FCM, Lung Mechanics Seminar, and Anatomy Office Hours

Ok, so after all of these weeks that I've been complaining about FCM, today's class was actually pretty good. The speaker was an environmental health professor from Case, and he started out by showing us a The Medical Detectives episode that starred himself (of course!). It was about a sudden break-out of lung problems among infants here in Cleveland. These babies were having serious bleeding in their lungs, and a few of them died. At first, no one could figure out what was wrong with them. They all lived within a few miles' radius of Case, so that suggested that it was probably an environmental problem, because similar babies in other areas were not affected. But no one could find anything that could be the cause. And in another weird twist, whatever was causing their lungs to bleed predominantly affected baby boys. Eventually the Case physician and a CDC physician whom he consulted figured out that it was because of mold growing in the basement of the affected babies' homes. The mold produced a toxin that interfered with protein synthesis in the babies' lungs. Apparently there are published reports of this phenomenon from other countries in Europe and South America, but it hadn't been recognized here in the United States before. The physicians never did figure out why the boys were more seriously affected than the girls were.

The lung mechanics seminar that we had afterward was also really good, if a little bit graphic. We watched a volunteer undergo several lung capacity tests. Some just involved him having to blow into a tube, but one required him to stick a small tube down his nose, and it was actually making him gag. It was interesting to see the tests being performed, but wow, that was pretty rough on him. On the bright side, it certainly made an impression on all of us, and I doubt we'll ever forget his demonstrations. Apparently he actually volunteers to do this for the medical students every year, and he'll be doing it again tomorrow for the other half of my class that didn't see it today. After we saw the lung capacity tests, we went into an exercise room and watched another lung capacity test for one of my classmates who was riding a bicycle. They kept raising the resistance he was peddling against, and we could watch not only his breathing rate and the size of his breaths increase, but also his heart rate, blood pressure, and other parameters. It was pretty neat to see all of the tests, and I have to say that overall I really enjoyed all of my classes today.

Unlike yesterday, the weather was not particularly nice today, and after lunch I went to the Walker gym and then to anatomy office hours. Anatomy office hours were awesome as usual. When I first got there, three of my classmates were already reviewing the cadavers, so I just joined in with them and went through two of the cadavers along with them. They had gotten there half an hour before me, so they left after we were done, and I was there by myself with the anatomy professor for the last cadaver. Like I said, it's really private tutoring, and I learn a ton when I'm there. I love anatomy office hours.

Happy Halloween to all of my blog readers. :-)

Anatomy and PBL

We started looking at the neck today in anatomy. Considering that I haven't read any of the chapter yet, I managed to pick up quite a bit. One thing I will tell you though is that there are seriously a ton of muscles in the neck, and they all have almost the exact same names. On the bright side, the neck muscle names tell you where they actually connect to, so it's more or less logical to learn where they are and what they do. One other thing that I don't think I've ever mentioned is that we don't see the faces of the cadavers during anatomy. They're always covered over with a cloth, and today was no different. I'm not bothered by the idea of seeing a cadaver's face, but I think it's sensible to keep them covered since we aren't studying that area of the body yet, and we want to preserve the bodies for as long as we can. But what did freak me out a little was that today the cloths were actually stapled to the cadavers' faces. I don't really know why that bothered me so much, but it did. I guess the residents were worried that we'd feel upset if one of the cloths fell off and we saw the cadaver's face, but I'd rather see their faces than have these cloths stapled on there like that.

We started a new PBL case too, and it's about a patient with a lung problem. We already have a pretty good idea about what's wrong with him based on today's session. My learning objective for Wednesday is about flow-volume loops for lungs. Basically these loops are graphs that describe how the lungs work when you inhale and exhale. Our patient did a test where he had to inhale as deeply as he could, and then exhale as much air as he could, as fast as he could. If he has problems doing this, then it means he has problems with his airways.

Today was actually a gorgeous day: sunny, relatively warm, and way too nice to spend it indoors. Right after we got out of PBL, one of my classmates and I grabbed some books and headed over to the Case campus to sit outside and read. This was a very welcome though rare occurrence, and it isn't going to last long. We're supposed to get another cold spell with more rain/snow by the end of the week.

FAQ #15: What Do You Like Most and Least about CCLCM?

I've been holding off answering this question because I wanted to wait until I had experienced more of the program. If you've been reading my blog, you probably already have a pretty good idea about what I like and don't like about the program. But here's my list in one place.


Things I Love about CCLCM:

• my classmates (well, most of them)
• no tests (generally speaking)
• anatomy lab (surprisingly, this is one of my favorite seminars every week)
• anatomy office hours (it's like private anatomy tutoring)
• PBL (kind of chaotic, but it's a lot more fun than lectures, and I learn a lot too)
• clinical skills class (challenging to the point of being overwhelming sometimes, but I'm learning a ton)
• clinic (also challenging, but it feels like I'm actually starting to learn how to be a doctor)
• the faculty (again, most of them)
• CHI (our free clinic)
• Thursdays off (I love Thursdays)
• research seminars (again, most of them)

Things I Don't Love so Much about CCLCM:

• FCM (no further comment, because I can't say anything nice)
• Ohio weather (I swear it rains here every single day)
• zillions of meetings (sometimes it seems like my meetings have meetings)

Overall, looking at the balance of positives and negatives, I mostly love CCLCM. However, I've said this before, and it bears repeating: this program is unique, and it's definitely not for everyone. I think that a lot of people don't feel comfortable about the idea of attending a school like CCLCM, and there is nothing wrong with feeling that way. There are a lot of great medical schools out there, and you can get a great education at any of them.

Coronary Vessels Lab, PBL, POD, and PA Meeting

Today was a really great day. I think the coronary vessels lab that we did this morning was one of the best seminars we have had all year so far, if not the best. We were broken up into our PBL groups, and we went through four different stations. Some of them were more of a question-and-answer kind of format, while the last one involved us getting to see a cardiac catheterization. It was seriously one of the coolest things I have ever seen in my entire life. We all had to put on these really heavy lead aprons to avoid exposure to the contrast agent, and then we filed into the OR to watch the procedure. When the contrast agent was injected, we were able to watch on the screen as it went through the coronary arteries. We were also able to determine that the patient has a right-dominant heart (meaning that her right coronary artery is the one that perfuses the back part of her heart). This is the most common arrangement in humans; most of us are right-hearters. We also got to see the catheters that they use, and I was surprised to learn that there are different catheters for the right coronary artery versus the left. It makes sense, because they go off at different angles, but I just had never really thought about that requiring two differently-shaped catheters before.

We finished this week's PBL case today. Since we only had four objectives to present, we didn't have any trouble finishing them all up in time. After that, we went back to discussing the patient's problems and how a recurrence could be prevented. We weren't very satisfied with how the case ended. It felt like we were just left hanging, and we never got some of our questions answered. But overall, the group is starting to work well together. Too bad that in a month we are going to all shuffle groups again.

