your desire to enter a particular specialty. It may not be possible, in such a short time span, for you to get an accurate glimpse into all available specialties.

Preparing for Residency

Question

My internship is coming up soon and I'm nervous. What can I expect?

Response from Geoffrey A. Talmon, MD Assistant Professor, Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska

Medical students spend 4 years waiting for the magic of graduation day. My own graduation ceremony made me feel like a transformation had occurred in me and my colleagues. We put on our robes, wore costume-like hoods, and heard a lot of Latin words. Soon after, my parents and nonmedical friends started calling me "doctor" and asked medical questions with more frequency. I remember feeling a twinge of excitement when I started signing checks with an "MD" after my name. Throughout all of it, though, I was terrified for July 1, the start of my internship. Nothing particularly magical -- no epiphanies of knowledge or confidence -- had occurred when I received my diploma, and I had heard plenty of stories about "intern mistakes."

10 Unwritten Rules About Surviving the Third Year

We took the boards after second year and celebrated our achievements. Overnight, we became third-year medical students. The beginning of a new world awaited us as we wore our white coats and strode through the doors of the hospital. Excitement, mixed with a sense of uncertainty, lingered in our minds. We were unfamiliar with the hospital environment.

There are many reasons to celebrate being a third-year medical student. Medicine becomes more practical and hands-on; there are no more endless lectures packed with information. You get to "play doctor" and meet the patients you read about in the books. You apply what you've studied -- or at least see it applied practically to real patients. You experience different aspects of medicine that will help you decide what you want to do for the rest of your life.

Unfortunately, there are also reasons to feel anxious about third year. You will miss having a flexible schedule. As a second-year medical student, your attendance was not mandatory, and you had the luxury of listening and relistening to lectures in the convenience of your own home. In third year, however, rotations are more like work: You never want to be late. If you are on surgery rotation, you have no option but to be there at 6 AM or earlier for the entire rotation. And because you're not in a classroom you no longer have a structured schedule. In addition, you and your classmates will get different experiences and learn different things. You will be tired after rotations and you won't feel like studying at the end of the day. Many third-year students will tell you it is vacation time. Should you believe them? No!

Bacterial Pharyngitis

Background

Pharyngitis, or sore throat, is often caused by infection. Common respiratory viruses account for the vast majority of cases, and these are usually self-limited. Bacteria are also important etiologic agents, and, when identified properly, may be treated with antibacterials, resulting in decreased local symptoms and prevention of serious sequelae.

The most common and important bacterial cause of pharyngitis is Streptococcus pyogenes. When suspected, bacterial pharyngitis can be confirmed with routine diagnostic tests and treated with various antibiotics. If left untreated, S pyogenes pharyngitis may lead to local and distant complications. To a lesser extent, bacteria other than S pyogenes are known to cause pharyngitis, and these are discussed in Causes.

2010 AHA Guidelines: The ABCs of CPR Rearranged to "CAB"

October 20, 2010 — Chest compressions should be the first step in addressing cardiac arrest. Therefore, the American Heart Association (AHA) now recommends that the A-B-Cs (Airway-Breathing-Compressions) of cardiopulmonary resuscitation (CPR) be changed to C-A-B (Compressions-Airway-Breathing).

The changes were documented in the 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, published in the November 2 supplemental issue of Circulation: Journal of the American Heart Association, and represent an update to previous guidelines issued in 2005.

"The 2010 AHA Guidelines for CPR and ECC [Emergency Cardiovascular Care] are based on the most current and comprehensive review of resuscitation literature ever published," note the authors in the executive summary. The new research includes information from "356 resuscitation experts from 29 countries who reviewed, analyzed, evaluated, debated, and discussed research and hypotheses through in-person meetings, teleconferences, and online sessions ('webinars') during the 36-month period before the 2010 Consensus Conference."

Mood Food? Depressed People Eat More Chocolate

PhotoCredit: themoneytimes.com

May 3, 2010 — A new cross-sectional study suggests individuals with depressive symptoms eat more chocolate, but it does not explain why.

