Today was another short day for me. I'm finally starting to eat normal meals again for the most part, but they are all bland things like bagels and pasta. It has taken me a lot longer to recover from my illness than I had expected. Our seminar today was GI histology. I really don't like histo seminars. This instructor went around the room and asked us what we noticed about the slide. The one I got asked about was of the tongue, so I mentioned that I saw the muscle. But that wasn't what she wanted. She wanted me to say that the color changed from dark pink to light pink between the muscle and the surface. Ok, yeah, that's true, but that's kind of an obvious observation assuming you're not colorblind. The whole session went on like this. We have this lady again on Friday and then again next week too. Sigh.
PBL went fine. I can't remember if I ever mentioned that the physicians in our PBL cases are real physicians here at CCF. One thing that is funny about this week's case is that the physician in the case is the same one we had as our tutor last block. My new group is pretty hardcore with coming up with learning objectives. We had eight of them on Monday, and we came up with eight again today. My learning objective for Friday is basically a review of what we're covering in the seminars, but that's ok. It definitely doesn't hurt to cover this stuff again. I'll just make my presentation more like a quiz. Today I was presenting about the pharmacology of drugs for gastroesophageal reflux, and just as I began, the pharmacist who is one of our coursemasters came in. I'm glad that I was well prepared, because I wasn't expecting to have a pharmacist in the room! She told me that I did a good job with all the drugs though.
I don't have anything that I have to do this afternoon, so I'm going home. I think tonight I am going to try to eat a normal dinner. I'm getting pretty sick of eating this bland diet.
Wednesday, February 28, 2007
Tuesday, February 27, 2007
FCM, Gastric Function, NMS Feedback, and Clinic
Today's FCM session was pretty interesting. Dean Franco, who is a psychiatrist, was the one running it. She had us watch a brief documentary about a mentally ill man who died in prison from neglect. Then we broke into our small groups to discuss the stigma against the mentally ill. A lot of them wind up going to prison, so our conversation tended to focus a lot on that aspect. At the end, we all got back together as a large group. A psych resident talked to us some more about problems with the mentally ill accessing care. All in all, this was a pretty good FCM session. Not that I expected any less from Dean Franco.
Our gastric function seminar unfortunately wasn't nearly as good. The seminar leader had us break up into small groups. Each group had a poster with a picture from the Boron physiology textbook. We were supposed to come up with a small presentation for the rest of the class. My group was doing hormonal regulation of acid secretion, which is a pretty complex topic. There were seven of us, and it wound up being hectic. At the end, when each group was presenting, it was really hard to see the posters. I was sitting near the front and had trouble seeing them, so I am sure the people in the back were definitely not able to see them. It's too bad, because this format might have worked if they had broken the class up into two or three groups first. But as a whole class, it was two hours of futility. I didn't learn much at all.
After seminar, I went to the NMS block feedback meeting. I had been asked a few weeks ago to give comments to the NMS block coordinators. They ask eight students to do this after every block; I did it last fall for summer block too. We had several suggestions, including adding more time for neuro, using a different book for the bone part, and studying cartilage before bone like they did last year. Hopefully some of those changes will be instituted for next year's class. They give us lunch at these meetings, but of course I didn't eat it. I am still not totally back to normal, actually, so I have been eating kind of bland things.
I had to leave the meeting a few minutes early because I had clinic this afternoon. It was a long day, because my preceptor wasn't working with residents. So I saw all four of my patients plus some of hers. It was kind of snowy, and I thought some of my patients might not show up, but they all did. I was doing the GI exam on them and screening them for alcohol use. I didn't find any problem drinkers who needed counseling, but I did find out about some interesting practices from one very religious patient. She told me that she didn't drink, and when I asked her why not (we're supposed to do this in case they are former alcoholics), she said it was for religious reasons. But then as we kept talking, it turns out that she takes these colon cleansing regimens (basically a laxative) while fasting. Apparently this is a very popular thing to do among some religious Christian groups. But it's actually pretty dangerous since it can lead to people dying of dehydration. My preceptor told the patient unequivocably that she could not do both things together in what I thought was a pretty respectful and nonjudgmental way. All in all, it was a really good learning experience for me.
The only other exciting thing to happen is that I had a patient with a hiatal hernia, which we have been learning about this week. Basically, there is hole in the diaphragm for your esophagus to pass down into your abdomen. (That's the hiatus.) In some people, the hole gets too big, and their stomach can actually start coming up through the hiatus into the chest. I don't know if that's what the patient had exactly, but that's the most common type of hiatal hernia.
Our gastric function seminar unfortunately wasn't nearly as good. The seminar leader had us break up into small groups. Each group had a poster with a picture from the Boron physiology textbook. We were supposed to come up with a small presentation for the rest of the class. My group was doing hormonal regulation of acid secretion, which is a pretty complex topic. There were seven of us, and it wound up being hectic. At the end, when each group was presenting, it was really hard to see the posters. I was sitting near the front and had trouble seeing them, so I am sure the people in the back were definitely not able to see them. It's too bad, because this format might have worked if they had broken the class up into two or three groups first. But as a whole class, it was two hours of futility. I didn't learn much at all.
After seminar, I went to the NMS block feedback meeting. I had been asked a few weeks ago to give comments to the NMS block coordinators. They ask eight students to do this after every block; I did it last fall for summer block too. We had several suggestions, including adding more time for neuro, using a different book for the bone part, and studying cartilage before bone like they did last year. Hopefully some of those changes will be instituted for next year's class. They give us lunch at these meetings, but of course I didn't eat it. I am still not totally back to normal, actually, so I have been eating kind of bland things.
I had to leave the meeting a few minutes early because I had clinic this afternoon. It was a long day, because my preceptor wasn't working with residents. So I saw all four of my patients plus some of hers. It was kind of snowy, and I thought some of my patients might not show up, but they all did. I was doing the GI exam on them and screening them for alcohol use. I didn't find any problem drinkers who needed counseling, but I did find out about some interesting practices from one very religious patient. She told me that she didn't drink, and when I asked her why not (we're supposed to do this in case they are former alcoholics), she said it was for religious reasons. But then as we kept talking, it turns out that she takes these colon cleansing regimens (basically a laxative) while fasting. Apparently this is a very popular thing to do among some religious Christian groups. But it's actually pretty dangerous since it can lead to people dying of dehydration. My preceptor told the patient unequivocably that she could not do both things together in what I thought was a pretty respectful and nonjudgmental way. All in all, it was a really good learning experience for me.
The only other exciting thing to happen is that I had a patient with a hiatal hernia, which we have been learning about this week. Basically, there is hole in the diaphragm for your esophagus to pass down into your abdomen. (That's the hiatus.) In some people, the hole gets too big, and their stomach can actually start coming up through the hiatus into the chest. I don't know if that's what the patient had exactly, but that's the most common type of hiatal hernia.
Monday, February 26, 2007
First Day of GI Block
I am still not feeling totally back to normal, but at least I have started eating solid food a little bit again. We had anatomy lab first thing this morning, and I wasn't sure how well I would take standing around looking at bowels for two hours. But I got through it all right, and the smell didn't really bother me. (You probably won't be surprised to hear that the abdomen is a pretty stinky part of the body.)
We are in new PBL groups now, but half of my group members were in my group last time. Two other people were in my group from last summer. I'm not really sure how the powers-that-be decide how to divvy up the groups, but it's definitely not totally random. There are some people in my class that I never work with all year long, and others that I will work with for two or even three blocks. We have a new tutor too. I can already tell that this tutor will not be as laid back as our last one was. Our case is an interesting one though. My learning objective is about the pharmacology of drugs to control gastric reflux. This week I am the board scribe.
Since I'm still not feeling too great, I'm going home early today. I'm going to have a late day tomorrow because I have clinic.
We are in new PBL groups now, but half of my group members were in my group last time. Two other people were in my group from last summer. I'm not really sure how the powers-that-be decide how to divvy up the groups, but it's definitely not totally random. There are some people in my class that I never work with all year long, and others that I will work with for two or even three blocks. We have a new tutor too. I can already tell that this tutor will not be as laid back as our last one was. Our case is an interesting one though. My learning objective is about the pharmacology of drugs to control gastric reflux. This week I am the board scribe.