Our POD seminar today was on angiogenesis. (Angiogenesis is the process of growing new blood vessels.) It was fairly interesting, but of course last week's talk was a very hard act to follow. This speaker studies the mechanisms of angiogenesis. Since she does cancer work, she is hoping to learn how to block angiogenesis so that she can starve tumors of their blood supply. After POD, I met with my PA to go over my portfolio essay. I need to make some corrections to it, but overall the meeting went well. One thing that I have to do is figure out how to fix my reference links so that we can click on them and go straight to the references I cited. I think I am going to have to go back to the tech support people and get them to help me.

Study Day

No classes today, so I spent most of the day reading and studying. The weather was pretty gross, the usual for Cleveland, but I still went to the gym for a short workout. I also got caught up with some of my reading. I'm very happy to say that I'm finished now with the entire chest chapter in the anatomy book. Next week we are going on to the neck, but before I start reading that section, I'm going back to read about the nerves. Dr. Drake had given us a presentation about them a couple of weeks ago, but we haven't covered them yet in lab as thoroughly as the presentation did. I don't feel like I understand the nervous system very well still. I also did quite a bit of reading in physiology. I think the most interesting thing I learned today is that diffusion of water is not the same thing as osmosis of water. Diffusion is based on concentration differences. Osmosis is a colligative property based on pressure differences, and it's a lot faster than diffusion. The only other major accomplishments for today are that I got all of my laundry done and I finished preparing my objective for PBL tomorrow. I know I've said this before, but it really amazes me how much more work I get done whenever I have a day off.

Histology, PBL, and Dean's Dinner

Today was another really long day, but it was absolutely fabulous from start to finish. We had a histology seminar this morning, and it was pretty helpful. I'm still not great at identifying histological structures, but sometimes I get lucky. And there are definitely a few structures that I can usually pick out, one of which is gap junctions, apparently. I'm also finally able to tell cardiac muscle cells from skeletal muscle cells, but sometimes the blood vessels still mix me up. Those muscular veins in particular always get me. I think that I need to spend some more time looking through the histology atlas. I ordered mine by mail and it came damaged, which didn't hurt the book much, but the CD that comes with it was broken in half. The company is sending me a new CD, so hopefully that will arrive soon. I think that histology is like anatomy in that you just have to keep looking at pictures of structures, and you have to keep going over them again and again so that you can get enough experience to recognize them.

We had a lot of objectives to go over for PBL, so we didn't get through all of them today. But we don't have as many objectives to go over for Friday, so I think it won't be too bad. It turns out that we were right about our case patient's diagnosis. My new objective for Friday is about V/Q tests. Our patient had to have one. Basically, to do the tests, two radioisotopes are needed. One is used to test how well the blood perfuses the patient's lungs, and the other is used to see where the air goes during ventilation of the lungs. (V is for ventilation, and Q is for perfusion aka blood flow.) Ideally, you want the blood flow in the capillaries and the air flow in the alveoli of the lungs to overlap, because it isn't very useful to have ventilation with no blood flow (which happens when a pulmonary blood vessel gets blocked), and it is also isn't very useful to have perfusion with no ventilation (which happens when an airway gets blocked, like when someone chokes).

Tonight's Dean's Dinner was just as good as last time. I wish we could have these things more often. The food was great, the speaker was fantastic, and even though we were all exhausted, it was definitely worth going. One of the most interesting things that we found out is that the traditional information that we had learned in college about how the hemoglobin proteins in blood bind to oxygen is not correct. It turns out that nitric oxide is responsible for the behavior of the hemoglobin molecules, and not oxygen. We looked up the paper from JBC where this was published, and I plan to read it when I have a chance. We'll probably use it as the next paper for Journal Cult. I haven't told you about Journal Cult yet, but the next meeting is Monday, so I'll post more about it then. There was a prospective student interviewing here tomorrow, and she came to the Dean's Dinner too. We were joking with her that she shouldn't expect to get this kind of catered dinner at all of the rest of her interviews.

FCM, Vascular Reactivity Lab, and Clinic

I had a very long day today. It started out being not so good, but it got better as the day went on. First thing this morning we had FCM. Our lecture this morning was about the Cleveland Free Clinic. (This is different than CHI, which is the CCLCM Free Clinic.) Technically we aren't supposed to have lectures here at CCLCM, but that's what this was. It actually wouldn't have been too bad if it had been about half or even a third the length. Afterward, we broke into our small groups to discuss our service projects. Ok, so aside from the fact that forcing us to volunteer completely defeats the purpose of calling it VOLUNTEERING, the thing that upsets me the most is that the students basically had no say in how anything was being done. My group is supposed to be doing a project at a women's shelter. We did not get to choose this venue. The expectation is that we will volunteer there one afternoon per month for the rest of this year doing some project that we ostensibly initiate on our own. I have to say that being forced to make this kind of time commitment for someone else's project is a real hardship, because I already feel like I'm doing about as much as I can handle in terms of school and extracurriculars, and I don't want to have to give up one of my other activities to make time for this one. The group came up with some preliminary information-gathering things that we wanted to do, and then it was time for seminar. My job is to see about getting a grocery store to donate some food to the shelter. I'm going to go over there on Friday with another student from my group.

The seminar was supposed to be a lab, but the lab was cancelled for some unexplained reason. So instead, we were broken up into four groups, and each group had a faculty facilitator who went over one of the topics with us. We were then supposed to get back together at the end and present our information to the other three groups. Well, let's just say that things didn't exactly go according to plan. I was lucky, because my group was with the senior scientist who organized the whole thing, and he was a very good tutor who got us to think about the topics and reason out the answers for ourselves. But one of the other groups actually got the wrong information from their tutor, and the presentations in general were not particularly helpful because of the lack of time and organization. All in all, I think that I learned a lot during the small group session, but I don't think that the experience was nearly as helpful as it could have been. It is unfortunate that we didn't get to do the actual lab that was planned for us.

Ok, so all in all, that was a pretty lousy morning, but things got much better in the afternoon. I had clinic today, and it was my first day of seeing patients on my own. The weather was very bad, and maybe that was why one of my patients cancelled and another didn't show up at all. So I only saw two patients instead of four. That actually wound up being good, because it gave me more time with those patients and with my preceptor and the residents. For the first patient, I went in to interview her and take her pulse and blood pressure. She wasn't feeling very well, and it was obvious that she didn't really want to talk to me, so I didn't spend very long interviewing her. She wound up getting an EKG, and I got to help the nurse place the leads. Afterward, I went over it with my preceptor. I still remember how to interpret the EKG, but I had to go review all of the leads. There are twelve of them for a standard EKG, if I hadn't mentioned that before, and I didn't remember where all of them go. The second patient was absolutely awesome. She and I spent quite a bit of time talking, and she told me that she was very excited about being one of my first patients. She's been coming to my preceptor for a long time, and since I am going to be working with the same preceptor for the rest of this year plus next year, I hope I will get a chance to see her again.

I was a little bit nervous at first, but overall both interviews and exams went well. I presented each patient and my findings to my preceptor afterward, and then the two of us went into the rooms to see the patients together. During the rest of the time, I followed some of the residents and sat in while they discussed their cases with my preceptor. At the end, I entered my patients into my patient log on the portal. I will have to do this each time after clinic. My preceptor was busy today, so we didn't get a chance to go over my logs, but we are going to do that next time I come. I also didn't do a pap smear yet. Maybe next time.

