Saturday, September 30, 2006

FAQ #11: Do CCLCM Students Play Sports?

Yes, definitely. It's not always easy to find time to work out, but you can do it with some planning. If you're into sports, you will have no problem finding things to do here. I would guess that about half of my classmates and I use the Walker gym at CCF on a regular basis. (I generally go three times a week.) It's free for students to belong, and there is a weight room, a swimming pool, a cardio room, a basketball court, a small indoor track, and locker rooms with showers. You can rent a locker for $50 a year, and it's worth it for the convenience of being able to leave your stuff there. It's almost never very busy in there, except right around 5 PM when the CCF staff get off from work. One other thing that I like about Walker is that they give you free towels to use while you work out or shower, too.

We are technically Case students, so we can also use their Veale gym for free. Veale is a lot bigger than Walker, but it's also a lot more crowded during the week because the Case undergrads can use it too. I usually only go there on weekends. Veale has all kinds of extra stuff, including racquetball courts, a large and really nice indoor track, two indoor swimming pools, a nice power lifting room, and just overall more equipment than Walker has. There are also outdoor fields where people play soccer and football. There is a second gym at Case called One-2-One, and it is probably the nicest gym of all, but you have to pay to go there. I don't think any of my classmates do it, although I know that some of the CCLCM upperclassmen have gotten group memberships there in the past.

Some of my classmates are planning to join an intramural soccer league. I know there is another group of them that regularly goes golfing too. There is a Case student running club, and also a CCLCM running club. And it seems like even the people who don't like working out themselves still like watching sports if nothing else.

Saturday, September 23, 2006

FAQ #10: How Safe Is the CCF Campus?

I've posted about this before, because we had a brief presentation by a CCF policeman during our orientation week back in July. But it's a good topic to talk more about, so I'm glad you brought it up.

First of all, you need to be aware that CCF (and Case also) are in Cleveland, which is a large city. (The city itself has about 500,000 people, and there are over 2 million people living in the metro area.) Thus, both campuses are smack dab in the middle of an urban environment. There are pros and cons to this. If you are looking for a bucolic small town, you aren't going to find it here at CCF. Also, some of the neighborhoods around the CCF and Case campuses are kind of rough. On the other hand, you have a lot of resources available to you in a large city that you probably wouldn't have in a small town, and the CCF campus itself is actually one of the safest places in the entire city. This is at least in part because CCF has its own police force. The CCF police force is quite large, with about 200 officers and guards just for CCF alone, and they patrol the campus heavily.

Case, which is located in University Circle, does not have its own police force. The campus is patrolled by the University Circle Police and the Cleveland Police. Since Case is a university, they publish yearly crime statistics reports. Click here to read the 2005 Case crime statistics report.

My opinion on this issue is that you must always use common sense and be aware of your surroundings. During the day it is safe to walk around both campuses as well as back and forth between them, but I advise against walking between the campuses after dark. Even if you're walking around on one of the campuses after dark, it's always best if you can avoid walking places by yourself. Both Case and CCF will provide police escorts for students who are on campus at night. Also, if you are going to drive to campus (and most of us do), you should spring for the parking pass. There are some streets right on the edge of campus where you could park for free, but again, you don't want to be walking by yourself to your car out there at night on a dark, isolated street that is not patrolled. Finally, you should always give some thought to the kind of message you are sending to other people by what you wear and do. Everyone knows not to flash jewelry and money in public. But I see all kinds of people walking down Euclid and Carnegie talking on their cell phones or listening to headphones, completely oblivious to what is going on around them. If you're distracted like that, you aren't paying attention to what's going on around you, and that is the kind of thing that can get you into trouble.

Friday, September 22, 2006

Clinical Block Orientation-Day 2

We still had to be here this morning at 7:30, but today's orientation was over at noon, happily. We started with a brief lecture about problem-based learning (PBL) at 8:00, and then we broke up into our PBL groups to work on a practice case for a couple of hours. The case was too easy (we figured out right away that the child had cystic fibrosis), but it was still helpful to go through the process as a sort of trial run so that we'd know what we were supposed to do when we start this for real. If you recall, last July was a very confusing and hectic time for my PSS group because we were just so lost, and it took us a few sessions to figure out how to work the kinks out. So hopefully this time things will go more smoothly. At the end of the practice session, we got back together as a class for a "debriefing," and then we were done for the week!