Since I'm still not feeling too great, I'm going home early today. I'm going to have a late day tomorrow because I have clinic.
Saturday, February 24, 2007
An Early Introduction to the GI Block
We're starting GI block on Monday as I said, but I started mine last night. I came home feeling kind of nauseated, so I was lying in bed reading. Unfortunately, the stomach pain kept getting worse until finally I started vomiting and having these horrible spasms in my abdomen. It felt like someone was tying my intestines into knots. I thought it was probably food poisoning because I made the unfortunate choice of eating the POD lunch yesterday. But the pain was so bad that I wound up going to the ER at CCF on the possibility that maybe it was appendicitis. My PA came with me, and a couple of the M3s who were on call came down and visited me in the ER. If any of you three are reading this, thanks again for hanging out with me in the ER last night. My PA in particular deserves extra kudos for getting out of bed in the middle of the night to come pick me up and take me to the ER, and then spending all night up with me before going to clinic this morning.
There are a couple of notable things that happened last night. One is that when the receptionist was signing me in, I had to stop to take a puking break midway through her questioning. I had a bucket with me though, so I was prepared. But she was really nice about it, as was the nurse. They both came across being very empathetic, offering me tissues, telling me to take my time, etc. The M3s did a good job with showing empathy too. But the resident who examined me has an awful bedside manner. He didn't make eye contact, didn't listen to my answers to his questions, and didn't use language that I'd be able to understand. Keep in mind that at this point, I am most of the way through my first year of med school. So I'm almost certainly far more educated about medicine than the vast majority of the patients he sees. But when he asked me if I had had any ill contacts, I had no idea what he was talking about. It turns out he was trying to ask if I'd been around anyone who was sick. I told him that of course I had--this whole hospital is full of them!
After he left, my PA commented to me about how the resident didn't make much eye contact or really listen to what I was telling him. I was actually more annoyed that the resident didn't laugh at a joke I had made. I told my PA that I always laugh at my patients' jokes, even if they aren't funny. People cope with illness in various ways, and humor is a pretty good way to go as far as coping mechanisms are concerned. Besides, MY jokes really ARE funny! But this experience does drive home why it's important for us to learn communications skills. This doctor was a textbook example of what not to do.
The other interesting thing was seeing all of the hospital protocols in action. I had a patient ID band on, and the staff are supposed to identify me by at least two methods (name, DOB, patient number), which they did. They are also supposed to ask me certain questions, which they did, and provide me with a copy of HIPAA laws, which they offered to do. But I told them not to bother since I've already read them several times for school. I feel like I could TEACH the HIPAA laws by now!
Fortunately, it looks like I just had a really bad case of food poisoning. My appendix is fine, and I didn't need emergency surgery. They did some blood tests on me, which basically came back normal except that I had a slightly elevated white blood cell count. My PA told me that this was nothing to worry about. The staff gave me a bag of saline solution by IV, and then some promethazine by IV as well. Promethazine (brand name = phenergan) is an anti-histamine along with being an anti-emetic (something that stops you from puking), so it totally knocked me out. I got discharged around 5 AM, and my PA drove me home. I slept for the rest of the morning.
So far today I feel mostly better, although my intestines are still having little twinges. I haven't been eating too much solid food yet. Unfortunately, I can't go to the gym today now. Plus, one of my classmates had her birthday earlier in the week, and a bunch of people went out to celebrate last night. I had planned to go. But when they called me to make plans, I was otherwise occupied and could not take the phone call, let alone hope to go out anywhere. I'm also concerned about how much that little IV drink of saline is going to wind up costing me. I have student insurance through Case, but it doesn't cover everything. So it looks like now I'll be getting a personal lesson in medical care financing along with my early intro to peristalsis. (Peristalsis is the contraction of the smooth muscles in your digestive tract. That's what you feel when your stomach is growling.) I am planning to find out about getting the fees waived due to my financial status and the fact that I'm a student. We'll see how things turn out.
There are a couple of notable things that happened last night. One is that when the receptionist was signing me in, I had to stop to take a puking break midway through her questioning. I had a bucket with me though, so I was prepared. But she was really nice about it, as was the nurse. They both came across being very empathetic, offering me tissues, telling me to take my time, etc. The M3s did a good job with showing empathy too. But the resident who examined me has an awful bedside manner. He didn't make eye contact, didn't listen to my answers to his questions, and didn't use language that I'd be able to understand. Keep in mind that at this point, I am most of the way through my first year of med school. So I'm almost certainly far more educated about medicine than the vast majority of the patients he sees. But when he asked me if I had had any ill contacts, I had no idea what he was talking about. It turns out he was trying to ask if I'd been around anyone who was sick. I told him that of course I had--this whole hospital is full of them!
After he left, my PA commented to me about how the resident didn't make much eye contact or really listen to what I was telling him. I was actually more annoyed that the resident didn't laugh at a joke I had made. I told my PA that I always laugh at my patients' jokes, even if they aren't funny. People cope with illness in various ways, and humor is a pretty good way to go as far as coping mechanisms are concerned. Besides, MY jokes really ARE funny! But this experience does drive home why it's important for us to learn communications skills. This doctor was a textbook example of what not to do.
The other interesting thing was seeing all of the hospital protocols in action. I had a patient ID band on, and the staff are supposed to identify me by at least two methods (name, DOB, patient number), which they did. They are also supposed to ask me certain questions, which they did, and provide me with a copy of HIPAA laws, which they offered to do. But I told them not to bother since I've already read them several times for school. I feel like I could TEACH the HIPAA laws by now!
Fortunately, it looks like I just had a really bad case of food poisoning. My appendix is fine, and I didn't need emergency surgery. They did some blood tests on me, which basically came back normal except that I had a slightly elevated white blood cell count. My PA told me that this was nothing to worry about. The staff gave me a bag of saline solution by IV, and then some promethazine by IV as well. Promethazine (brand name = phenergan) is an anti-histamine along with being an anti-emetic (something that stops you from puking), so it totally knocked me out. I got discharged around 5 AM, and my PA drove me home. I slept for the rest of the morning.
So far today I feel mostly better, although my intestines are still having little twinges. I haven't been eating too much solid food yet. Unfortunately, I can't go to the gym today now. Plus, one of my classmates had her birthday earlier in the week, and a bunch of people went out to celebrate last night. I had planned to go. But when they called me to make plans, I was otherwise occupied and could not take the phone call, let alone hope to go out anywhere. I'm also concerned about how much that little IV drink of saline is going to wind up costing me. I have student insurance through Case, but it doesn't cover everything. So it looks like now I'll be getting a personal lesson in medical care financing along with my early intro to peristalsis. (Peristalsis is the contraction of the smooth muscles in your digestive tract. That's what you feel when your stomach is growling.) I am planning to find out about getting the fees waived due to my financial status and the fact that I'm a student. We'll see how things turn out.
Friday, February 23, 2007
Psychiatric Genetics, PBL, and POD
Our seminar this morning was on psychiatric genetics. There were two parts. The first part was led by a psychiatrist and covered autism. It was kind of rough to sit through, and I zoned out after the first fifteen minutes or so. The second half was done by the same geneticist who came and presented to us a few times last summer during our cell and molecular bio block. His part was a little better, but he ran over time and made us late to PBL.
Today is our last PBL session for this block. On Monday, we will start the GI block with new PBL groups and new PBL tutors. We finished off our learning objective presentations, and then we got to go meet the patient that the case was based upon. He gave us a brief talk about growing up with his illness and described what his life was like now. I really like that we had a chance to ask him questions about some of the issues that came up in the case that we were wondering about. And of course, it makes the case more real to life when you are meeting the actual person that inspired it.
Our POD speaker was from the NIH and spoke to us about child and adolescent mental health. She was a really interesting speaker, and we asked her a lot of questions. Unfortunately, however, the psychiatrist from this morning (who used to be someone she worked under) attended her talk as well, and he was kind of overly involved in her talk. She was gracious about him constantly interrupting her, but still, we wanted to hear her speak, not him again.
Right now, I'm not feeling so great, so I'm going to go home and lie down for a while. One of my classmates had her birthday earlier this week and we are planning to go out this evening.
