Choosing a Specialty

My favorite part of my job is teaching. There, I’ve said it. Yeah, it’s cool picking apart diseases and mix-n-matching treatment regimens for the optimal balance of cure and side effect. I love hand-holding people through concepts that are far beyond their educational level and helping patients and families make impossible decisions with uncertain data.

But give me a new third-year medical student who’s been dropped in the middle of the hospital for her First Real Rotation Ever, and I am just in heaven. I love teaching med students.

One of the things I love the most is helping them figure out what flavor of doctor they want to be. Third year is all about sampling it all, and experiencing what actually happens in the various medical specialties. You rotate through Surgery. You rotate through Internal Medicine. You rotate through Family Practice. You rotate through Anaesthesia. You rotate through Psychiatry. In fourth year, you’re supposed to be narrowing it down to your most likely options for residency.

Tips on Excelling on Rotations

I know that my performance on clinical rotations is important for how I will be assessed. How can I distinguish myself?

Response from Sheila M. Bigelow, DO Resident Physician -- Pediatrics, UH Rainbow Babies and Children's Hospital, Cleveland, Ohio

Clinical rotations can be very challenging. For the first time, you're expected to follow patients, present on rounds, show your medical knowledge, and work well in a team environment with people who are new to you, knowing that you'll be moving on before long. Not only are you expected to meet the basic requirements, you are expected to do well enough to earn an honors grade or a strong letter of recommendation from the attending.

Fortunately, there are some "must know" tricks that can help you distinguish yourself and help get the grade or letter that you want.

Thinking of Quitting

Question:

Medical school and residency can be tough physically, mentally, and socially. What's the best way to get through those tough times when all I want to do is quit?

Response from Sheila M. Bigelow, DO
Resident Physician - Pediatrics, UH Rainbow Babies and Children's Hospital, Cleveland, Ohio




Depression in Medical Students

Medical school and residency are some of the biggest challenges of our careers. Along with the good, exciting times come the hard, rough times. Long hours, little sleep, and a high-stress environment all create the perfect storm. These feelings can fall anywhere in the spectrum from burnout and depression to suicidal thoughts and suicide attempts.

Deep Tendon Reflex

In a normal person, when a muscle tendon is tapped briskly, the muscle immediately contracts due to a two-neuron reflex arc involving the spinal or brainstem segment that innervates the muscle. The afferent neuron whose cell body lies in a dorsal root ganglion innervates the muscle or Golgi tendon organ associated with the muscles; the efferent neuron is an alpha motoneuron in the anterior horn of the cord. The cerebral cortex and a number of brainstem nuclei exert influence over the sensory input of the muscle spindles by means of the gamma motoneurons that are located in the anterior horn; these neurons supply a set of muscle fibers that control the length of the muscle spindle itself.

Hyporeflexia is an absent or diminished response to tapping. It usually indicates a disease that involves one or more of the components of the two-neuron reflex arc itself.

Hyperreflexia refers to hyperactive or repeating (clonic) reflexes. These usually indicate an interruption of corticospinal and other descending pathways that influence the reflex arc due to a suprasegmental lesion, that is, a lesion above the level of the spinal reflex pathways.