The PBL groups have eight students in them just like our summer PSS groups did. Most of the people in my group are different than the ones I worked with over the summer, but there is one person who I was with before and am still with now. Even though I still feel kind of sad that our PSS group got broken up, I think it will be good to have a chance to work with some new people and get to know some of my other classmates better.

Next week is our break week, as I've said, and I'm going out of town. So there will be fewer posts for a while until I get back for the next block on Oct. 2.

Thursday, September 21, 2006

Clinical Block Orientation-Day 1

We had a whole day of orientation today to prepare us for our first clinical block, which is cardiovascular/pulmonary/renal. It was kind of painful for us--we've really gotten accustomed to not sitting there listening to someone lecture for hours and hours. But today we got a real earful. We started out at 7:30 AM in the library, and happily they had bagels and fruit for us. At 8:00, Dr. Drake, the anatomy professor, came to take us to the anatomy lab, where he explained how the class would work. Afterward, we went back to the library, and Dr. Prayson, the histology/pathology prof, worked with us on those slides I was looking at a couple of days ago for about an hour and a half. The class was divided into teams, and he asked each team questions about the slides. My team actually won somehow, and our prize was tic-tacs.

After that, the cardiologists and pulmonologists who are running this block came to tell us about our schedule, and Dr. Hull (one of the CCLCM education directors) came to tell us about the homework questions we have to complete each week. They're called SAQs and CAPPs, and I'll tell you more about them after I've actually done some. Our final speaker for the morning was Dr. Moravec, who runs the process of discovery (POD) series. This is a seminar series where we have a member of the faculty come to speak to us each week about their research. It is supposed to tie in to whatever we're studying at the time, so we're going to be hearing from some cardio people at the beginning. Dr. Moravec herself is a cardiology researcher, and she is our first speaker.

During lunch, the bookstore people came to sell us our equipment. We have to buy stethoscopes of course, and then some other things like eye cards and babinski hammers. We also have to have a tuning fork. I'm not quite sure yet what I'll be doing with a tuning fork, but I'm curious to find out. After that, we heard from the physicians who will be teaching us clinical skills, and they also told us about our longitudinal preceptors. We'll start going to the clinics during the second week of the block. The next speaker was Dr. Goldman, who is a pharmacist. He'll be teaching us pharmacology. I thought it was pretty cool that we have a pharmacist as a prof, and he was a really funny guy. The last thing we did was a workshop about portfolios, because in a few weeks we have to do our first formative portfolios so that we can discuss our progress with our PAs. They gave us a fake set of evals for a hypothetical student and asked us to practice determining his strengths and weaknesses in small groups, as well as to come up with plans to improve. All I can say is that it's a lot easier to do this for someone else versus for yourself!

We finally got out at 5:30, and I am just brain-dead. Tomorrow thankfully our orientation is only for half a day, and then we are off for break for a week.

Wednesday, September 20, 2006

Research Talks-Day 3

The last third of our class presented today, again on diverse topics including cell signaling, preconditioning organs to prevent damage due to hypoxia, and CT scanning. I still learned a lot and enjoyed the talks in general. But I have to confess that I'm glad my class is as small as it is, because I'm reaching a point of talk saturation! Overall though I thought that the talks went really well and everyone did a very good job. Some of my classmates said that they planned to continue working in their labs during the next block. That is kind of the downside of this whole summer lab rotation. It's not really long enough for you to do more than just get some preliminary results. I know that I could have used another couple of weeks for sure, and I think that most of us got the results we presented within the last week or two that we spend in the lab!

I also received an evaluation for my talk yesterday from one of the faculty who was present, and it was mostly positive. The evaluator thought that I should have been clearer about presenting a hypothesis. I definitely did have trouble doing that, mainly because I worked on several projects and kind of jumped around during the summer instead of just working on a single one. I think that next summer I will try to do just one project so that I can tell a more coherent story. (We have to do these research projects and presentations again next summer, only for a clinical lab instead of a basic science or translational lab.) That reminds me: I need to upload my slides to my porfolio also. I'd better do that now while I'm thinking about it.

Tuesday, September 19, 2006

Research Talks-Day 2

I gave my research talk today, and I think it went reasonably well. I did not go over time, so there's one tangible measurement of my improvement since my journal club talk. On the other hand, I don't think that I answered some of the audience's questions as well as I could have. My preceptor and some of my labmates came to see my talk, which was really nice of them.