Today is our last PBL session for this block. On Monday, we will start the GI block with new PBL groups and new PBL tutors. We finished off our learning objective presentations, and then we got to go meet the patient that the case was based upon. He gave us a brief talk about growing up with his illness and described what his life was like now. I really like that we had a chance to ask him questions about some of the issues that came up in the case that we were wondering about. And of course, it makes the case more real to life when you are meeting the actual person that inspired it.
Our POD speaker was from the NIH and spoke to us about child and adolescent mental health. She was a really interesting speaker, and we asked her a lot of questions. Unfortunately, however, the psychiatrist from this morning (who used to be someone she worked under) attended her talk as well, and he was kind of overly involved in her talk. She was gracious about him constantly interrupting her, but still, we wanted to hear her speak, not him again.
Right now, I'm not feeling so great, so I'm going to go home and lie down for a while. One of my classmates had her birthday earlier this week and we are planning to go out this evening.
Thursday, February 22, 2007
How to Create a Survey
I had my clinical research class today. We were going over methods to develop surveys and questionnaires for research. It's a lot more complicated of a task than I had ever appreciated. Besides coming up with the questions, you have to figure out how to standardize them and validate them. The instructor had each of us present an article about survey development to the rest of the class. Mine was written by some researchers here at CCF who had come up with a clinic-wide teacher evaluation form to be used by every department and division at CCF. It was fun. I like that we did presentations ourselves instead of having to sit through three straight hours of powerpoints. I don't know what it is, but the longer I'm here, the more I am coming to just detest sitting through lectures and seminars.
My paper was due today, and I finished it and submitted it with no problem. The M2s have a formative portfolio essay due tomorrow, so a lot of them were around today working on them. I have a lot of reading for tomorrow again, and I am totally not in the mood to do any of it. Sigh.
My paper was due today, and I finished it and submitted it with no problem. The M2s have a formative portfolio essay due tomorrow, so a lot of them were around today working on them. I have a lot of reading for tomorrow again, and I am totally not in the mood to do any of it. Sigh.
Wednesday, February 21, 2007
Psychopharmacology Seminar, PBL, and Clinical Skills
We had a ridiculous amount of reading for today, and I didn't come close to finishing it all. But I probably got about halfway, which is enough to let me fake it anyway.
The same psychiatrist who did the disastrous child development seminar last Friday talked to us again today about antipsychotics. This time we started more or less on time. There are two main antipsychotics that he wants us to know about, one that is low potency (clozapine) and one that is high potency (haloperidol) for dopamine-2 receptors. Dopamine is one of the neurotransmitters in the brain. It's the same one that gives cocaine users their high, which hopefully none of you know about from personal experience. ;-) Clozapine has some nasty side effects like an increased risk of seizures, significant weight gain, and increased risk of high blood sugar. Oh, and it can lower your white blood cells, which isn't such a good thing for your ability to fight off infections. The second half of the seminar was given by another psychiatrist who is just awesome. He looks like he's about our age, and he was just a lot more interactive. I actually paid attention for the entire hour.
This week's PBL case has an interesting twist to it. It turns out that the diagnosis we made on Monday was not right. We weren't completely off base though. And to be fair, I think the people who wrote the case purposefully withheld some of the pertinent info so that we'd go down this wrong turn because they wanted us to study both diseases. There are only four learning objectives for Friday, so I don't have to do one this time.
We had our last regular clinical skills class this afternoon. For the rest of this year, we'll be doing special clinics like pediatrics and subacute care as well as taking our OSCEs. I'll explain more about the OSCEs later, but they are basically a practice session for Step 2 CS. Step 2 CS is a part of the medical boards that we'll be taking our senior year. We have an OSCE review session next week, so I'll know more myself then. Our communications and physical diagnosis skills for this week were to discuss alcohol use with patients and to do the abdominal exam. The abdominal exam is pretty easy. Actually, EVERYTHING is pretty easy compared to the neuro exam!
I am more excited than I realized about the fact that after today, we don't have to go to these communications sessions any more. Plus this is the last week of NMS block. Finally, things have GOT to start easing up....
The same psychiatrist who did the disastrous child development seminar last Friday talked to us again today about antipsychotics. This time we started more or less on time. There are two main antipsychotics that he wants us to know about, one that is low potency (clozapine) and one that is high potency (haloperidol) for dopamine-2 receptors. Dopamine is one of the neurotransmitters in the brain. It's the same one that gives cocaine users their high, which hopefully none of you know about from personal experience. ;-) Clozapine has some nasty side effects like an increased risk of seizures, significant weight gain, and increased risk of high blood sugar. Oh, and it can lower your white blood cells, which isn't such a good thing for your ability to fight off infections. The second half of the seminar was given by another psychiatrist who is just awesome. He looks like he's about our age, and he was just a lot more interactive. I actually paid attention for the entire hour.
This week's PBL case has an interesting twist to it. It turns out that the diagnosis we made on Monday was not right. We weren't completely off base though. And to be fair, I think the people who wrote the case purposefully withheld some of the pertinent info so that we'd go down this wrong turn because they wanted us to study both diseases. There are only four learning objectives for Friday, so I don't have to do one this time.
We had our last regular clinical skills class this afternoon. For the rest of this year, we'll be doing special clinics like pediatrics and subacute care as well as taking our OSCEs. I'll explain more about the OSCEs later, but they are basically a practice session for Step 2 CS. Step 2 CS is a part of the medical boards that we'll be taking our senior year. We have an OSCE review session next week, so I'll know more myself then. Our communications and physical diagnosis skills for this week were to discuss alcohol use with patients and to do the abdominal exam. The abdominal exam is pretty easy. Actually, EVERYTHING is pretty easy compared to the neuro exam!
I am more excited than I realized about the fact that after today, we don't have to go to these communications sessions any more. Plus this is the last week of NMS block. Finally, things have GOT to start easing up....
Tuesday, February 20, 2007
FCM, Neuro Circuits, Class Meeting, and Some Awesome News
Ok, so I'm going to post things out of order from my title today because I'm really excited. A few months ago, I applied for a research fellowship for this summer, and I just found out today that I received it! The fellowship includes a stipend for ten weeks of summer research plus funding to go present my work at a national conference in the fall. Our summer research time is only nine weeks, but I'm going to come back to school a week early to get started.
All of the classes today were really good too. (It's not just because I'm in an exceptionally good mood, because I didn't find out about winning the fellowship until after class.) Our FCM session was about racial disparities. The reading consisted of two articles about the different perceptions of doctors and medical students toward patients of different sexes and races, and a third article about kidney transplant likelihood based upon race. I thought the articles had a lot of confounding variables, and it turns out they were all written by the same group. So they're not exactly independent, either. But they were certainly food for thought, and we had a really lively discussion when we met in our small group. The FCM speaker today was pretty good too. I have to say that FCM has gotten a lot better compared to how it was last fall.
Our neuro circuits seminar was nicely done too. It was actually like three mini seminars in one. We were covering three circuits, and we had a short seminar about each one. My favorite was the seminar for the dorsolateral prefrontal circuit, which regulates executive functioning (planning). The seminar leader had us try some of the tests that they give the patients. One is called the Wisconsin Card Sorting Test. The examiner doesn't tell the patient the rules for sorting the cards; the patient has to hypothesize what the rules are, and then periodically the examiner changes the rules without warning. Another test was to copy a drawing. Someone with a dorsolateral lesion wouldn't be able to plan the drawing correctly, and it would turn out distorted. There were some other tests too that tested numerical recall, ability to find numbers and letters, etc. The other two seminars were for the other two pathways. One is the anterior cingulate pathway. Lesions in that pathway cause the patient to become apathetic and sometimes mute and motionless. The third one is the lateral orbital pathway, which is involved with personality. People with lesions in this region become disinhibited and stop filtering what they do and say. It's basically like what happened to Phineas Gage.
We had a class meeting afterward, and it wound up being a good one. Of course there was some discussion of the new attendance policy. But the more interesting thing is that Dean Franco discussed some rumors that had been going around. One was about how our SAQ scores were being monitored by the administration. (They aren't.) The other rumor was that the administration was going to use the SAQ scores to secretly rank us. (They aren't.) All good news as far as I am concerned.