Anatomy, PBL, Anatomy Office Hours, and SINNAPS Panel

Today was a really long day, but it was a good day too. We're still doing the chest, but our anatomy lab is now focusing more on the lungs instead of the heart. Somehow, we wound up with no residents or fellows there to teach us this morning. So Dr. Drake and his assistant showed us the cadavers, and we also had a radiology station like normal. The groups were bigger, but we also had more time at each station, which I think the class generally preferred. It seems like we never have as much time at each station as we'd like to have. We're still trying to get anatomy lab extended until 10AM instead of 9:50, which means that we would start PBL at 10:15 instead of 10AM. That way, we'd also have that last few minutes we need to finish changing and get back to the LRI on time. There are only two sinks in the locker rooms for 16 guys and 16 girls, so by the time everyone washes up and changes clothes, we usually wind up getting to PBL a few minutes late every Monday.

Our PBL case this week centers around a woman who is obese, a heavy smoker, and who was taking a cross-country drive. We're pretty sure we already know what is wrong with her. But since our main focus this year is on normal physiology and anatomy, most of our learning objectives are about the normal function of the lungs, the pulmonary circulation, and the coronary circulation. I am going to be talking about how the body prevents the blood from clotting, very briefly!

Since I have clinic tomorrow, I went to anatomy office hours today after going to the gym. Again, I went at 4:00 with just one other student, and we basically had a private review session. It was fantastic. I still don't think that I know a ton of anatomy, but it definitely is getting easier. I'm actually starting to remember some of the structures. I try to read three or four pages out of the textbook every day, and this week I will finally finish the entire megachapter about the chest. Anatomy is not a subject that you can just breeze through. It takes me about half an hour to read two pages on average, including time to study the illustrations.

Afterward, a couple of my classmates and I practiced taking each other's blood pressures and pulses. In the evening, there was a dinner held by SINNAPS. I don't think I've told you about SINNAPS yet. It's the interest group for people who want to go into any of the brain sciences (neurology, neurosciences, neurosurgery, psychiatry). There was a panel of physicians from different specialties in neuro and psych, and they talked to us about their careers and what they thought about the futures of their specialties. One of the things that I thought was neat about the panel members is how several of them managed to combine neurosciences with so many other specialties. For example, there were two people who did neurological radiology, one who did neurological pathology, and one who did pediatric neurosurgery. One other thing I learned tonight is that I definitely have a long road ahead of me if I decide to go into any of these superspecialties. The pediatric neurosurgery one in particular is way intense.

FAQ #14: What Is Your Typical Clinical Block Schedule Like?

This post complements the one from last summer where I described our summer research block schedule. Our schedule now is very different, as you are already aware if you've been reading my blog. What follows is my own schedule. My classmates' schedules are more or less similar, and I've pointed out the things I do that are optional. Some of my classmates do other optional things like research in the lab, shadow physicians, or hold regular study groups. The hardest thing is that there are always more activities that you'd like to do than there is time to do them all. That balance is something you have to find no matter where you go to medical school.

Monday:
8AM-9:50AM Anatomy Lab
10AM-11:50AM PBL
3PM-5PM Anatomy Office Hours (this is optional, and sometimes I go instead on Tuesday between 3-5PM on the weeks when I don't have clinic)

Tuesday:
8AM-9:30AM FCM (the fluff class I'm always complaining about)
10AM-11:50AM Seminar
1PM-5:30PM Clinic (some of my classmates have their clinic days on M, W, or R afternoons)

Wednesday:
8AM-9:50AM Seminar
10AM-11:50AM PBL
1PM-5PM Clinical Skills (every other week on the weeks when we don't have actual clinic)

Thursday:
Off-there are optional anatomy office hours from 3-5PM, but I never go on Thursdays.

Friday:
8AM-9:50AM Seminar
10AM-11:50AM PBL
12:15-1:15PM POD (that's the research seminar with free lunch)
1:15-1:30PM Orientation for the following week
2PM-5PM CHI (the student-run free clinic-optional-I am doing this once a month, but other people go more or less often)

During the four days that I do have classes, I typically am at school from about 7:30AM until about 5 or 6 PM. I always plan and want to go home earlier, but a lot of times it just doesn't happen that way. Sometimes I wind up staying much later for other optional events like seminars or meetings. It's a very busy schedule because we also have to find time to read and prepare our PBL objectives. I still study at least for a few hours every day, but I get the most studying done on Thursdays and weekends for obvious reasons. I love having those Thursdays off. I'm not sure why we have Thursdays off in particular. I guess it's a Case thing, because the UP students have Thursdays off too. But I love Thursdays the way that most people love Saturdays.

Histology, PBL, POD, and CHI

I had a very full, busy day today, but I learned a lot too. In the morning, we started out with a histology seminar. I didn't expect to enjoy it, but it was actually pretty interesting. We were mostly looking at slides of blood vessels and learning how to tell them all apart. Once I had seen several examples, I was starting to be able to distinguish between, say, arteries and arterioles, or veins and lymphatic vessels. I still don't think that histology is very easy, but it's not horrible, either.

After histology, we finished up our PBL case and discussed how things had gone this week. I think that we had some issues with talking over one another and that we should work on improving on that. But overall, it was a good case and everyone did a good job of presenting their objectives.

Our POD seminar today was fantastic. The presenter had brought two patients with her, which of course always makes any seminar more interesting and relevant to the students. Basically, her work is on Marfan's Syndrome and other diseases of connective tissue, and the patients talked to us briefly about their experiences and medical histories. The main risk of having a disease like this is that the aorta can dissect and form an aneurysm, even in younger people. One patient had a heart valve problem, and we were allowed to listen to it with our stethoscopes. It made a kind of swishing sound because of the blood backflowing, and I could hear it along with the regular lub-dub heart sounds that one normally hears through a stethoscope.

Afterward, I went to volunteer at CHI. If you don't remember, CHI is the CCLCM Community Health Initiative, which is our own student-run free health clinic. It was really a blast. I was kind of limited as to what I could do because I'm only a first-year, but I helped with getting healthy snacks for the patients, practiced taking blood pressures, learned how to use the new cholesterol machine, and gave out pamphlets at the sexual health table. I also learned how to take the body mass index (BMI) of the patients, which gives an idea of how overweight they are based on their age, weight, sex, and height, and I watched a pregnancy test be performed. I think it was a great experience for us and for the patients, and I will be going back to volunteer again in November.

First Formative Portfolio

We didn't have class today, so I spent most of the day reading and finishing my formative portfolio. Although there are nine competencies, we were only responsible for discussing four of them at this point: research, science knowledge, communication, and professionalism. I think that they'll add another two or three of them to the next essay that we write at the end of this block, and by the end of the year, we'll be discussing all nine of them. For each competency, we are supposed to discuss our strengths and weaknesses, and we are also supposed to come up with a learning plan at the end to help us work on our weaknesses. It wound up being a lot more work than I had expected it to be, but I'm pretty happy with the results. I meet with my PA to discuss it next Friday, so I'll find out then if she agrees.