In the afternoon, I worked on all of the evaluations we have to write for the end of the block. One is for the block in general; one is for my PSS tutor; and one is for my research preceptor. For the tutor and preceptor evals, we were asked to comment on the person's strengths and weaknesses. There were just basically those two boxes and a list of points we were asked to discuss, and that was the entire eval. The end of block eval covers every class we took during the entire summer block, and it had a ton of multiple choice questions asking about our experiences in each class we were taking, followed by some boxes where we could write in comments and suggestions.

After I finished those, I went through the histology slides that we were assigned to review for Thursday. We don't have an actual class-Thursday is just an orientation day. But I think the pathology prof just wants us to start familiarizing ourselves with the book and with the way the different cell types look. The assignment was open book, which helped because I had to look up what all the cell types were. After about an hour and a half of doing this, I have discovered that nearly all cells look alike. I mean, they all have a nucleus and some cytoplasm and a membrane. The only ones that are easy to distinguish are the adipocytes (fat cells) because they just look fatty, the skeletal muscle cells because of their sarcomeres, and the epithelial cells that have cilia on them. One of my classmates who already took path and histo said that eventually you can start to tell them apart after enough practice. I hope so!

Monday, September 18, 2006

Research Talks-Day 1

Today was the first day of my class's research talks. The M2s gave their talks last week, and they are on vacation now. Our vacation starts Friday afternoon.

The way the talks work is that each student gets about 10-12 minutes to present, and then there are 3-5 minutes for the audience to ask questions. The total time for each person to present is supposed to take fifteen minutes, including the time for questions. Ten people presented today, and now eleven will present tomorrow and the last eleven on Wednesday. It was surprisingly interesting to hear about the projects that my classmates were working on. People were doing some really neat things, and the projects are on all kinds of topics from Parkinson's disease to epilepsy to immunotherapy against cancer. I hadn't really appreciated the breadth of the research that is going on here at CCF as much as I am starting to do now.

My talk is tomorrow, so I spent some time today working on my slides and practicing presenting. I ended up with thirteen slides including the title and acknowledgments. That seems to be just the right number. It took me about eleven minutes to go through them, which is right where I want to be lengthwise. A couple of people went over time today, and the moderator was not very happy about that. When I did my journal club talk earlier this block, I went over time too. That was mentioned in my evals, so I need to be extra careful not to go over time again tomorrow.

Saturday, September 16, 2006

FAQ #9: I've Been Invited to Interview! Any Tips?

First of all, congrats! Word is that fewer people are getting invited this year versus last, so you should be very proud. I'm not sure what kind of info you're wanting specifically, but here are some thoughts about making the trip to Cleveland, as well as for the interview itself.

Traveling to Cleveland:
If you fly, you have a few options to get to campus from the airport. You can rent a car (I don't recommend this, because you'll pay an arm and a leg for parking), take a shuttle from the airport (I think it costs about $35 one way), or take the RTA train to University Circle and then a bus. Depending on how much stuff you have with you and how savvy you are about navigating public transportation in a new city, it might be worth your while to take the shuttle. That's what I did when I interviewed.

Where to Stay:
The cheapest option is to stay with a student. Our admissions office has a list of M1s and M2s who are willing to host interviewees. They probably sent it to you with your interview packet, but if not, you can get it from them. You will have to contact students from the list and ask them to host you. One thing to note if you're also interviewing for the UP: you should not expect your student host to necessarily let you stay with them for both nights. They might be nice and offer to do it, but you should only expect them to host you for one night. You might consider either staying with a UP student for the other night (not a bad idea anyway so that you can talk to them about their program) or staying at the Intercontinental Suites Hotel, which is right on campus. If you do stay at the hotel, make sure to tell them the code word "Lerner" when you make your reservation. Otherwise, you will get charged even more. Last year they charged us $79 per night. The hotel is within walking distance of the Lerner Institute, and they also have a free shuttle you can take if the weather is bad. Don't buy food at the hotel. There is a plaza with a drug store on campus a couple of blocks away from the hotel off 93rd Street and Euclid, plus some reasonably priced restaurants in there. If you like Mediterranean food, I highly recommend Cedarland.