"There is a lot of lore about chocolate and depression and precious little in the way of scientific evidence, which is what motivated us to do this study," Beatrice A. Golomb, MD, PhD, of the Department of Family and Preventive Medicine, University of California, San Diego, told Medscape Psychiatry.

The study, published in the April 26 issue of the Archives of Internal Medicine, included 931 adults not using antidepressants. The mean age of study subjects was 57.6 years and mean body mass index was 27.8 kg/m² or less; 70.1% were male, 80.4% were white, and 58.8% were college educated. Subjects provided information on chocolate consumption (frequency and amount) and completed the Center for Epidemiological Studies-Depression (CES-D) scale.

How Bizarre

Kendra Campbell, MD, Psychiatry/Mental Health, 08:05PM Dec 22, 2010

One of the more intriguing concepts in psychiatry is that of “bizarre delusions.” Delusions are fixed, false belief, and psychiatrists are taught to categorize these delusions as being either bizarre, or non-bizarre, as this can help with diagnosis.

Bizarre delusion is one that is simply 100% impossible. An example of a non-bizarre delusion would be that one is pregnant with President Obama’s child. This is certainly not likely, but it’s not 100% impossible, either. A bizarre delusion would be that one is an alien from another planet and can shoot laser beams out of one’s eyes. Perhaps this is still only 99% impossible. And therein lies the problem with defining a bizarre delusion.

It's All in the Family (History)

When talking with salespersons, you expect each one to push his or her own product. Sometimes it's just hype. But often the opinions seem to reflect a sincere belief in the value of a product or service.

So it's reasonable that geneticists would extol genomic testing as the best way to understand personal health risks and susceptibilities, right? Odd as it may seem, many genetics experts are convinced that, given our current understanding, family health history, not genetic testing, provides the best insight into personal disease risk and possibly even disease prevention.

Pathology Practice Test

1. The cardinal feature of atypical pneumonia secondary to Legionella pneumophila is:

A. clinical presentation incompatible with chest X-ray
B. rust colored sputum
C. stepwise fever pattern
D. hyponatremia
E. bloody diarrhea


2. A 4yo/m develops an infection with Chlamydia trachomatis. How does infection with this organism cause blindness?


A. Cataract formation
B. Hemorrhage into the anterior chamber
C. Hemorrahge into the posterior chamber
D. Retinal detachment
E. Scarring of the cornea

3. Paroxysmal pattern of hacking coughs, accompanied by production of copious amounts of mucus, that end with an inspiratory gasp is the characteristic clinical manifestationof infection with which of the following organism?

A. Haemophilus influenzae
B. Staphylococcus aureus
C. Parainfluenza virus type I
D. Bordetella pertussis
E. Corynebacterium diphtheriae

Self-Starter on Clerkships

Question

Halfway through my third year, I realized that my biggest weakness is that I'm not enough of a self-starter. I am somewhat anxious and shy, and if I'm not asked to do something, I tend to stand around watching. How can I get over my shyness and take initiative without getting in the way or being really obnoxious?

Response from Alisa R. Gutman, MD, PhD Psychiatry Resident, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania

You’ve hit on a common concern for rotating medical students: how to be active and interested without coming off as annoying. Being naturally shy can make it even more challenging to take the initiative.

First, your team knows that medical students have different dispositions. You're not expected to be bubbly if you're reserved or outgoing if you have social anxiety. But one lesson you should learn during your inpatient months is that your home personality should not necessarily match your work personality. Being a professional means knowing how to leave your personal life at home. Likewise, shyness has no place in the hospital as it pertains to interacting with your residents and attendings. To your team, shyness can look like disinterest or even boredom.

2010 New Cardiopulmonary Resuscitation Guidelines

New Food Allergy Guidelines

Dr. Fenton: Hello. My name is Dr. Matthew Fenton. I'm Chief of the Asthma, Allergy, and Inflammation Branch at NIAID. I led the Institute's effort to create clinical guidelines for the diagnosis and management of food allergy.

Here with me today is my colleague Dr. Hugh Sampson, Professor of Pediatrics and Dean for Translational Biomedical Sciences at the Mount Sinai School of Medicine in New York City where he serves as the Director of the Jaffe Food Allergy Institute. Dr. Sampson is past president of AAAAI. Dr. Sampson made the food allergy guidelines one of his presidential initiatives, and he chaired an expert panel writing group and served on the guidelines coordinating committee.