Now I have to finish with my PBL objective for tomorrow. I'm going to be going over the Valsalva Maneuver test and the Cold Pressor test. The first one tests people's baroreceptor response (baroreceptors sense pressure changes in the circulatory system), while the second tests people's response to pain. I also need to look over histology slides for tomorrow. I realize as I do this that although I've learned so much in the last three weeks, there are still a lot of things that I don't understand very well. The histo is getting a little better though. I am starting to be able to identify more kinds of cells and structures now that I'm getting some more experience with it. I have a histo atlas too, and that helps, as does the histo website they asked us to look at.

Artificial Hearts, PBL, Class Meeting, and Clinical Skills

Today was absolutely jam-packed and non-stop from 8 to 5. The morning began with a visit to a lab in the LRI where they are working on developing artificial hearts. The work was really interesting, and we talked some more about pressure-volume loops to describe heart activity and how these loops are generated also. The textbook mentions them, but the seminar went into a lot more detail about why they change the way they do under certain circumstances, and I think that almost everyone found it to be really useful. The artificial heart work is also really neat. There are already some in clinical trials, which I didn't realize before, but they still have a long way to go before they will be available to the general public.

In PBL, we are continuing with the case of the girl who faints. My group is still having some issues with getting all of the objectives presented in a timely manner. I'm not sure what the best solution is for this problem. On one hand, I think that it's important to avoid stifling discussion of topics if people are interested or have questions. On the other hand, we need to keep moving so that we finish on time. PBL can be frustrating at times when you have eight people arguing over minutiae like whether a particular topic should be one objective or divided into two, but overall I still am enjoying it, and I feel like I am learning a lot from it. Both preparing my own objectives as well as listening to other people's presentations are really helpful.

Right after PBL, we had a class meeting. There were several topics discussed, but one that was of special interest to me is that the SAQs will not be used like quizzes. The powers that be basically want us to beta-test the questions, and they can't get enough feedback unless everyone does them because our class is so small. They are going to keep the data anonymous, and they are not going to break the code or report the scores to our PAs as a general rule unless they see that someone is consistently totally bombing the questions over the course of the entire block. I felt a lot better after hearing that, although I still don't think that they should make the questions required. But I understand that they need feedback, and if they don't require them, probably a lot of people will choose not to do them. I also understand that they want to be able to watch in case any students are falling through the cracks. I just think that there are better methods of doing this besides multiple choice quizzes. For example, I think that the CAPPs, which are essays, are a lot more useful for assessing student knowledge than the SAQs, because with the CAPPs the students can show what they know without it having to be all or nothing. This week's CAPPs are particularly good.

Our clinical skills class was all afternoon right after the class meeting. We spend half the time doing actual clinical skills, and the other half doing practice interviews with standardized patients. (Standardized patients are actors who get paid to pretend to have some problem, and we practice interviewing or checking them.) We are in groups of four for both halves of the class. I have clinical skills first. We learned how to take blood pressure, pulse rate, respiration rate, and generally observe the patient. Our standardized patient was very relaxed, and toward the end while we were talking with the preceptor who was training us, he actually fell asleep! In the second part, I did the practice interview. It's very interesting how different an interview with the same patient can be depending on who performs it. For example, my patient was initially less friendly and open with me compared to how he was with the other student in my group who interviewed him, but once I got him to start talking, it was hard for me to get him to stop!

FCM, Tilt Table Test, Anatomy, and Obesity Talk

Today was a rough day as far as classes go. The FCM class was supposed to be about the Tuskegee Syphilis Experiment, at least based upon what the portal said and the reading we were assigned. Instead, we started out by having a person from the Cleveland Department of Public Health tell us about all of the subdepartments in the department for a full hour. There are a ton of subdepartments, and as you can imagine, this got kind of monotonous after a while. We broke up into our small groups to talk about the Tuskegee experiment afterward, and again this was kind of frustrating because the facilitators were talking more than the students were in many of the groups. I would prefer to have the FCM facilitators be more like the PBL facilitators, where they basically let the students do most of the talking unless the students are going completely off track. FCM has just not been the highlight of my CCLCM experience in general. I think that the issues covered are important, but the course is really not as interactive as it could and should be.

Afterward, the class split up. Half of us went to the CCF hospital for a clinical lab, and the other half had a science lab at the LRI. I was in the first group. We were supposed to be seeing some demonstrations of clinical tests (of which the tilt table test is one) that are used to determine how the patient's circulatory system responds to normal changes such as standing up. The tilt table test has the patient strapped to a board for up to 45 minutes at a seventy degree angle to see if their blood pressure will rise to compensate for the change in position. Anyway, it could have been very interesting, but again we wound up beginning by sitting through an hour of power point lectures in a small, hot room. At the end of the second power point, we asked if we could go see the clinical tests, but unfortunately it was kind of rushed and we didn't really get a full demonstration of how they worked. Afterward, we went back to the small, hot room and answered fill-in-the-blank questions, which was actually pretty helpful.

Things got a lot better after lunch. First, I worked on my PBL objective for tomorrow, and then I went to anatomy office hours. Again, it was fantastic, and I felt like I really got a lot out of it. I went with one other student, and we were the only two people in the whole lab. So the anatomy assistant was going over each cadaver with just the two of us, and it was like a private lesson. I really like the anatomy office hours, particularly because sometimes it is hard to see everything when there are seven or eight people all crowded around one cadaver during the Monday labs. I plan to keep going all year.

In the evening, a few of us went to the Page Lecture, which is an award lecture given by a scientist who is chosen each year for his or her work in medical research. This year's winner was Jeffrey Friedman from Rockefeller University, who was one of the discoverers of the hormone leptin. Leptin is produced by fat cells, and normally high levels of leptin should signal your brain that you need to stop eating. However, in people with leptin deficiencies or who are leptin resistant, the signal doesn't get through, and they keep eating. It's a really interesting topic. I learned two things that were especially interesting. One is that part of the reason why obesity and overweight is more prevalent in developed countries is because of our aging population. People naturally tend to gain a little weight as they get older, and since we are getting older as a society, naturally we are also getting heavier. In addition, there are two types of leptin problems, which you can equate with the two types of insulin problems that a diabetic has. Type I problems are in people who don't produce the hormone, and they tend to be less common. Type II problems are in people who are resistant to the hormone. It is not yet known how many obese people are obese because of leptin resistance, but most obese people are known to not be Type I (i.e., leptin deficient).

Anatomy Lab, PBL, and Block 1 Feedback Meeting

Our anatomy lab this morning was, to put it mildly, absolutely awesome. The surgeon who presented the case for us this morning was great. He gave us all his number and email and invited us to contact him if we ever wanted to come watch him do an aorta repair. He also showed us pictures of the surgeries being done. It was totally fascinating, but I have to tell you that I will be having nightmares about dissecting aortic aneurysms now for weeks. Basically what happens is that the layers of the walls of the aorta, which is the main artery coming out of the heart, separate from each other. That's the dissection. Blood is supposed to go through the center, but if the aorta dissects like that, then some of the blood goes in between the layers instead. It can make the aorta swell up (that's the aneurysm), and if it swells too much, it can actually burst. Since the aorta is such a large, important artery, if that happens to you, chances are good that you won't live long enough to make it to the hospital. Yikes.