What to Wear:
It's already starting to get cold in Cleveland, so I'd recommend that you be prepared for that. Check the Cleveland weather at before you leave. If you're a girl, you might want to wear slacks instead of a skirt. If you're a guy, a suit and tie is probably fine for now. CCF is a fairly conservative place since it's a hospital and not a medical school, so you should all definitely should wear a suit when you come to interview here. You will do a lot of walking because they give you a lab tour as well as a medical tour, so try to wear comfortable shoes. I think they tell you that in the interview packet.

How to Prepare:
As of 2008, there are now three interviews: two with faculty and the third with a student. One faculty interviewer will be a clinician, and the other will be a PhD or MD scientist. You will definitely get asked about your research experience, so be prepared to talk about it. Also, make sure to read your app over, because the faculty interviewers will have seen it. The student interviewer will not have read your app before interviewing you, but some of the student interviewers are adcomms and will read your app later. Don't forget to read the CCLCM website at so that you know the basics about our curriculum and you can discuss that with your interviewers too. Finally, I'd recommend that you read the CCLCM interview feedback on SDN at so that you can get an idea about other people's interview days. Some of them even post questions they got asked during the interview, so it's a great resource.

Good luck to everyone interviewing and waiting to hear, and I hope I will get to meet some of you when you come to Cleveland.

Friday, September 15, 2006

Last Day of Class and Under Siege by Midges

We had our last PSS today, and it covered free radicals and antioxidants. Two of the girls in my group baked cookies and a chocolate cake from scratch for all of us. It was a little early in the morning for such a huge sugar rush, but somehow we managed to rise to the occasion. We actually ate that entire cake. Afterward, we had our last journal club, and the articles also covered lipid oxidation and free radicals. I was on a bit of a sugar buzz, which definitely isn't the best condition to be in when you're sitting through people's presentations. The cake and cookies were awesome though. I told you I had a great PSS group!

In the afternoon, I went to the lab and finished my experiment. At first, I thought it hadn't worked. But after I let it sit for a while, I came back to discover that it had indeed worked. So I am happy to report that I actually have some results to show for my presentation next week. Everyone else in the lab had left by the time I finally figured out that things had worked, so I didn't even have anyone to tell. But I left a note for the staff scientist who has been helping me, and went home feeling a lot better about the whole experience.

When I got home, it was starting to get dark already. It rained all week including today, so that makes it get dark really early. Because we had so much rain, there were all these little flies around (which I later found out are called midges). I had noticed them earlier when I was outside, but I hadn't thought much about them besides being annoyed at having to walk through swarms of them. Well, what I hadn't thought about was that I had left my kitchen windows cracked open this morning, and I came home to find my kitchen absolutely FULL of these little flies. I slammed the windows shut so that no more would come in, but there were already plenty inside, and the windows were coated with even more that wanted to get in. At first I thought they were mosquitoes, but after I realized that they weren't coming after me, I figured out that weren't. They do look like mosquitoes though. Anyway, I wound up leaving my kitchen light on so that they'd stay in there and not go all over my apartment. It seems to be working. I'll have to figure out how to get rid of them all tomorrow.

Thursday, September 14, 2006

Lab Day-Proposal, Experiment, and End of Block Stuff

Yesterday I played hooky from the lab since I spent most of the afternoon in the anatomy lab tying knots. But today I had to get serious again, because my proposal is due tomorrow and tomorrow is also my last day in the lab. I'm pretty much done with the proposal, but I wanted to see if there were any further comments from the staff scientist in my lab before I turned it in. Those corrections were pretty minor, so I'm going to make them tomorrow afternoon and then submit the proposal. I have to email it to the research education office and also upload it to my portfolio. I've already uploaded the drafts I wrote so that I can use them as evidence for my research competency evaluation.

So far my experiment still seems to be going well. I picked up where I left off on Tuesday and I haven't run into any problems yet. It helps a lot that I'm paying more careful attention to what I'm doing!

Tomorrow is our last day of classes for this entire block. We have our normal Friday schedule of PSS and journal club. Next week we have our research presentations and our orientation to the clinical block that we're starting in October (cardiovascular system), and then that's it for the first block. I will officially be one fourth of the way through my first year of medical school as of next Friday.