The food allergy guidelines were released in December 2010; with their release how should they now guide clinical practice? That's the topic we're going to discuss today for Medscape Allergy & Clinical Immunology.

Although the exact prevalence of food allergy in the United States is not known, it's estimated that 10-12 million Americans are affected. A number of different diseases with similar symptoms are shared with food allergy, so there is a real potential for overdiagnosis of food allergy. Current increases in the prevalence of food allergy match the increases in prevalence that we see with other allergic diseases such as asthma. Hugh?

Tonsillectomy in Children

Medscape: One of the most relevant recommendations in the guideline for primary care providers is the first statement, which recommends watchful waiting for recurrent throat infections if there have been fewer than 7 episodes in the previous 12 months or fewer than 5 episodes per year in the previous 2 years or fewer than 3 episodes per year in the past 3 years. So bottom line, children should be observed for at least 1 year before a referral to a surgeon to consider tonsillectomy. Is this number of episodes irrespective of the severity of the episodes? Is the intent that these episodes will have all been of sufficient intensity to warrant a visit to a healthcare provider?

Dr. Wald: To put this in perspective, and this is stated clearly in the document, the purpose of the guideline is to avoid unnecessary intervention in children who have recurrent throat infection who are very likely to have a favorable natural history and improve on their own and therefore will be benefited by avoiding surgery. There may be exceptions occasionally on the basis of either very severe or very complicated infections. But in general, I think this is a good outline and the idea is that, yes, these episodes would have been seen by a clinician and the infection would be adequately documented. A lot of this work dates back to a study that was done by Jack Paradise in the late 1970s.^[2] His research used very stringent criteria that described what were termed "counting episodes." A child was considered to have had a counting episode that contributed to the number of episodes if they had, in addition to their sore throat, at least 1 of the following 4 criteria:

• A fever > 38.3° Celsius;
• Cervical adenopathy, which was defined as a lymph node in the neck that measured > 1 cm and was tender;
• Tonsillar exudates; or
• A positive test for group A streptococci.

"Worst Drug in History"

February 2, 2011 — An estimated 10 million patients have used the pain reliever propoxyphene and were sent scrambling to doctors' offices when it was recently pulled from the market. Many physicians are still dealing with the aftermath of the product, first approved by the US Food and Drug Administration (FDA) in 1957.

"Propoxyphene is the worst drug in history," Ulf Jonasson, doctor of public health, from the Nordic School in Gothenburg, Sweden, told Medscape Medical News. The researcher played a role in the decision to stop the pain reliever in the United Kingdom, Sweden, and later in the entire European Union.

"No single drug has ever caused so many deaths," Dr. Jonasson said.

Clinicians are now prescribing analgesic alternatives to propoxyphene.

Propoxyphene was banned in the United Kingdom 5 years ago because of its risk for suicide. It was taken off the market in Europe in 2009 over concerns about fatal overdoses and now in the United States for arrhythmias.

"I agree that propoxyphene is among the worst drugs in history," Eduardo Fraifeld, MD, president of the American Academy of Pain Medicine, said in an interview. "I'm surprised it stayed on the market so long. It's addictive, in my experience not very effective, and toxic."

Surviving Medical School

PhotoCredit: drsharma.ca 

Remember when you were a premedical student in college? It seems like a century ago for many of us who have just completed the first year of medical school. It feels that way because our lives have changed dramatically. Normal life seems to have vanished, and suddenly, 24 hours in a day are not enough to get through the enormous volumes of information that we are expected to learn for every exam. It seems virtually impossible. We barely have time to eat or sleep.

Medical school is not the end of the world. Take it from us, 2 students who have been there, when we say that medical school is what you make of it. Do not let medicine define you; instead, you should tailor medicine to your lifestyle. Otherwise, you might become overwhelmed by the demands of your new life and lose the sense of why you chose medicine in the first place.

Studying Tips

"I hate studying," admits Carl Streed Jr., a student at Johns Hopkins University School of Medicine in Baltimore, Maryland. "I don't know how to do it well," he continues. "And apparently it's required in medical school."