The cadavers we saw today were really well done too. A couple of the residents and fellows who have presented the anatomy to us in the past kind of pimped us in a not so pleasant way, but the four we had today were all really nice and helpful. They still asked us questions and tested us, but they were nice about it. This was the first time where I went into the anatomy lab and felt like I actually had a clue about what was going on. I even knew the answers to several of the questions that they asked us, and that had never happened before. Two weeks ago, I knew zero anatomy, so I'm feeling a lot better about how far along I've come with learning it. I still have a long way to go with anatomy though.

We started our third PBL case today, and it revolves around a girl who gets dizzy spells. My learning objective for Wednesday is to describe chemoreceptors. Chemoreceptors are specialized cells in the blood vessels that detect levels of chemicals like carbon dioxide. I'd tell you more about them if I knew any more at the moment. Maybe tomorrow.

After PBL, I went to a meeting with the course directors from the summer block to give feedback about the strong and weak parts of the summer curriculum. They randomly pick eight students to do it after each block. I think we were able to give some useful input, but I was surprised to hear that my classmates thought the course directors should add SAQs for the summer block too. I hope that the course directors don't decide to do that. But if they do, and you come here next summer as an M1 and have to do them, for the record, I want you to know that I tried my best to talk them out of making you do it.

FAQ #13: What Is There to Do Around Cleveland?

I've mentioned a few places that I've gone and seen since I've come to Cleveland, but here's a single post about some of the things to do around Cleveland. Please realize that I've only been here for three and a half months, and I don't have tons of free time. So my knowledge of Cleveland is admittedly limited.

Parks: There seem to be a lot of parks you can visit here, and you can even go to the beach at Lake Erie. I've already mentioned the Emerald Necklace, which is a series of parks that surrounds the city. I've only been to Brandywine Falls, and it was really nice. Some of my classmates have been to the beach, but I haven't gone yet. Maybe I'll make it over there next summer. You can find a lot of information about Cleveland recreation opportunities online. I've also gone to some smaller recreational parks in some of the areas just east of campus. There was a preserved one-room schoolhouse that we saw in Cleveland Heights, but unfortunately we couldn't go inside because it was by appointment only.

Neat Areas of the City: I recommend checking out University Circle (lots of things to do there, and it's really close by), Shaker Square (cute, quaint), and Cedar-Fairmount. There is a grocery co-op near the Case campus that I have visited once. I'm sure there are some other cool areas too that I don't know about.

Museums: The Rock and Roll Hall of Fame gets all the publicity, but there are a lot of other museums here, including an art museum, a science museum, and a football museum. There is a botanical garden at University Circle too. You can read more about the Cleveland museums here. Cleveland also has a famous orchestra which plays right on the Case campus at Severance Hall. Even better, students can sign up for cheap tickets. The Case medical library has a really neat medical history museum in it. They were running an exhibit about the history of contraception last summer when I went there, and it was just fascinating.

Politics: Ohio is a battleground state, so no matter what your political persuasion, you're bound to find others who share your views here. I've seen signs for both student Democrat and student Republican groups on the Case campus. However, I'm not really up on local politics, so I'm afraid I can't tell you much more than that. Well, I can tell you that based on the level of nastiness in the radio ads I've heard, it looks like the governor's race here is going to be pretty ugly.

Electrophysiology Lab, PBL, POD, and RefWorks

Today we started out by going to an electrophysiology lab at the LRI. We were divided into two groups of eight (the other sixteen people in my class were doing the pharm seminar that my half of the class had on Tuesday). First my group used a computer program that shows the currents due to ion channels. You can vary the ion concentrations of sodium, calcium, and potassium inside the cell and outside, and then see how it affects the action potentials. We had a worksheet we were supposed to be doing, but we wound up just playing around with the program as a group instead. Afterward, we went into the lab and saw some experiments with rabbit hearts where the current was moving around in a circle instead of spreading out through the ventricles like it was supposed to do. The computer was able to model the current in colors, and we could actually watch it swirl around in circles. It was pretty neat.

Afterward, we finished our PBL case, and my group got into an interesting discussion about whether the treatment the patient in the case got was appropriate. She was a teenager, and they implanted a defibrillator in her chest. Some of the group members felt that she was too young to have to have the defibrillator, while others thought it was important to give her since if she had another episode she could die. I can see it from both sides. You want to be conservative on one hand and avoid overtreating the patient. But on the other side, she has a serious illness and she could literally just drop dead with little warning. Maybe next time there wouldn't be someone around to revive her like there was when she collapsed during the case.

Our POD talk was by a researcher who works on the same illness (long QT syndrome) that our hypothetical PBL patient had. It was a good talk. He was involved with figuring out the genetic causes of long QT syndrome, and he also went into the possibilities of personalized medicine. This is a neat idea, where the doctor will figure out what to prescribe to you based upon your specific subtype of illness.

In the afternoon, I started working on the SAQs, and I also figured out how to download my portfolio evidence into RefWorks. You would think it would be pretty straightforward to do, but you would think wrong. I had to go to the tech support office to get them to help me. Now all I have left to do is write the essay itself. I can cite the evidence that I downloaded to RefWorks. I'm hoping to get some work done on the essay this weekend, but we'll see whether that actually happens.

Portfolios, SAQs and CAPPs

We don't have any Thursday classes, so I spent my time today working at home. It's amazing how much more I get done at home versus at school! One thing that I did was to catalog my evidence in the Selected Evidence section of the portfolio. This is for my formative portfolio essay that is due next week. You can't see the portfolio section of the portal unless you're a student, so I'll tell you about it. There are six areas in the portfolio: Online Evidence (which contains all of the evaluations that the faculty and the other students write for you); Required Coursework (where you upload the assignments that are required, such as the research proposals that we wrote over the summer); Unique Evidence (where you upload things that aren't required for school--for example, I wrote an essay about doing this blog and put it in my Unique Evidence folder); Selected Evidence (this section has folders for each of the nine competencies, and you file the evidence from the first three folders into the proper categories here); Formative Portfolio (that's what's due next week--it is only seen by the students and our PAs, and we do three of them per year); and Summary Portfolio (that's due at the end of the year and is seen by the MSPRC, which is the committee that decides whether we get to be promoted to the next year of medical school).

Another thing that I did was to start looking at the CAPPs for this week. I mentioned SAQs and CAPPs before, but I haven't really told you much about them yet. You can read the gist about them on the CCLCM portal if you follow the link that I told you about earlier. (Remember to log in as "guest" for both your ID and PW. Then click on the Cardio/Pulmonary block link, and you can read about the SAQs and CAPPs.) The SAQs are multiple choice questions that cover anatomy, physiology, pharmacology, histology, and whatever else we've been covering that week. There are thirty of them, and you have to submit them first before you can submit the CAPPs. However, the SAQs are not available until Friday afternoon, while the CAPP questions are available on Wednesday afternoon. So we are able to start thinking about the CAPPs before we get the SAQs. There are two CAPPs each week, although the two for this week have multiple subparts--I hate when they do that. The CAPPs are essay questions that should take about 1-2 pages to answer. They seem to have one question that is more specific to the particular research or clinical labs that we visited that week, and another that more broadly covers the general topic of the week. (Keep in mind though that I've only seen two sets of them, so I don't have much of a sample size to draw from here!) It helps to read some of the lab's papers in order to answer the first CAPP question.