Wednesday, September 13, 2006

Surgery Interest Group Meeting

This afternoon, the surgery interest group had a "suture lab" where we could learn how to tie knots and sew people up. Of course, we first years did not do any actual sewing! Instead, we spent our time practicing tying two-handed knots. One of the surgery residents showed us how to do it, and then he paired us each with another student to try it ourselves. It took some practice and concentration, but toward the end I was finally starting to get the hang of it. Not that I think I'm surgeon material by any stretch of the imagination! The student I was partnered with caught on very quickly and helped me until I caught on too. We started out tying knots in ropes, then we used actual sutures, and finally we used sutures while we were wearing gloves. It's a lot easier to tie knots in ropes because the knots are bigger, so you can actually see what you're doing. In contrast, the sutures are very fine, and the knots are so small that you can barely see them. Once you put the gloves on, it gets even harder because you can barely feel the sutures in your hands any more. I'm sure I'll forget how to tie these knots pretty quickly, but I'm hoping that the next time I will learn how to do them faster.

After practicing with my partner for about an hour, I went to see what the upperclassmen were doing. They had an actual cadaver that they were sewing up. I know I've mentioned before that the cadavers we use here at CCLCM are not preserved like they are at most med schools. So this guy was lying on the table, and he looked like he could just wake up at any moment, hop off the table, and walk out of the room. Of course, the weird thing was that half a dozen students were crowded around him sewing up gashes in his limbs and abdomen. And of course he didn't bleed. One thing that impressed me though was how bright and yellow his fat was. Apparently that is the real color.

We had PSS this morning, and today we covered the urea cycle. Nothing out of the ordinary to comment on as far as that's concerned, except that we totally skipped covering nucleotide metabolism and individual amino acid pathways. So I'm thinking that I'm going to need to read those sections of the book myself, because Friday's session doesn't cover them either, and that's the last PSS.

Tuesday, September 12, 2006

Case-Based Genetics Seminar

We had a really great seminar today. The speaker was the same medical geneticist who gave our seminar two weeks ago. But today what he did was to give us the clinical information from a real patient that he had, and he went through it all with us step by step to show us how he came up with the diagnosis. The family had two children who were mentally retarded and had seizures and all kinds of other problems. They had been to several other doctors, and no one could figure out what was wrong with their children. It turns out that this was a disease that had not previously been described in the literature, and it was a problem with serine synthesis. After the doctor figured that out, he tried giving the children serine, and that helped with their seizure symptoms. But unfortunately, it was too late to reverse the retardation for these children. However, the child of another family who also had this disease was treated while still in the uterus by having the mother take large doses of serine. That child was born seeming normal; he has to take serine every day for the rest of his life, but so far it seems to still be working.

The speaker said it took him a few years to figure out what the problem was. I thought it was really amazing. I asked him afterward how one becomes a medical geneticist (he's an MD, not a PhD), and he said that many people start out as pediatricians and then go into medical genetics. He actually started out as a pathologist. So here's yet another pull for me to go into pathology.

Monday, September 11, 2006

More Biochemistry

We had another PSS today on metabolism, covering fatty acids specifically. I didn't really know too much about fatty acid metabolism before doing today's reading. So it was a lot of new material, but it was still interesting. I've told you before that there are these clinical correlations in the Devlin book where they relate the biochemistry to medical concepts. One of them had to do with the Atkins diet and what happens to your body when you go on a low-carb diet like that. Basically, you start mobilizing fatty acids and proteins so that you can produce glucose. You get halitosis because of the ketone bodies you produce, one of which is acetone. Apparently the diet works and it's probably safe. But it's not something you can stay on for the rest of your life, because the carb restrictions are so severe and most people eventually cheat. The experts don't really understand why you lose more weight on a low carb diet that is isocaloric with a low fat diet. Anyway, the Atkins diet is still pretty controversial, so it was interesting to learn about. Personally, I'd rather work out more or something than reduce my caloric intake if I were trying to lose weight.

In the afternoon, I went to the lab and worked some more on my proposal. My preceptor had given me a ton of corrections, so now I need to go back and fix all of those things. I also re-started the experiment I had screwed up before. So far, it seems to be going well. This is a really hectic week. I'll be glad when it's over. Why does it seem like the end of a school period is always so crazy?

Saturday, September 09, 2006

FAQ #8: What Are All of the Summer Block Books That You Are Using?