All of the classes today were really good too. (It's not just because I'm in an exceptionally good mood, because I didn't find out about winning the fellowship until after class.) Our FCM session was about racial disparities. The reading consisted of two articles about the different perceptions of doctors and medical students toward patients of different sexes and races, and a third article about kidney transplant likelihood based upon race. I thought the articles had a lot of confounding variables, and it turns out they were all written by the same group. So they're not exactly independent, either. But they were certainly food for thought, and we had a really lively discussion when we met in our small group. The FCM speaker today was pretty good too. I have to say that FCM has gotten a lot better compared to how it was last fall.
Our neuro circuits seminar was nicely done too. It was actually like three mini seminars in one. We were covering three circuits, and we had a short seminar about each one. My favorite was the seminar for the dorsolateral prefrontal circuit, which regulates executive functioning (planning). The seminar leader had us try some of the tests that they give the patients. One is called the Wisconsin Card Sorting Test. The examiner doesn't tell the patient the rules for sorting the cards; the patient has to hypothesize what the rules are, and then periodically the examiner changes the rules without warning. Another test was to copy a drawing. Someone with a dorsolateral lesion wouldn't be able to plan the drawing correctly, and it would turn out distorted. There were some other tests too that tested numerical recall, ability to find numbers and letters, etc. The other two seminars were for the other two pathways. One is the anterior cingulate pathway. Lesions in that pathway cause the patient to become apathetic and sometimes mute and motionless. The third one is the lateral orbital pathway, which is involved with personality. People with lesions in this region become disinhibited and stop filtering what they do and say. It's basically like what happened to Phineas Gage.
We had a class meeting afterward, and it wound up being a good one. Of course there was some discussion of the new attendance policy. But the more interesting thing is that Dean Franco discussed some rumors that had been going around. One was about how our SAQ scores were being monitored by the administration. (They aren't.) The other rumor was that the administration was going to use the SAQ scores to secretly rank us. (They aren't.) All good news as far as I am concerned.
Monday, February 19, 2007
Neuroanatomy, PBL, and Transplant Surgery Talk
Today was a long day, but it was a good one. We finished up neuroanatomy in the morning. This week we are covering the limbic system, which is responsible for governing emotions. These brain circuits are pretty complex, and I have a lot of trouble keeping them all straight. I think that part of the problem is that I still don't have a very good three-dimensional picture of where things are in the brain. That is something that I need to spend more time working on at some point. I went back to the anatomy lab in the afternoon to review the atlas, but I still need a lot more review.
Our new PBL case is really interesting. It's a pediatrics case, which excited one of my group members who wants to go into peds. Even though there is only one case this week, it's one with enough information for us to come up with a bunch of good learning objectives. I am going to be presenting on normal child development for children between the ages of six and twelve. And the best part is that we are going to meet the patient the case is based on this Friday. He's an adult now, but he is going to talk to us about growing up with his illness. I really like when we get to meet patients. It makes these things we're learning more applicable and interesting.
This evening, a really neat doctor named John Fung gave us a talk about how he became a surgeon for the Surgery Interest Group. One of the interesting things about him is that he also has a Ph.D. in immunology, and he managed to combine his research interest with his surgery interest by going into transplant surgery. Since transplants get rejected due to immune processes, his immunology background is really useful. He still runs a lab that does basic science research in immunology as well as performing liver transplants and running the liver transplant center here at CCF. And like all of the CCF faculty, he invited us to come on one of the organ harvests and to see the surgery. I'm not sure how gung ho I am about doing that, but maybe I will over the summer when I have more time. It would be an interesting experience for sure.
I hadn't realized how big the liver transplant program at CCF is. Here is the link to a brochure describing the CCF liver transplant program. It has a little blurb about Dr. Fung and his background too.
Our new PBL case is really interesting. It's a pediatrics case, which excited one of my group members who wants to go into peds. Even though there is only one case this week, it's one with enough information for us to come up with a bunch of good learning objectives. I am going to be presenting on normal child development for children between the ages of six and twelve. And the best part is that we are going to meet the patient the case is based on this Friday. He's an adult now, but he is going to talk to us about growing up with his illness. I really like when we get to meet patients. It makes these things we're learning more applicable and interesting.
This evening, a really neat doctor named John Fung gave us a talk about how he became a surgeon for the Surgery Interest Group. One of the interesting things about him is that he also has a Ph.D. in immunology, and he managed to combine his research interest with his surgery interest by going into transplant surgery. Since transplants get rejected due to immune processes, his immunology background is really useful. He still runs a lab that does basic science research in immunology as well as performing liver transplants and running the liver transplant center here at CCF. And like all of the CCF faculty, he invited us to come on one of the organ harvests and to see the surgery. I'm not sure how gung ho I am about doing that, but maybe I will over the summer when I have more time. It would be an interesting experience for sure.
I hadn't realized how big the liver transplant program at CCF is. Here is the link to a brochure describing the CCF liver transplant program. It has a little blurb about Dr. Fung and his background too.
Friday, February 16, 2007
Neuropsychiatry, PBL, POD, CHI, and Attendance Policy
Yesterday I was still not feeling well, so I didn't go to my clinical research class. I did the readings though. They were about bioethics, and there wasn't very much there that we hadn't already covered in FCM and our online ethics training for med school.
I have to say that I was really looking forward to today's seminar. Our reading was about Freud and Erikson and all the other big psych gurus, and even the term "neuropsychiatry" sounds interesting and full of promise. Unfortunately, the actuality did not match the anticipation. First of all, the seminar leader spent the first half hour of the class fiddling around with the AV equipment, which used up a quarter of our time. When he finally got it working, the majority of the seminar consisted of him showing us movie clips of a baby growing up into a toddler and then a young child. He would stop the movie at various points and ask about what we had seen. The answer was something profound like, "The baby sat up." Wow, the baby sat up. Amazing. We were supposed to spend the last 45 minutes meeting with psychiatrists in small groups to discuss child development, but it ended up being about 10 minutes. To make matters worse, our guy spent most of that time defending the existence of his field. I also still don't feel like I really understand what neuropsychiatry is exactly or how it differs from plain neuro or plain psych. All in all, this was one of the more disappointing seminars that I've attended since I started med school.
PBL went better though. We were right about the diagnoses for this week's case, and I think everyone in my group did an especially good job with their presentations. We also had a talk about how if anyone has to miss a day of PBL (like half the group did on Wednesday), that doesn't absolve them from submitting their learning objective to the portal or emailing it to the rest of us so that we can use it. I had thought that was our understanding all along, but apparently not. Anyway, it is our understanding now.
The POD talk today was really good. It was about neuropathic pain, and the presenter did a nice job of making it interactive. I can always tell when it's a good talk because people ask more questions, and they asked a lot today. The research group is focusing on how to control pain by manipulating the calcium channels in neurons. There are different subtypes of neurons, and the ones that carry pain have unique calcium channels that react differently than other neurons with different calcium channels do. What the researchers were able to do was to convert one type of neuron's reaction into the other's by removing and inserting various calcium channels. It was really neat.
In the afternoon, I volunteered at CHI. There was another CCF media person there taking pictures of us for some newsletter. I was mostly doing the cholesterol and glucose testing again, although I did some blood pressure measurements also. Since one of my classmates wanted to learn how to do cholesterol and glucose, I had her practice doing the test on me. I am pleased to say that my cholesterol and glucose were both excellent, especially my cholesterol.
I came back to CCF to find an email from the deans about the new official attendance policy. The policy says that we cannot have more than one unexcused absence from any course. Courses could be blocks, or they can be yearlong threads like anatomy or FCM. I was not very happy about getting that email. But the more I think about it, the more I realize that what really upsets me is not the policy itself, because the policy is pretty reasonable and fair. What annoys me is that there is even a need for a policy. We were all told from the beginning that attending classes is part of our professionalism competency. So I don't understand why anyone thinks they don't have to attend classes. All I can say is that this is really the wrong school for people who don't want to attend their classes.