As soon as you submit the SAQs, you get the correct answers and explanations right away. So I wind up going through the SAQs three times: once quickly to preview them, a second time more carefully before I submit them, and then a third time after I submit them to read the explanations. I read all of the explanations, even the ones I got right, just to reinforce the material. For the CAPPs, I go through them twice: once to answer them, and again later to make sure there's nothing I want to add or change in my essays. Then I submit them. They don't get evaluated right away since they're essay questions. It's supposed to take about a week until we get faculty feedback on our essays, so we haven't gotten any feedback from last week yet. The faculty's answers to the questions are released on Monday morning after the CAPPs are due. Both the CAPPs and the SAQs must be submitted by 8 AM on Monday morning.

Sound confusing? Don't feel bad, because it confuses us too. But although this evaluation system isn't perfect, I definitely prefer doing this over stressing out about memorizing minutiae for exams like my friends at other schools do. I guess there is bound to be some amount of pain at any medical school that goes along with mastering the massive amounts of material we all have to learn.

EKG Lab, PBL, and Anatomy of Nerves

Today was another dress-up day for us because we went to the EKG lab over at the CCF hospital. They divided us into our PBL groups, and we rotated through four stations. In a couple of them, we were watching the surgeons perform procedures like implanting a pacemaker and ablating (destroying) an overactive piece of heart tissue. Those stations were really neat. A third station was for us to learn how to read EKGs. The doctor who was going through the EKGs with us didn't realize how little we knew, and so a lot of the exercise was over our heads, unfortunately. But we took copies of the EKGs with us, and after I'm done with this week's reading, I want to work on them some more. The last station was for us to learn how to place the electrodes on a person to take an EKG. A couple of the people in my group put electrodes on a nurse who had volunteered to be the "patient." We were the last group to visit this station, and the poor guy had red marks all over his chest from where our classmates who were there earlier had been sticking electrodes on him. At least his chest wasn't very hairy. If it were, they'd have had to shave him, because otherwise the electrodes wouldn't stick to his skin well, and getting them off again would be a major pain. Literally.

We continued on with our EKG PBL case today. It's still hard for us to get through all of the objectives in an hour, so we are going to do the last two on Friday. Mine in particular was very long because I was going over how to read EKGs. I didn't discuss placing the electrodes or how the leads are oriented at all because there just wasn't time. I'm going to cover that on Friday now.

At lunchtime, I went to another talk about providing medical care for gays, lesbians, bisexuals, and transgendered people (GLBT). The speaker was a physician from Case who is active in the Cleveland community in this area, and he spoke to us about some of the special considerations for GLBT patients. I think that most people probably know that certain diseases like AIDS tend to be more prevalent in the GLBT community, but I didn't realize that certain other diseases like cancer are also more common in gays and lesbians. Part of that may be due to the fact that lesbians in particular tend to have higher rates of obesity versus straight women, and both gays and lesbians tend to smoke more than heterosexuals do. I also didn't know that human papilloma virus, which is the virus that causes cervical cancer in women, can also cause anal carcinoma (cancer) in men who are the recipients during anal sex. GLTB patients also tend to not visit doctors as often as the general population does, possibly at least in part because of their experiences with homophobia among physicians. It was a very interesting talk all in all.

In the afternoon, I went to the gym, and then I went to see Dr. Drake in the anatomy lab. He is going to be giving a review session tomorrow about the nervous system, but I won't be in tomorrow. So I went to talk to him about it today, and he was very helpful. Dr. Drake is basically here because of CCLCM, and he really goes out of his way to help us. I think we were very lucky to get him to come here to run our program.

FCM, Pharmacology, and First Day in the Clinic

We had another Foundations of Clinical Medicine (FCM) session today. It was on paying for health care, and we had to go over to Case. I thought the point of it was going to be for us to work with the UP students. But instead, we all just sat together in a huge lecture hall and listened to a couple of physicians talk about the problems with health care in America, and then a patient with sickle-cell anemia spoke about the problems she had with getting health insurance as a chronically ill person. The patient's part of the talk was the most useful as far as giving me things to think about. Afterward, we broke up into our usual small groups, so that the CCLCM students were with the CCLCM students and the UP students were with the UP students. Not only was that disappointing, but it was also kind of awkward for us to be there all dressed up like we were, considering that the UP students wear jeans, t-shirts and sweat shirts. We definitely stuck out like a sore thumb. Those of us with clinics today (about a quarter of the CCLCM class, including me) were particularly dressed up, like shirt-and-tie kind of dressed up. We weren't wearing our white coats, but still. Speaking of dressing up, I have to admit that I was kind of surprised that the UP students were not dressed up, actually. If that same patient had come over to CCF to speak to just the CCLCM students, we would all have had to not only be dressed up, but also wearing our white coats. It's interesting how different the conventions are at CCF versus just a mile down the road at Case.

At the end of the small group session, we went back to the LRI, and then half of the class did an electrophysiology lab while the other half had a pharmacology seminar. I had pharm today. We'll switch on Friday, so that's when I'll be doing the electrophysiology lab. I normally really like pharm, but somehow I just felt distracted today and it was hard to pay attention. I think maybe my mind was on it being my first day in the clinic.

I have an hour in between finishing my classes at noon and starting clinic at 1 PM. There was a lawyer who came over from Case and to give a brief talk (sponsored by the American Medical Student Association, I think) about racially based medicine. It was interesting, but not nearly as controversial as I had expected it to be. I had to leave early so that I'd have time to get to the clinic. I already knew where to go because I had gone over there once before to make sure I could find it. People have clinics all over town, pretty much. Some people are way far out, like an hour drive away, and others were lucky enough to have clinic on campus. Thankfully, I am in the second group.

My preceptor is an internist, and today was mostly a shadowing day. Next week we are going to be learning how to do things like take blood pressure during our clinical skills class, and I think we will be practicing interviewing standardized patients too. Then in two weeks when I go back to the clinic, I'll be doing those same things for real with patients. I am supposed to see four patients each session, two with my preceptor and two by myself, and I have to keep a log of each patient that I see. My preceptor was encouraging me today to ask patients the difficult questions, meaning subjects that are normally awkward to talk about with perfect strangers like sexual history, or if it was a woman, about any physical abuse. I was kind of amazed at how directly my preceptor asked the couple of women we saw today about whether they were being abused. Apparently sometimes a woman really will just start confiding about abuse when she is asked about it bluntly like that. Apparently sometimes also patients will tell students things that they don't tell their doctors. I hope I won't be finding out more than I can handle hearing! At any rate, I think I am going to be learning an awful lot over the next two years, and I also think that I got a really good preceptor. Like I said before, this is the reason why I am in medical school.