Why, are you going to go out and buy them or something? That's pretty ambitious to start your reading for med school this early. ;-)

Ok, so seriously, these are the books we used for the first block (summer), which covers molecular/cell biology, biochemistry, and genetics:

For molecular and cell biology, we used Molecular Cell Biology 5th ed. by Lodish, et al. This was the book we used the most this whole summer, and I thought it was a pretty decent book. It has nice figures and it's fairly readable. You would definitely need this book for the summer block. Even though we have online access to it through the library here, it isn't complete access. I don't know how they picked which sections to let us read on line, but it's really annoying that we don't have access to large portions of it.

For biochemistry, we are using Textbook of Biochemistry with Clinical Correlations, 6th ed. by Devlin, which I already told you about. This is a pretty dense book, and I have to read it in small spurts with a lot of breaks. I really like the clinical correlations in there though. Basically they give these little blurbs about what happens when this or that enzyme is mutated, and it helps you relate all of this biochemistry to various diseases. That makes it more interesting to learn about things like lipid metabolism that might otherwise seem pretty dry. My biggest criticism of Devlin is that the pictures aren't very good. That's part of why so many of us are also using Lippincott's Illustrated Reviews: Biochemistry. The Lippincott's book has great pictures, but it isn't nearly as detailed as the Devlin book, so you really need to read both. The other annoying thing about the Devlin book is that there are a ton of typos. Someone seriously needs to proofread it before the seventh edition comes out.

For genetics, we are using Thompson and Thompson’s Genetics in Medicine, 6th ed, revised re-print, by Nussbaum. I actually like this book a lot. It's basically a medical genetics book, and again, that makes learning about some of these topics a lot more interesting. We only were assigned three chapters out of this book for two seminars, though, so a lot of people didn't buy it. But I think it's worth buying, and it's short enough (400 pages) and easy enough to read that you could finish the whole thing. There is a bonus section with 31 different diseases that tells you all about the clinical presentations of various genetic disorders.

I haven't finished buying all of the books for next block yet, so I'll tell you about those another time. But I recommend in addition to buying these books that you consider also buying a copy of First Aid for the USMLE Step 1. You might be thinking, why buy a board review book now when you won't be taking the Boards until after your second year? But, it's really helpful to go through the First Aid book while you are learning your organ systems. As you finish each subject, read the corresponding section in First Aid and annotate it. So for example, over the summer, you can read the biochem and molecular bio section of First Aid while you are covering those subjects in school. As you go through each organ block (cardiovascular, respiratory, and so on), read the corresponding sections in First Aid. A new version of First Aid is put out every year around January. I got the 2006 version, which is the first one that has the sections organized by organs. It's ok if you get a used version that is older, but if you can get a version from 2006 or newer, it will follow our curriculum better since we go by organ blocks.

Friday, September 08, 2006

Finished with My Rough Draft

Today our PSS covered gluconeogenesis and glycogenesis. Could they have made the terms glycogenesis versus glycogenolysis versus glycolysis any more similar and easy to mix up? We were trying to figure out which pathways were turned on and which were turned off in various tissues under different dietary conditions, and the hardest part of it was saying the pathway that you actually mean.

I finally finished with my proposal rough draft today. It is about four pages long, but I think I will wind up adding more to it after my preceptor has a chance to read it. I don't know why, but somehow writing it has been kind of torturous. You would think that churning out a 4-6 page paper would be a piece of cake, but somehow I have just not been feeling very motivated to do it. At least now I have something to work with. Editing papers is always easier than writing them from scratch.

The weather here has been gorgeous all week: sunny, seventies during the day and sixties at night. The grad student I'm working with and I went and ate lunch outside today. I know this isn't going to last, but I'm sure going to enjoy it while it does.

Thursday, September 07, 2006

The Effect of Ethanol on Fruit Flies

This is not my normal lab work, but it's still interesting science anyway. We had been having a major fruit fly infestation in the lab. It was really annoying. Even if you weren't eating anything, these stupid insects were flying around your head all the time, swarms of them. We had tried all kinds of things, from swatting them to putting our garbage out every day. Nothing seemed to help. Finally, one of the lab people stumbled onto the answer. She poured 95% ethanol into a large beaker, and set it on the countertop. Holy cow, those flies were dive-bombing it! Of course, once they hit the ethanol, they'd fall in and drown. As an added bonus, these fruit flies were very nicely preserved, too. I don't know if fruit flies can get drunk, but they sure do seem to like ethanol a lot. And here's a little physics for you too: evidently fruit flies are denser than ethanol, because they sink to the bottom instead of floating on the surface like they do in water.