I have to say that I was really looking forward to today's seminar. Our reading was about Freud and Erikson and all the other big psych gurus, and even the term "neuropsychiatry" sounds interesting and full of promise. Unfortunately, the actuality did not match the anticipation. First of all, the seminar leader spent the first half hour of the class fiddling around with the AV equipment, which used up a quarter of our time. When he finally got it working, the majority of the seminar consisted of him showing us movie clips of a baby growing up into a toddler and then a young child. He would stop the movie at various points and ask about what we had seen. The answer was something profound like, "The baby sat up." Wow, the baby sat up. Amazing. We were supposed to spend the last 45 minutes meeting with psychiatrists in small groups to discuss child development, but it ended up being about 10 minutes. To make matters worse, our guy spent most of that time defending the existence of his field. I also still don't feel like I really understand what neuropsychiatry is exactly or how it differs from plain neuro or plain psych. All in all, this was one of the more disappointing seminars that I've attended since I started med school.
PBL went better though. We were right about the diagnoses for this week's case, and I think everyone in my group did an especially good job with their presentations. We also had a talk about how if anyone has to miss a day of PBL (like half the group did on Wednesday), that doesn't absolve them from submitting their learning objective to the portal or emailing it to the rest of us so that we can use it. I had thought that was our understanding all along, but apparently not. Anyway, it is our understanding now.
The POD talk today was really good. It was about neuropathic pain, and the presenter did a nice job of making it interactive. I can always tell when it's a good talk because people ask more questions, and they asked a lot today. The research group is focusing on how to control pain by manipulating the calcium channels in neurons. There are different subtypes of neurons, and the ones that carry pain have unique calcium channels that react differently than other neurons with different calcium channels do. What the researchers were able to do was to convert one type of neuron's reaction into the other's by removing and inserting various calcium channels. It was really neat.
In the afternoon, I volunteered at CHI. There was another CCF media person there taking pictures of us for some newsletter. I was mostly doing the cholesterol and glucose testing again, although I did some blood pressure measurements also. Since one of my classmates wanted to learn how to do cholesterol and glucose, I had her practice doing the test on me. I am pleased to say that my cholesterol and glucose were both excellent, especially my cholesterol.
I came back to CCF to find an email from the deans about the new official attendance policy. The policy says that we cannot have more than one unexcused absence from any course. Courses could be blocks, or they can be yearlong threads like anatomy or FCM. I was not very happy about getting that email. But the more I think about it, the more I realize that what really upsets me is not the policy itself, because the policy is pretty reasonable and fair. What annoys me is that there is even a need for a policy. We were all told from the beginning that attending classes is part of our professionalism competency. So I don't understand why anyone thinks they don't have to attend classes. All I can say is that this is really the wrong school for people who don't want to attend their classes.
Wednesday, February 14, 2007
Snowstorm!
We got over a foot of snow last night, and the roads were pretty slushy. I haven't ever seen it snow this much since I got here, and everyone keeps saying that it's unusual for the snow to be this bad in Cleveland. I was sinking in to the tops of my boots. I had wanted to go to surgery grand rounds this morning, so I got up really early. But I still got there a little late. The seminar was about how to decrease the risk to patients who are undergoing surgery by having a medical consultant evaluate them first. Not the most exciting seminar I've ever seen. But the speaker must have been someone big, because they made up posters for him and put them up all over the Lerner Institute.
A lot of my classmates didn't make it to our class seminar because of the snow. It's too bad, because I thought it was a pretty good seminar. The speaker was talking about how we can get drugs to cross the blood-brain barrier and get into the brain. The problem is that only small, nonpolar compounds can easily cross the blood-brain barrier, but many neurological and psychiatric diseases cannot be treated with these kinds of drugs. It's an interesting problem. Only half of my group showed up for PBL, so we finished a little early because we had fewer presentations than we had expected.
My throat is still hurting. The good news it that the snow has finally stopped though, and it's actually sunny outside right now.
A lot of my classmates didn't make it to our class seminar because of the snow. It's too bad, because I thought it was a pretty good seminar. The speaker was talking about how we can get drugs to cross the blood-brain barrier and get into the brain. The problem is that only small, nonpolar compounds can easily cross the blood-brain barrier, but many neurological and psychiatric diseases cannot be treated with these kinds of drugs. It's an interesting problem. Only half of my group showed up for PBL, so we finished a little early because we had fewer presentations than we had expected.
My throat is still hurting. The good news it that the snow has finally stopped though, and it's actually sunny outside right now.
Tuesday, February 13, 2007
Cultural Disparities, Motor Control, and Clinic
FCM was fairly decent today. We met in our small group first and discussed health care disparities for minorities and gays. Then we got back together for a seminar. The speaker was the same guy from Case who I already heard speak about health disparities for gays and lesbians a few months ago, so I didn't go to his talk. I wanted to finish reading the chapter for the motor control seminar anyway. I'm glad I did, because the seminar wound up consisting of the instructor going around the room and asking people to explain what happened in each experiment. This was the homunculus foot fetish guy again. He was basically just outlining the chapter, so I was only halfway paying attention. But when he got to me, happily I had just read the second half of the chapter, so I knew what was going on in that experiment.
I had clinic in the afternoon. Ok, I know I've told you multiple times that seeing real-life patients is nothing like seeing standardized patients. Today was no different in this regard. I was doing the musculoskeletal exam and counseling the patients about smoking. The first part went more or less without a hitch. By this point, we're all pretty comfortable with the musculoskeletal exam. But the smoking cessation counseling didn't go according to plan. I saw three patients today. The first one has never smoked herself, but her husband does. So I counseled her about getting him to come see his doctor for help with cessation. The second patient was a former smoker, but she had already stopped four months ago. So I didn't have much counseling to do for her, obviously. The third patient is a current smoker. Finally, at last I had the chance to counsel someone who actually needs it! I went through the whole spiel with the patient and everything went quite well. The patient even agreed to talk to the physician about getting help to quit. It wasn't until the end of the exam that I found out that the patient is a narcotics addict, which means that smoking cessation is the least of this person's worries.
My throat is sore and I feel kind of lousy. I hope I'm not getting sick.
I had clinic in the afternoon. Ok, I know I've told you multiple times that seeing real-life patients is nothing like seeing standardized patients. Today was no different in this regard. I was doing the musculoskeletal exam and counseling the patients about smoking. The first part went more or less without a hitch. By this point, we're all pretty comfortable with the musculoskeletal exam. But the smoking cessation counseling didn't go according to plan. I saw three patients today. The first one has never smoked herself, but her husband does. So I counseled her about getting him to come see his doctor for help with cessation. The second patient was a former smoker, but she had already stopped four months ago. So I didn't have much counseling to do for her, obviously. The third patient is a current smoker. Finally, at last I had the chance to counsel someone who actually needs it! I went through the whole spiel with the patient and everything went quite well. The patient even agreed to talk to the physician about getting help to quit. It wasn't until the end of the exam that I found out that the patient is a narcotics addict, which means that smoking cessation is the least of this person's worries.
My throat is sore and I feel kind of lousy. I hope I'm not getting sick.
Monday, February 12, 2007
Neuroanatomy Continued and PBL
This week's neuroanatomy session was much better than last week's. For the first half, we had a review of the pathways of the motor system. Afterward, we went into the lab and looked at preserved brains and screens with pictures from a neuroanatomy atlas on them. A lot of my classmates didn't find this exercise very useful, but to be fair, they weren't all exactly putting the most effort into getting something out of it. I wound up going back later on my own to review the structures again with Dr. Drake.
Our PBL case this week has only one patient, but he has two problems. So far it's shaping up to be a pretty interesting case. You might remember how five weeks ago when we came back from winter break, we covered all the anatomy of the arm in a single week. Needless to say, we don't remember much, so we're in major need of a review. I am covering the innervation of the arms for my learning objective. This is a really complex topic. All of the arm nerves come from a group of nerves called the brachial plexus. Here's a diagram of the brachial plexus so that you can see the complexity for yourself. There are five spinal nerve roots that come together into three trunks, which separate again into six divisions, which combine together again to form three cords. These three cords then give rise to all of the nerves in the arms. There are four major nerves (see the diagram,) plus tons of tiny branches. Like I told you, it's pretty complex.