Anatomy, PBL, and Anatomy Office Hours

We had our second anatomy lab today, and this time the case revolved around a guy who has electric conduction problems in his heart. Basically we are studying conduction in the heart all week, so this was just to get us started. A cardiac surgeon went over the conduction pathway with us, and then we put all of our protective gear on and went into the lab. There were two cadavers today. One we had already seen last week, and the resident did a review of the heart, lungs, blood vessels, and nerves with us. The other cadaver was a new one with diseased lungs (emphysema). You could see and feel that they weren't like normal. Lungs are supposed to feel kind of spongy, but these felt hardened and there was a bunch of air trapped inside them.

There were two other stations with hearts for us to look at. One had the same group of preserved hearts that we looked at last week, and the other had fresh pig hearts. It's pretty uncanny how much pig hearts look like human hearts, although they aren't exactly identical. On a kind of related note, I finally learned from one of the residents how to tell the right and left sides of the heart apart from one another. It's easy to tell the ventricles from the atria, but I always was struggling to distinguish between right and left. He showed me how to do it by looking at the grooves in the heart.

Our PBL case involves a girl who is basically healthy except that she has a somewhat abnormal EKG. It looks like there is a problem with her ion channel conductance. Back in August we had that patient with the sodium channel problem who had this same conduction abnormality (along with a bunch of other problems). My learning objective for Wednesday is how to read an EKG.

In the afternoon, I spent some more time in the anatomy lab looking at the cadavers and pig hearts. Anatomy is just one of those things that you have to keep studying over and over until you finally get it. I still feel like I barely know anything, but I learn a few new things every time I go over there, and I think I am finally starting to make some sense of it all. Dr. Drake is going to give us an extra session on the nerves later this week.

Tomorrow afternoon I have my first clinics session. On one hand, I can't believe they are actually going to let me start seeing patients. I don't know anything yet! On the other hand, I am really excited, because this is such a huge part of the reason why I'm here.

FAQ #12: What Kinds of Stats (MCATs, GPAs, USMLEs) Do CCLCM Students Have?

I get asked this question a lot, and the good news is that I can finally answer it, at least in part. Regarding the MCAT and GPA averages, unfortunately all I can tell you is that our application stats are lumped in with the UP students' stats. There are no separate published stats for CCLCM students versus UP students. So you will have to look in your MSAR to find out what the current stats are for the combined UP/CCLCM/MSTP previous entering class, and that's the only information that is available about our stats. Dr. Franco, our admissions dean, stresses that CCLCM has no minimum MCAT limit. In other words, your application here will be considered even if your MCAT is lower than the CWRU average published in the MSAR. There are some schools that do set minimums for MCAT scores, so if you're concerned about this, you should definitely check with the schools where you're applying.

Now for the good part, which is the United States Medical Licensing Exam (USMLE) scores. If you're interested enough in CCLCM to have been reading through my blog, you probably already know that no one has graduated yet from the program. Our first class is currently in their third year, and they are the only ones who have taken Step 1 of the boards, which is the first of three parts of the USMLE that all American allopathic medical students must pass in order to become licensed physicians. At most schools, medical students take Step 1 during the summer after they finish their second year of medical school. Our schedule is the same here, although a couple of the M3s received permission to take the test later, which is why no score information was released before now. We just got an email from the dean a couple of days ago informing us that all of our M3s passed, and that their average score was higher than last year's national average. (They didn't tell us how much higher it was.) The national first time pass rate for Step 1 at all med schools is 92%, and ours was 100%. If any of you M3s are reading this, way to go! You're going to be a tough act for the rest of us to follow.

Cardiomyocyte Lab, PBL, POD, and Portfolios

Today was another busy day. In the morning, we visited another lab that studies contraction in heart muscle cells. The difference between this lab and the one we visited on Wednesday is that the other lab studies contraction in entire heart muscles, while this lab studies contraction in single muscle cells, which are called myocytes. We were actually able to see some individual myocytes contracting under the microscope, and it was pretty wild to watch. Besides looking at individual cells, this lab also looks at whole hearts, and we saw another experiment using rat hearts where they were testing their contraction after adding different drugs.

When we returned to the education building, we had our third PBL session. This time, we managed to avoid going over our time, and in fact we even had some extra time at the end to talk about how the week had gone. The facilitator gave us a checklist of objectives, and we went through them as a group to discuss whether we had covered them either during PBL, in seminar, or both. We found that we had covered almost all of the objectives during PBL, and the few that we hadn't covered ourselves were covered during the seminars.

Normally, we'd be done with school for the day at this point, but since it's Friday, we had one additional class, called Process of Discovery (POD). POD is a research seminar series where various faculty come and describe their research to us. The school provides us with lunch, and we each take turns being moderators for the speakers. Since there are 32 of us and 32 speakers, we will each be moderator for one seminar during the course of the year. What you have to do as moderator is get a copy of the speakers's CV, write up a brief biosketch and turn it in to be posted on the portal, help the speaker set up for their talk and check out the microphone for them, and introduce them before they start speaking. At the end, if there is time for questions, the moderator is in charge of handling the question period and coming up with questions if none of the audience does. But there were plenty of questions yesterday, and the speaker's heart transplant beeper even went off toward the end of the talk to let her know that a heart was available, so it was all very exciting. She was the same physiologist whose lab we visited on Wednesday.

After POD, we had another session to help us with managing our portfolios. Our first formative portfolio summary essays are due on the 19th, so it's getting to be time to start working on them. We have four competencies to consider: research, professionalism, medical knowledge, and communication, along with personal development. We will be doing three of these formative portfolios this year, one after each of the first three blocks. At the end of the fourth block, we will be doing a summary portfolio, and that's the one that the Medical Student Promotions and Review Committee uses to decide whether we get to go on to the second year of medical school.

By the way, if you're interested in seeing our portal, you can, kind of. Click on this link for the CCLCM portal, and type "guest" as both your user ID and password. You won't be able to see all of the features that the students see, including the portfolios. But at least you can get an idea of what the portal is like so that you'll know what I'm talking about when I mention it. If you look at the bottom left, you'll see a listing for the class of 2011 course syllabus. We're doing the second block right now, which is Cardiology/Pulmonology/Hematology I. Click on that link, and it will tell you about the block. If you want to see what our PBL cases are like, from the main portal page, click on the link that says "sample PBL." You will see the same sample PBL case on cystic fibrosis that we did for practice before break last month.

CHI Training and Anatomy Office Hours

Thursdays are supposed to be a day off for us, but I wound up having a very busy day. In the morning, I did my training for the Community Health Initiative (CHI). That is the new student-run CCLCM community health clinic that I mentioned before. It was pretty fun, actually. They had five different stations, and we learned to measure blood glucose levels and cholesterol, do urine dipsticks, conduct pregnancy tests, and take blood pressure. One of the other students practiced measuring glucose on me, and my glucose level was pretty good: 112 mg/dL nonfasting. That would almost be decent even if I had been fasting (normal fasting glucose level is less than 110 mg/dL). But I am especially excited to report that I FINALLY have learned to take blood pressure. I had tried a few times before, but I could never hear anything through the stethoscope. The trainers today had a two-eared stethoscope, so first I heard my own BP and then I heard one of my classmates' BP. Apparently I had been placing the stethoscope in the wrong place up until now. I guess it helps to know that the brachial artery (the one you put the stethoscope on while you take the BP) isn't right in the middle of the arm. It's actually a little bit toward the elbow. I've signed up for my first volunteer date on October 20.