Other than that, nothing too exciting is going on in lab. I'm still working on my proposal draft. And I screwed up the experiment I did last week, so I'm going to have to redo it next week. I could get away with not redoing it, but eventually someone is going to have to redo it. Since I'm the one who screwed it up, I guess it's only fair that I be the one. Otherwise the grad student I work with will probably have to do it, and that would make me feel guilty.

Wednesday, September 06, 2006

Metabolism PSS and Proposal Draft

Our PSS today covered glycolysis and the Krebs cycle. There was a section on the regulation of glycolysis that we were not assigned to read, but some of the answers for the problem set came from it. So I went and read it this evening, because these regulation issues are pretty complex and we had some trouble hashing them out as a group. I wish the coursemasters would assign us to read EVERYTHING that we are supposed to learn, and not only about half of it. The thing is, they don't let us see the problem sets before we get to class, so we don't have any way of knowing what they are going to ask us about until after the fact. Today's PSS was more hectic than usual, and we had to really struggle to finish on time too. But I do feel like I understand what's going on a little more now.

I've been working on the draft of my proposal for lab, and I'm about half done with it. I'm hoping to finish it by Friday afternoon so that I can ask my preceptor to look at it over the weekend, and I'll have lots of time to make whatever corrections I have to make. Once I'm finished with the final draft, the only thing I have left to do for the lab is to make the powerpoint slides for my presentation.

Tuesday, September 05, 2006

Metabolism Seminar

Our seminar today was by Dr. Richard Hanson from the Case Biochemistry Department. He is a very enthusiastic presenter, and I thought he did a nice job of making connections between different metabolic systems. He pointed out to us several times that all metabolic pathways do not occur in every tissue of the body, and also that whether a particular pathway is on or off will depend on the dietary status of the individual.

For example, red blood cells perform glycolysis and the pentose phosphate pathway (they need NADPH to keep their glutathione reduced--glutathione is used to detoxify organic peroxides). But that's about all they do. They don't have any mitochondria, so they don't have a TCA cycle, electron transport chain, etc. In contrast, the liver has just about every possible metabolic pathway out there. The only thing the liver cells don't do is to use ketone bodies as a source of fuel, which makes sense because it's the liver's job to make ketone bodies for the rest of the tissues to use. As far as diet is concerned, if you've just eaten a meal, your anabolic pathways will be turned on, and your catabolic pathways will be turned off. But in the morning or any other time when you've been fasting, it's the other way around. The particular pathways also vary depending on what you eat. If you don't eat any carbs, guess what: your liver will make them via gluconeogenesis.

I noticed that Dr. Hanson wrote a chapter in our textbook about lipid metabolism. (We're using the Textbook of Biochemistry with Clinical Correlations by Devlin.) Several Case biochem professors have written sections of this book, actually. We've basically just started using it, but I can tell you now that it's a pretty dense book. I was reading the reviews for it on Amazon. The medical students almost all thought it was too detailed and dense for med school. The biochemists and professors thought it was great, particularly the section on metabolism, which is what we've been assigned to read. It does seem to be more like a grad school book to me too, but maybe they picked it for us because we're kind of a grad program here as well as a med program. And our problem sets are coming from there. So I am going to split the difference: I am doing the assigned readings out of Devlin for class, but I'm also going to read the Lippincott biochem book that a lot of my classmates are using. That book is supposed to have great illustrations and be good for board review anyway.

Monday, September 04, 2006

Research Proposal Outline and Labor Day

No school today because of Labor Day. Have I mentioned yet how much I love three day weekends? Not only am I way ahead with my reading, but I slept in this morning until 9AM, which is a much appreciated luxury nowadays. The weather today was gorgeous, and I spent a few hours this afternoon hanging out with a friend. Every day should be like today.

I also spent some time working on my research proposal today. It is not due until Friday of Week 9, but I figure it is best to not wait until the very last minute. (In case you've lost track, we are now beginning Week 8 of this summer block.) There are three assignments for the proposal. One is to write an outline. The second is to write a rough draft of the actual proposal, which should be 4-6 pages single-spaced. And the third thing is to write a final copy after our preceptor corrects the rough draft. All three of these assignments will be submitted to our portfolios so that we can be evaluated on our research competency. (If you remember, research is one of the nine competencies which we must meet in order to be promoted to the next year.) There are four main sections of the proposal:

Hypothesis and Specific Aims: This should summarize the broad problem being addressed, the hypothesis of the proposal, and specific questions or aims that will be addressed.