Our PBL case this week has only one patient, but he has two problems. So far it's shaping up to be a pretty interesting case. You might remember how five weeks ago when we came back from winter break, we covered all the anatomy of the arm in a single week. Needless to say, we don't remember much, so we're in major need of a review. I am covering the innervation of the arms for my learning objective. This is a really complex topic. All of the arm nerves come from a group of nerves called the brachial plexus. Here's a diagram of the brachial plexus so that you can see the complexity for yourself. There are five spinal nerve roots that come together into three trunks, which separate again into six divisions, which combine together again to form three cords. These three cords then give rise to all of the nerves in the arms. There are four major nerves (see the diagram,) plus tons of tiny branches. Like I told you, it's pretty complex.
Saturday, February 10, 2007
FAQ #26: How Does Financial Aid Work at CCLCM?
Note: I wrote this post before CCLCM went tuition-free in May 2008. So some of the information below about grants and loans no longer applies for CCLCM students. However, I'm leaving the old post up to help premeds who may be wondering how financial aid works in general. Also, you should know that the Dean's Scholarships are still offered at CCLCM. All CCLCM students get free tuition, but the Dean's Scholars get full tuition plus a stipend that covers all of their living expenses. It is a truly free ride that covers everything.
_____________________________________________________
This is going to necessarily be a very brief overview, because financial aid is a really complicated topic. I recommend that if you have any specific questions, start by going to the CCLCM financial aid webpage for help. If you still don't find an answer to your questions, then call the admissions office (toll free: 1-866-735-1912) and ask to speak to Liz Myers, or email her. She is the CCLCM financial aid director.
There are basically two main kinds of financial aid: grants/scholarships, and loans. This is true at every med school. Grants and scholarships are the best of course, because you don't have to pay them back. Loans do have to be paid back after med school. Depending on the type of loan you have, the interest may be subsidized (paid for you by the government while you're in school), or it may be unsubsidized (the interest is accruing even while you're in school). Considering that our tuition alone is over $40,000 per year (with a total yearly budget of just under $65,000), you obviously want to minimize the amount of money you have to borrow. A list of scholarships and loans is given on the CCLCM financial aid webpage.
Here are the answers to some financial aid questions I've been asked. Again, if you don't find the info you need here, take a look at the website or contact the financial aid office.
1) Can foreign students be eligible for financial aid?
Yes, you are eligible for institutional aid, but no, you're not eligible for U.S. government aid. So you can't get federally subsidized loans, but you can be eligible for CCLCM grants or scholarships. See the international student section of the CCLCM types of assistance webpage for more info.
2) When do you find out if you've been awarded a scholarship?
Financial aid awards are made in the spring. Last year, we got ours at the second look weekend near the end of March. If you're accepted after March, I don't know when you'll find out. But I assume it would be soon after you are given your acceptance, if not with your acceptance.
3) Do you have to fill out FAFSA to be eligible for financial aid?
Yes, if you want to be considered for any type of need-based aid. But you don't have to for the Dean's Scholarship, which is solely merit-based.
4) How many Dean's Scholarships get awarded?
Sorry, I don't know the answer to that, and I'm not sure that it's constant from one year to the next anyway.
5) What do you have to do to get a Dean's Scholarship?
I don't think there's any simple answer to this question. There is no application for the Dean's Scholarship or forms to fill out or anything like that. My impression is that the adcomm is looking for people with unique backgrounds, whatever you interpret that to mean. The CCLCM website is pretty vague on the subject and only says that
These scholarships are offered to a limited number of students in recognition of personal accomplishments, leadership potential, academic achievement, humanistic dedication, passion for research and make an important contribution to the depth and breadth of their class.
_____________________________________________________
This is going to necessarily be a very brief overview, because financial aid is a really complicated topic. I recommend that if you have any specific questions, start by going to the CCLCM financial aid webpage for help. If you still don't find an answer to your questions, then call the admissions office (toll free: 1-866-735-1912) and ask to speak to Liz Myers, or email her. She is the CCLCM financial aid director.
There are basically two main kinds of financial aid: grants/scholarships, and loans. This is true at every med school. Grants and scholarships are the best of course, because you don't have to pay them back. Loans do have to be paid back after med school. Depending on the type of loan you have, the interest may be subsidized (paid for you by the government while you're in school), or it may be unsubsidized (the interest is accruing even while you're in school). Considering that our tuition alone is over $40,000 per year (with a total yearly budget of just under $65,000), you obviously want to minimize the amount of money you have to borrow. A list of scholarships and loans is given on the CCLCM financial aid webpage.
Here are the answers to some financial aid questions I've been asked. Again, if you don't find the info you need here, take a look at the website or contact the financial aid office.
1) Can foreign students be eligible for financial aid?
Yes, you are eligible for institutional aid, but no, you're not eligible for U.S. government aid. So you can't get federally subsidized loans, but you can be eligible for CCLCM grants or scholarships. See the international student section of the CCLCM types of assistance webpage for more info.
2) When do you find out if you've been awarded a scholarship?
Financial aid awards are made in the spring. Last year, we got ours at the second look weekend near the end of March. If you're accepted after March, I don't know when you'll find out. But I assume it would be soon after you are given your acceptance, if not with your acceptance.
3) Do you have to fill out FAFSA to be eligible for financial aid?
Yes, if you want to be considered for any type of need-based aid. But you don't have to for the Dean's Scholarship, which is solely merit-based.
4) How many Dean's Scholarships get awarded?
Sorry, I don't know the answer to that, and I'm not sure that it's constant from one year to the next anyway.
5) What do you have to do to get a Dean's Scholarship?
I don't think there's any simple answer to this question. There is no application for the Dean's Scholarship or forms to fill out or anything like that. My impression is that the adcomm is looking for people with unique backgrounds, whatever you interpret that to mean. The CCLCM website is pretty vague on the subject and only says that
These scholarships are offered to a limited number of students in recognition of personal accomplishments, leadership potential, academic achievement, humanistic dedication, passion for research and make an important contribution to the depth and breadth of their class.
Friday, February 09, 2007
Neuropharmacology, PBL, and POD
Today was a pretty good day. We started out with neuropharm, which I really find interesting. They divided us into two groups of sixteen, but I wound up in the wrong group because I didn't check where I was supposed to go on the portal until afterward. As it turned out, this was a fortuitous mistake, because I ended up in Dr. Najm's group. He did a nice job with his seminar as usual.
Our PBL session today went well. We had a lot of learning objectives to go over since there were two cases this week, but that's a good thing. The past few Fridays have been pretty sparse, and I feel like I got a lot more out of today's session because we had enough learning objectives this time. Next week's case is going to be another double one.
The POD speaker today was an ophthamologist who studies how to prevent retinal damage or detachment in prematurely born infants. Basically, when premature infants are put into incubators with high levels of oxygen, it affects the development of blood vessels in their eyes. The blood vessels don't grow as much as they should because the baby's eyes don't need them in such a high oxygen environment. But as soon as the baby is taken out of the incubator and now is in a normal oxygen environment, the blood vessel growth in its eyes becomes excessive and abnormal, leading to retinal detachment and other problems. That happens because relative to the incubator, the baby's new environment is hypoxic (too low in oxygen). So these researchers are trying to prevent abnormal blood vessel growth and retinal detachment, and they are having some success. Pretty neat stuff.
This afternoon I need to meet with my summer research group, and then I'm outta here.
Our PBL session today went well. We had a lot of learning objectives to go over since there were two cases this week, but that's a good thing. The past few Fridays have been pretty sparse, and I feel like I got a lot more out of today's session because we had enough learning objectives this time. Next week's case is going to be another double one.
The POD speaker today was an ophthamologist who studies how to prevent retinal damage or detachment in prematurely born infants. Basically, when premature infants are put into incubators with high levels of oxygen, it affects the development of blood vessels in their eyes. The blood vessels don't grow as much as they should because the baby's eyes don't need them in such a high oxygen environment. But as soon as the baby is taken out of the incubator and now is in a normal oxygen environment, the blood vessel growth in its eyes becomes excessive and abnormal, leading to retinal detachment and other problems. That happens because relative to the incubator, the baby's new environment is hypoxic (too low in oxygen). So these researchers are trying to prevent abnormal blood vessel growth and retinal detachment, and they are having some success. Pretty neat stuff.
This afternoon I need to meet with my summer research group, and then I'm outta here.