In the afternoon, I went to the gym, studied a little, met with my PA, and then went to the anatomy office hours. Since we only have two hours of anatomy lab per week, there are extra optional office hours where they take out the cadavers and we can go look at them longer on our own. The anatomy professors are there in the lab to answer our questions, and it's a lot less stressful and hectic because fewer people are in the room and we can stay and look at each body for as long as we want instead of having to change stations at a set time. They are having the office hours on Monday, Tuesday, and Thursday afternoons from 3-5. The bodies were all of the same ones that we saw on Monday, but I knew a lot more of the structures this time. I think from now on though I will try to avoid coming on Thursdays, because I'd like to not go in to school at all on Thursdays. Since I have clinics every other Tuesday, that means I'll have to start going on Mondays. Well, I guess Mondays are just going to be my anatomy days.

Muscle Prep Lab, PBL, and First Clinical Skills Session

Today we started out by going to a cardiac muscle physiology lab. The lab personnel had set up several stations for us to learn about various aspects of muscle cell contraction, and they also showed us how they conduct the heart muscle cell contraction experiments. It's pretty barbaric, actually. Basically they use the heart muscle cells out of human hearts if they can get them from transplant patients, or rat hearts if they can't. One end of the muscle is tied down to a weight, and the other is attached to a transducer. The muscle isn't strong enough to actually lift the weight, but they can measure how much force the muscle exerts when it tries to lift the weight. They can look at the effect of adding various drugs to the muscle cells so that for example they can determine whether some drug makes the muscles contract harder. The muscle cells are still alive, of course (or else they wouldn't contract), so we could see them twitching as they tried to contract. It was both really cool and at the same time kind of grotesque.

After we finished touring all of the lab stations, we went back to the education building to have our second PBL session. I think I already mentioned that our case revolves around a heart failure patient, and this week we are learning about the anatomy of the heart and how the heart contracts. Today was the first day that we have presented objectives, and it went fairly well except that we had an issue with running over time, and we had to start rushing toward the end. Still, it was a lot better than the first week of PSS last summer. We were talking about how lost we all were that first week. I guess the other groups didn't have any more clue than mine did. We came up with more objectives for Friday. Mine is huge, like a whole chapter, and it's not going to be easy to present that in just five to ten minutes.

In the afternoon, we had our clinical skills class. Since it was the first class, basically we just heard short introductions from various faculty members, but we didn't really do too much besides talk about what makes a doctor good or bad and watch some videos showing doctor-patient interactions. The videos were actually pretty funny, because they were exaggerated vignettes of all the things NOT to do when you're seeing a patient. From now on, though, we'll be spending every other Wednesday afternoon learning clinical skills and practicing them on standardized patients. I'm really excited about that. Like I said on Monday, it finally is starting to feel like I'm a real medical student.

Foundations of Clinical Medicine, Echocardiograph Lab, and Stress Test

Foundations of Clinical Medicine (FCM) is kind of a fluff class. There isn't too much reading, and what little reading there is tends to be on the light side. Basically what we do is work on development of professionalism, and talk about the social and ethical issues of medicine. Today we started by having a brief introduction, and then we broke up into small groups in the PBL rooms to come up with suitable goals of professionalism for M1s. (The FCM groups are also groups of eight, but they are different groups versus the PBL groups.) My group came up with principles like arriving to classes and clinics on time; being responsible for our learning and for the learning of our classmates; getting involved in community service; and being prepared properly for class. It's not the most exciting class, at least so far. But from what I've heard from my friends at other schools, it's one of those things that everyone has to do no matter where they go to med school. The good thing is that later on in the year we'll be doing some service projects, and we'll also have some joint sessions with the UP students.

Afterward, we went to the echocardiograph lab at the CCF hospital. We rotated at several stations, where we learned how to interpret echocardiograms as well as about the physiology of the heart. Echocardiograms are performed by using sound waves, and you can see the valves of the heart opening and closing and the chambers contracting in real time. It's amazingly cool to watch someone's heart actually beating. Since we were seeing real patients, we had to be dressed professionally, including our white coats. It's amazing how much wearing the shirt and tie (or blouse) and a white coat makes us look like "real" doctors. But many of us were also wearing our backpacks, and I have to say that the backpack definitely ruins the effect!

In the afternoon, I studied in the library for a while until it was time for me to take my stress test. This was for a seminar that we're having next month. The scientist doing it is a physiologist, and he wants to collect data on a few of the people in my class to use during his presentation. Basically the stress test consisted of me having to walk and jog on a treadmill at progressively more difficult levels. I was wearing electrodes so that the technician could get an EKG, and I also had my nose clamped off and I had to breathe into a snorkel-like mouthpiece the entire time. Every few minutes, my blood pressure got measured using a standard BP cuff. I started out at rest, then walked at 1.5 mph at a 10% incline. Every couple of minutes, the tech would increase both the speed and incline. By the end, I was jogging at 5 mph at an 18% incline, and I finally had to stop because I was starting to feel lightheaded. I did reach my maximum heartrate though, and the technician said that he got really good data. Even though it's pretty early, I am totally exhausted now and ready to go to bed.

First REAL Day of Medical School

Today I finally felt like I was really in medical school. When we got there this morning, we had to go over to the CCF hospital and change out of our clothes into scrubs. Then we had a lecture for about 20 minutes by a heart surgeon. He showed us some echocardiograms and went over the heart anatomy with us. We spent the last hour and a half or so in the actual lab looking at several different stations in groups of six. Each station had a cardiothoracic surgery fellow or one of the PhD anatomists there to explain what we were looking at. One station had several dissected hearts so that we could see the valves and chambers. Another was a superficial dissection so that we could see the pecs, ribs, and sternum. There was a station to show us the lungs and diaphragm, and a station to show us the outside of the heart in the chest. The last station was the Leonardo program that shows 3D anatomy and radiological pictures.

I've told you before that we do not use embalmed bodies here at CCLCM. Because of that, when we do our anatomy labs, we not only wear scrubs, but also gloves, masks, and safety glasses. Booties to cover your shoes and surgical hair nets are optional. Also, although we don't do any cutting at all the entire first year, we do get our hands dirty, so to speak. The fellows had us reaching into the cadavers to feel structures like the lungs (kind of soft and squishy, with crackly pockets where air was trapped in them), the ventricles of the heart (the left one is much thicker since it has to pump blood all around the body), the blood vessels, and the nerves (they feel kind of like guitar strings). It was amazingly cool. I didn't expect to like anatomy lab very much, but so far at least it has been one of the neatest things I've done in medical school.

After anatomy, we went back to the LRI to do our first PBL. The hypothetical patient in the case has congestive heart failure, and we are studying the normal function of the heart and circulatory system. I'll tell you more about the PBL later (we have two more sessions for the same case on Wednesday and Friday), but suffice it to say for now that today went MUCH more smoothly than our first PSS did last July! We were finished at noon, and it was raining outside, but now the sun is out and it's just beautiful.