Background and Rationale for the Experimental Plan
This section should provide a brief but informative introduction to the problem and a focused presentation of current knowledge and how the proposed research will extend this information. A consideration of potential practical impact is appropriate.

Research Plan: This should be an expansion of the specific aims. The discussion should center around the detailed experimental questions that are to be answered and should include only brief description of the experimental methodologies that will be employed. Possible outcomes should be considered as should alternative approaches and future directions.

Literature cited: Provide the appropriate references in a format acceptable for a scientific journal using standard bibliographic software.

I already have emailed the outline to my preceptor. As soon as it gets approved, I am supposed to upload it to my portfolio and start writing the rough draft. Apparently, I was supposed to do this outline during Week 5, but somehow I missed seeing that deadline until this weekend. But it doesn't seem to be a very strict deadline for the outline, and we don't really need four weeks to write what is basically a five page single-spaced paper anyway. The deadline for submitting the final proposal definitely is strict though, so I'm not fooling around with that one.

Saturday, September 02, 2006

FAQ #7: How Are You Motivated to Study When You Don't Have Any Exams?

I am surprised by how often this question comes up. Some people seem to have this idea that if you aren't studying for exams, you just won't be studying period. That is definitely not the case. I would say that the tempo of studying is probably different here than it is at schools that have tests. In other words, we don't cram right before a test, then ease off, then cram again before the next test here. Instead, we tend to work more constantly at a steady pace. But I do study, and I study a lot.

Ok, so if not exams, then what is the motivation? Well, one thing is that our coursework is very participatory. We are evaluated in large part based upon our participation. This is true in PSS, in seminars, in journal club, and in the lab. If you haven't done the reading, it's hard to participate and avoid making a total fool of yourself. That not wanting to make a fool of yourself is actually a second very strong motivator. I've mentioned here before that your fellow students in medical school are very bright, and very good. No one wants to be the person who is the class slacker or who never knows what is going on. Third, we still have to take Step 1 of the United States Medical Licensing Exam (USMLE, aka the National Boards) at the end of next year. Step 1 covers all of this basic science that medical students learn during M1 and M2. If you don't learn the material, you won't pass the Boards. If you don't pass the Boards, you won't be a physician. Again, this is a very powerful motivator. And finally, a lot of the material is interesting, and I find that I enjoy learning about it. In college you are required to take a lot of fluff classes that aren't all that interesting, and I'm sorry to say that there's some of that in medical school too. But there's not nearly as much of it. The vast majority of the things we do are related to learning about the sciences of the human body. If you're a person who is interested in the human body and disease (and presumably you are if you want to go to medical school), then you now have all of the resources and support to spend your time learning about it for two straight years. It's not that everything is equally interesting. I've definitely learned some things that I could have happily lived my life without knowing. But in general, I have to say that medical school subjects are very interesting to learn about.

Friday, September 01, 2006

Last Day of Molecular Biology

Today our PSS focused on signaling and regulation of transcription again. After today, we are going to be moving on to biochemistry and covering the metabolic pathways. We've had a couple of readings already from our biochem book when we covered proteins and receptor-mediated endocytosis. But for the most part, we've generally been focusing on molecular cell biology up to this point. One of the upperclassmen recommended to me that I buy Lippencott's Biochemistry and read that. I think I am going to go ahead and do it, because our textbook is pretty dense. For those of you who were wondering about the difference between med school and college coursework pacing, well, here you go. In college, you spend a couple of months covering all of this metabolism stuff. We're going to do it now in a couple of weeks. There is a very good reason why they make biochem a pre-req to come to CCLCM!

I am very glad that we have a three day weekend this week. I need to spend some time writing up my research proposal. It's due the week after next, and I'll write more about it next week. We have two more weeks of actual class to go now, and then the last week will be our research presentations and orientation for the first organ block to start the first week of October. Time is really flying by. I can't believe that I've been in medical school for two months already. Nearly everyone at every medical school has started by now, but orientation seems like a very long time ago to me at this point.

One other thing: the first CCLCM interview invites apparently went out today. So if you got one, congrats. :-)