Thursday, February 08, 2007
Clinical Research Class
Today's clinical research class was the best one we've had. I suppose I should start out by saying that I didn't get my paper done in time for class, but neither had anyone else. So the prof gave us a two week extension, which was a huge relief. And instead of being subjected to three hours of mind-numbing powerpoints, we spent the entire class period working on editing our papers and making them clearer and easier to read. Each of us projected a section of our paper on the screen and got comments and suggestions from other classmates, the prof, and the writing specialist. (The same lady who spoke to us about scientific writing last week came back to help us some more today.) I thought it was really helpful, and I feel much better about how my paper is shaping up now.
In the afternoon, I went to anatomy office hours and then to the gym. I was trying to study in the library right after lunch, but it was really tough because I'm so freaking tired. I finally had to give up. Now I'm feeling a little better, but I still have to do my learning objective for tomorrow plus finish tomorrow's seminar reading. If I hadn't mentioned it before, this has not been my favorite block. Two more weeks of neuro to go....
In the afternoon, I went to anatomy office hours and then to the gym. I was trying to study in the library right after lunch, but it was really tough because I'm so freaking tired. I finally had to give up. Now I'm feeling a little better, but I still have to do my learning objective for tomorrow plus finish tomorrow's seminar reading. If I hadn't mentioned it before, this has not been my favorite block. Two more weeks of neuro to go....
Wednesday, February 07, 2007
Neurophysiology, PBL, and Clinical Skills
Dr. Najm was leading our neurophysiology seminar today. I really like him. He gets so excited about anything to do with the brain, and his seminars are always fun. He's one of the directors of our basic science curriculum. The first part of the seminar was pretty basic and a review about ion channels and action potentials. But in the second part, he showed us a video of a patient having an epileptic seizure and we looked at an electroencephalogram (EEG). The takehome lesson about reading an EEG is that seeing repetitive, organized waves is a bad sign. It's too bad that he spent so much time going over the basic stuff on ion channels, because the second half of his seminar was a lot more interesting.
Our PBL case is still good. We spent some time trying to figure out which sensory pathways were affected for each patient, and we got the diagnoses right for both of them. My learning objective is to look up the lab values for one of the patients and explain what they all show. I also have a paper due tomorrow for my class, so it's going to be a busy night without much sleep.
Clinical skills class today went well. We covered the musculoskeletal exam (mainly neck, shoulders, back, and knees) and then reviewed parts of the neuro exam. It's a lot easier to do the neuro exam now that we've actually learned some neuro! Plus, our standardized patient today had great reflexes.
Our communications skill for this week was about counseling patients who are smokers. They gave us cards to use that show a ladder with five levels of readiness to quit. I can't imagine actually using the card with a real patient, but the idea is good. I think if people are resistant to even discuss quitting, there isn't much point in arguing with them about it. But if they're willing to listen and think about it, then it's worth making the effort to help them do it. One thing I hadn't realized is that most people take multiple tries to quit, but they do quit eventually if they keep trying. I also hadn't realized that there are free quit lines nationwide that smokers can call for help. If any of you readers are smokers and are thinking about quitting, you can call 800-QUIT-NOW to get the number for your state. This is the Ohio quitting website, and other states have them too. If you smoke, quitting is the number one thing you can do to improve your health.
Our PBL case is still good. We spent some time trying to figure out which sensory pathways were affected for each patient, and we got the diagnoses right for both of them. My learning objective is to look up the lab values for one of the patients and explain what they all show. I also have a paper due tomorrow for my class, so it's going to be a busy night without much sleep.
Clinical skills class today went well. We covered the musculoskeletal exam (mainly neck, shoulders, back, and knees) and then reviewed parts of the neuro exam. It's a lot easier to do the neuro exam now that we've actually learned some neuro! Plus, our standardized patient today had great reflexes.
Our communications skill for this week was about counseling patients who are smokers. They gave us cards to use that show a ladder with five levels of readiness to quit. I can't imagine actually using the card with a real patient, but the idea is good. I think if people are resistant to even discuss quitting, there isn't much point in arguing with them about it. But if they're willing to listen and think about it, then it's worth making the effort to help them do it. One thing I hadn't realized is that most people take multiple tries to quit, but they do quit eventually if they keep trying. I also hadn't realized that there are free quit lines nationwide that smokers can call for help. If any of you readers are smokers and are thinking about quitting, you can call 800-QUIT-NOW to get the number for your state. This is the Ohio quitting website, and other states have them too. If you smoke, quitting is the number one thing you can do to improve your health.
Tuesday, February 06, 2007
Patient Safety and Organization of the Sensory Nervous System
Our FCM class this morning was about patient safety. We met in our small groups first, and we were given a case to read about a patient who had gotten a morphine overdose in the hospital. It was pretty similar to one of our PBL cases, actually. We've covered this topic several times already, so it wasn't too hard for us to come up with ways to improve the system to make it harder for these kinds of errors to occur. Afterward, the whole class got back together to hear a lecture on improving patient safety. This would have been unremarkable except for a comment by one of the preceptors, who is a surgeon. With typical surgeon arrogance, he proclaimed that the morphine overdose was clearly due to the nurse who administered it being incompetent. As if surgeons don't ever screw anything up, say, by leaving towels inside of patients. That's a man who I can definitely envision getting sued for all he's worth at some point in his career.
Our seminar was really good. We came into the library classroom to hear Celine Dion blasting on the stereo (which wasn't so really good), and all of the chairs organized in a circle in the middle of the room. The speaker had brought a neurology resident with him, and he demonstrated several neurological exams on her to illustrate the cases that we were discussing. I think that this was one of the better seminars we've had since we came to CCLCM. I'm still kind of disappointed that we were learning about touch instead of vision, but we'll apparently get to vision next year. And touch did turn out to be a more interesting subject than I had expected it to be.
After seminar, about half of the class went to the Internal Medicine noon conference. I don't think I've told you about those. They are hour-long clinical talks held at lunchtime every day, and the salient thing about them is that free food is served. Each day has its own standard menu: stir-fry on Mondays, Lebanese on Tuesdays, and so on. One of my classmates discovered this and told all of the rest of us about them. Now a bunch of us have started going. Today's talk was about prenatal care for pregnant women. It was actually pretty interesting. And the Lebanese food was excellent.
Our seminar was really good. We came into the library classroom to hear Celine Dion blasting on the stereo (which wasn't so really good), and all of the chairs organized in a circle in the middle of the room. The speaker had brought a neurology resident with him, and he demonstrated several neurological exams on her to illustrate the cases that we were discussing. I think that this was one of the better seminars we've had since we came to CCLCM. I'm still kind of disappointed that we were learning about touch instead of vision, but we'll apparently get to vision next year. And touch did turn out to be a more interesting subject than I had expected it to be.
After seminar, about half of the class went to the Internal Medicine noon conference. I don't think I've told you about those. They are hour-long clinical talks held at lunchtime every day, and the salient thing about them is that free food is served. Each day has its own standard menu: stir-fry on Mondays, Lebanese on Tuesdays, and so on. One of my classmates discovered this and told all of the rest of us about them. Now a bunch of us have started going. Today's talk was about prenatal care for pregnant women. It was actually pretty interesting. And the Lebanese food was excellent.
Monday, February 05, 2007
Neuroanatomy and PBL
Today's anatomy lab was pretty disappointing. It definitely was not up to par as far as anatomy lab usually goes. Basically, Dr. Drake had us in groups of six looking at preserved specimens of brains and spinal cords with neuroanatomy atlases for part of the time. I don't feel like I got very much out of that. One single spinal cord isn't enough for six people to all get a good look. We also had a classroom lecture portion, which was better. But I hadn't gotten that far in the reading, so it was kind of hard to follow the parts that I hadn't seen yet.
Our new PBL case is awesome though. There are actually two cases, which does make things more hectic. But we came up with several good learning objectives, and this case is a lot more interesting than the ones that we've gotten the past few weeks. My learning objective is about vitamin B deficiencies.
I don't have anything I need to do this afternoon, so I'm going home early. It's really freezing cold here. The high for today was 5 F, with a windchill of -19 F.