Streed lamented his difficulties with studying on The Differential, a popular Medscape blog for medical students. He asked other students how they master the large volume of material that begins to accumulate on the first day of medical school, and he invited them to share their thoughts on the discussion board. Over 220 readers responded.


Many students offered their own secrets to studying. Of course, studying efficiently is partly a matter of getting motivated, as many hinted. There is no single best technique to study: rather, the method you choose will depend on what sort of learner you are, what type of material is presented in class, and how interested you are in the topic. The main challenge is to figure out what works best for you.

That said, you may find some of their specific advice very helpful:

Job Satisfaction in Geriatrics

I am often asked by my patients, medical students, residents, and even my colleagues, "Why did you choose to go into geriatrics?" The answer is not simple. Much like the patients I care for, my reasons for practicing geriatrics are complex and nuanced. They have a great deal to do with my underlying values as a physician. That said, I will do my best to describe why I chose Geriatrics and why medical trainees should consider it as a career path.

The oldest of the US "baby boomers" generation turned 65 on January 1, 2010. Every day for the next 19 years thereafter, another 10,000 baby boomers will turn 65. To put this in perspective, this is the equivalent of a Boeing 747 airplane full of baby boomers turning 65 every hour. By 2030, the country's population of "senior boomers" will double to an estimated 71 million individuals.

Making Most of Surgery Rotations

Question

When rotating on a busy surgical service, how can I be helpful and show that I am interested without getting in the way?

Response from Sarah N. Bernstein, MD Resident, Department of Obstetrics and Gynecology, St. Luke's-Roosevelt Hospital, New York, NY

In the surgical subspecialties, physicians are usually busy from dawn until dusk, and you may find it difficult to find your place and understand the expectations of the rotation. Just remember that your primary goal is to learn and get as much exposure to the subject as possible. If it is not an area of interest, remember that this may be the only time in your career when you observe particular aspects of this area of medicine. Therefore, you should still try to see as much as possible. If you plan to pursue surgery as your specialty, this is your time to learn the basics and show your enthusiasm. I'm sure each teaching hospital is a little different, but here are some general pointers:

Scheduling Your 3rd Year Clerkship

Question

In what order should I schedule my rotations? What are the best strategies?

Response from Megan L. Fix, MD Assistant Professor, Tufts University School of Medicine; Director, Medical Student Education, Maine Medical Center, Portland, Maine

Your third year of medical school can be exciting and also daunting. Many students ask what the "best" schedule is for their third-year clerkships. Although there is no right answer, there are a few guidelines that can be helpful.

The Forsaken Specialty

PhotoCredit: guardian.co.uk

Abstract and Introduction
Introduction

As a medical student I found that most other students thought that psychiatry was not a true profession—the consultants sit and sip tea, talk nonsense, and nobody ever seems to gets better. No blood test confirms what is wrong. No imaging shows the diagnosis. Simply put, ward rounds that consist of sitting in a room and chatting just didn't seem like "real medicine" to most of my peers. Psychiatric patients were people to be mocked, feared ("you were left alone with them?"), or ignored. Revision for objective structured clinical exams and written papers was left to the last minute because it was "only psych."

I don't know why I thought this would be different when I qualified. Perhaps the "doctor" title would equate to being surrounded by those who understand, appreciate, and respect psychiatry? Goes to show that a label does not define how you act.

How Can I Get Enough Sleep During Med School?

Question:

Sometimes I can't sleep, and other times I'm afraid to sleep because of the amount of work that I have to do. How do I fit in quality sleep during medical school?

Response from Graham Walker, MD Resident, Emergency Medicine, St. Luke's-Roosevelt Hospital Center, New York, NY

Sleeping well -- or at least enough -- is a challenge for medical students and even for physicians long after they've finished a grueling residency. If it's not the long hours, it's a late call in the middle of the night or the tossing and turning while you worry about a patient you saw on the previous day. At the same time, not sleeping well sets you up for a rotten next day filled with brain fog and the mistitration of caffeine. One of the most frustrating things is knowing that you need to sleep but feeling wide awake. What are we to do?