Our new PBL case is awesome though. There are actually two cases, which does make things more hectic. But we came up with several good learning objectives, and this case is a lot more interesting than the ones that we've gotten the past few weeks. My learning objective is about vitamin B deficiencies.
I don't have anything I need to do this afternoon, so I'm going home early. It's really freezing cold here. The high for today was 5 F, with a windchill of -19 F.
Saturday, February 03, 2007
FAQ #25: What's the Deal with Second Look Weekend?
It's getting to be time for second look. I hope that all of you who were accepted for next year can come. We had a lot of fun last year, and if you're struggling with deciding where to go to med school, second look will give you a chance to meet your potential future classmates and learn more about the CCLCM program. I've been asked several questions about second look, so I am going to address them in this one post.
1) Can people who are on hold come to second look?
Unfortunately, no. If you haven't been accepted by the end of March, which is when second look is held, you will not be able to come.
2) Does CCLCM cover my expenses?
Maybe, depending on where you are traveling from. We got $200 toward travel expenses last year, plus free room and board. But if you're coming from CA or somewhere else really far away, you may have to pay for part of your airplane ticket.
3) What if I can't come that weekend but I want to revisit?
Call the admissions office and talk to them about making arrangements to come another time. I'm not sure how that would work, but they'd be able to tell you what to do.
4) What do you do at second look?
You'll learn more about the program, meet with current students and faculty, eat a lot of good (and free!) food, and see more of Cleveland. Riding Lolley the Trolley is an experience that no one should be denied. ;-) You'll also get a chance to ask questions about the school to the faculty and current students.
I hope this info helps. If you guys have any more questions about second look, feel free to leave me a comment or PM me on SDN.
1) Can people who are on hold come to second look?
Unfortunately, no. If you haven't been accepted by the end of March, which is when second look is held, you will not be able to come.
2) Does CCLCM cover my expenses?
Maybe, depending on where you are traveling from. We got $200 toward travel expenses last year, plus free room and board. But if you're coming from CA or somewhere else really far away, you may have to pay for part of your airplane ticket.
3) What if I can't come that weekend but I want to revisit?
Call the admissions office and talk to them about making arrangements to come another time. I'm not sure how that would work, but they'd be able to tell you what to do.
4) What do you do at second look?
You'll learn more about the program, meet with current students and faculty, eat a lot of good (and free!) food, and see more of Cleveland. Riding Lolley the Trolley is an experience that no one should be denied. ;-) You'll also get a chance to ask questions about the school to the faculty and current students.
I hope this info helps. If you guys have any more questions about second look, feel free to leave me a comment or PM me on SDN.
Friday, February 02, 2007
Nervous System Seminar, PBL, and POD
I am so tired today and glad that it's Friday! Our seminar was split up into two parts. I was in Dr. Najm's group first. He's hysterical. You know how there are some people who when they laugh, you can't help laughing too? He has that kind of laugh. His powerpoint was like sixty slides long, and I told him there was no way he could get through them all in an hour. He told me that he would, and sure enough he did, but he had to skip some.
The second half of the seminar was led by another neurologist who was puzzling about the fact that the sensory homunculus has the genitals right next to the feet. A homunculus is a drawing that maps where the nerves from each part of the body travel to in the brain. There are actually two homunculi, one for the motor nerves and one for the sensory nerves. If you click on the link, you can see how exaggerated the hands and faces of the homunculi are. This shows how certain body parts, like the lips and fingers, get proportionally more innervation for their actual size than do other body parts, like the trunk. So this neurologist concluded that the location of the genitals next to the feet on the sensory homunculus is the origin of some people's foot fetishes. We told him that the genitals are located there because the spinal nerves that go to the genitals come out of the spinal cord right below the ones that go to the feet. Neurologists are totally weird. I'm adding neurology to my list of possible specialties.
Our PBL session was kind of pointless. I told you that we basically had no learning objectives or case for today. So we talked a little bit about the CAPPs for this week, and then we talked about Medicaid. Here is some really shocking news for you: it's a lot more expensive to get surgery done and stay in a hospital now than it was sixty years ago. And another shocker: it sucks to be poor and not have insurance, especially if you're chronically ill. We wound up getting out a little early though, so I had some time to print out the reading for next week before POD.
POD was kind of rough too. The speaker was doing outcomes research for multiple sclerosis. She was basically doing a pilot project to set up a secure web page for people with MS to be able to communicate with their doctors and get info and support. It's a neat idea, but good god, I was not up for another hour of looking at boring powerpoint slides after that PBL session. Plus, I ate one cookie too many and have been feeling nauseated since about midway through her talk. Since no one really asked questions, she finished early. I have to meet with my PA in a little while to go over my portfolio essay. After that, I'm going home to relax.
The second half of the seminar was led by another neurologist who was puzzling about the fact that the sensory homunculus has the genitals right next to the feet. A homunculus is a drawing that maps where the nerves from each part of the body travel to in the brain. There are actually two homunculi, one for the motor nerves and one for the sensory nerves. If you click on the link, you can see how exaggerated the hands and faces of the homunculi are. This shows how certain body parts, like the lips and fingers, get proportionally more innervation for their actual size than do other body parts, like the trunk. So this neurologist concluded that the location of the genitals next to the feet on the sensory homunculus is the origin of some people's foot fetishes. We told him that the genitals are located there because the spinal nerves that go to the genitals come out of the spinal cord right below the ones that go to the feet. Neurologists are totally weird. I'm adding neurology to my list of possible specialties.
Our PBL session was kind of pointless. I told you that we basically had no learning objectives or case for today. So we talked a little bit about the CAPPs for this week, and then we talked about Medicaid. Here is some really shocking news for you: it's a lot more expensive to get surgery done and stay in a hospital now than it was sixty years ago. And another shocker: it sucks to be poor and not have insurance, especially if you're chronically ill. We wound up getting out a little early though, so I had some time to print out the reading for next week before POD.
POD was kind of rough too. The speaker was doing outcomes research for multiple sclerosis. She was basically doing a pilot project to set up a secure web page for people with MS to be able to communicate with their doctors and get info and support. It's a neat idea, but good god, I was not up for another hour of looking at boring powerpoint slides after that PBL session. Plus, I ate one cookie too many and have been feeling nauseated since about midway through her talk. Since no one really asked questions, she finished early. I have to meet with my PA in a little while to go over my portfolio essay. After that, I'm going home to relax.
Thursday, February 01, 2007
Clinical Research, Histology Review, and Anatomy Office Hours
Today should have been a short day, but that's not how things worked out. I had my clinical research class this morning, and it was like going back to grade school. The speaker was a medical writer who, among other things, reviewed grammar rules with us. I know it's important to consider the audience and make sure my writing is comprehensible to someone who isn't inside my head with me, but wow, three hours of that was a bit rough to endure.
Dr. Prayson had a histology review session for the M1s this morning, but of course the few of us who were taking the clinical research class missed it. I was ok with missing it---I'm pretty sick of histology at this point. But one of my classmates emailed him about it, so he set up a special review session in the afternoon just for us. I didn't really want to go, but I kind of felt obligated to go after he went out of his way to make a second review session. Actually, it turned out to be pretty helpful, and I'm also glad that I went because only one other person besides me showed up. When it was over, I went to anatomy office hours with one of my classmates. There were only two cadavers this week, and Dr. Drake went over them with us. I like neuroanatomy so far. It's a lot more interesting than musculoskeletal was. Obviously I am not cut out to be an orthopedic surgeon, but maybe there is some chance for neurology.
Dr. Prayson had a histology review session for the M1s this morning, but of course the few of us who were taking the clinical research class missed it. I was ok with missing it---I'm pretty sick of histology at this point. But one of my classmates emailed him about it, so he set up a special review session in the afternoon just for us. I didn't really want to go, but I kind of felt obligated to go after he went out of his way to make a second review session. Actually, it turned out to be pretty helpful, and I'm also glad that I went because only one other person besides me showed up. When it was over, I went to anatomy office hours with one of my classmates. There were only two cadavers this week, and Dr. Drake went over them with us. I like neuroanatomy so far. It's a lot more interesting than musculoskeletal was. Obviously I am not cut out to be an orthopedic surgeon, but maybe there is some chance for neurology.
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