Today was my last day of Family Medicine. I can't believe how fast these three weeks have gone by. I went around to thank all of the doctors and staff and to say good-bye, and they were amazed at how fast the time went too. I am going to come back this winter for a physical, though. It turns out that the Cleveland Clinic doctors are on the new Student Health plan that we have through Case this year. (This is the third insurance company that I've had since starting medical school, which is a whole other nuisance, but I won't get into that now.)
Tomorrow we have didactics. I'll be presenting one of my patients for the IM/FM morning report, and the group will be going over the differential diagnosis for headaches. I chose this patient to present because we haven't gone over the differential for headaches yet, and I thought her case had some interesting psychosocial issues that could be contributing to the problem. After that we will have a clinical seminar about chest pain, and I have the POD research class (I still can't get used to calling it ARM) in the afternoon. So it's going to be a long day, because the third year POD/ARM class is three hours long and we have a class meeting after that. Yikes. 7AM to 5PM with an hour off for lunch is a lot of time to spend in the classroom. At a school like CCLCM, a full day of classes ought to just about qualify as treason. I mean, one of the reasons that I came to this school was so that I wouldn't have to spend all day in classes!
Thursday, July 31, 2008
Friday, July 25, 2008
End of Second Week
I'm done now with my second week of family med, and the time is really flying. I am still having a great time. You never know what you're going to see when you come into the clinic. Yesterday I got to observe and help a bit with a minor outpatient surgery. I also met a really fascinating patient who survived pancreatic cancer. The coolest part of his story is that the cancer was found incidentally when he participated in a research study that involved imaging his abdomen. He was extremely lucky that it was found so early, because pancreatic cancer is often too advanced to be cured by the time it becomes symptomatic.
Today we had classes. Like I said before, there is never clinic on Fridays unless you are unlucky enough to have call Friday night on one of the inpatient services. Again, we had a surgery patient presentation, then an IM patient presentation. For both cases, we went through the differential and talked about what studies to order to figure out how to narrow the differential. We never did figure out what was wrong with the IM patient, but that's ok. None of the docs who were caring for this patient figured it out either. After that we had a clinical rounds session on abdominal pain led by two surgeons. We didn't get through more than about half of the cases, but I can see now why the surgeon said that he likes abdominal pain so much. There is a huge differential, especially if the patient is female and of childbearing age. The surgeons ran over, but we had to stay afterward for a path presentation on appendicitis. I was having a very hard time concentrating by this point, and the UP students were upset because they had to get back to Case by noon for an orientation and it made them late. Somehow, we got this whole afternoon off, so I had plenty of time to run all of the errands that I needed to do.
Today we had classes. Like I said before, there is never clinic on Fridays unless you are unlucky enough to have call Friday night on one of the inpatient services. Again, we had a surgery patient presentation, then an IM patient presentation. For both cases, we went through the differential and talked about what studies to order to figure out how to narrow the differential. We never did figure out what was wrong with the IM patient, but that's ok. None of the docs who were caring for this patient figured it out either. After that we had a clinical rounds session on abdominal pain led by two surgeons. We didn't get through more than about half of the cases, but I can see now why the surgeon said that he likes abdominal pain so much. There is a huge differential, especially if the patient is female and of childbearing age. The surgeons ran over, but we had to stay afterward for a path presentation on appendicitis. I was having a very hard time concentrating by this point, and the UP students were upset because they had to get back to Case by noon for an orientation and it made them late. Somehow, we got this whole afternoon off, so I had plenty of time to run all of the errands that I needed to do.
Wednesday, July 23, 2008
Finally Got My Step 1 Score
I didn't sleep very well at all last night. I kept waking up at least once every hour, and I was having these totally bizarre dreams. In one of them, I had gotten a 34 on the MCAT, but it was a 15 VR, 4 PS, and 7 BS. (Note: VR = verbal reasoning, PS = physical science, BS = biological science.) I was worried that I wouldn't get into medical school because of the 4 in PS. (For the record, I know that these subscores only add up to 26, but somehow they added up to 34 in my dream!) In another dream, I was washing my favorite pet cat, now deceased. I had to wash him a little at a time so that he wouldn't struggle while I was bathing him. Because of this, it took me several hours to wash the whole cat. When I was finally done, he was emanating a soft, whitish light. People were crowding around and commenting about how silky and shiny his coat was.
Once my alarm finally went off at 5:20 AM, I got up and went to the computer. I had left it on all night so that I could check for my score as soon as I woke up. My heart was pounding when I logged into the NBME website and saw that the score report was indeed there. I opened it up, and the first thing I saw was the word, "PASS." This caused an immediate resolution of my palpitations (pounding heart) and tachypnea (faster than normal breathing). Then I scrolled down a little farther and saw my actual scores. Total, utter relief. I have been trying so hard for the past three weeks not to think about the USMLE that I hadn't even realized how anxious I was about it subconsciously. I feel like such a huge weight has been lifted off me. I know that this one test score is not the end-all, be-all of residency applications. But I am just relieved to know that if I don't get the residency of my dreams, it won't be because I bombed Step 1.
The score report breaks down your performance by subject area, just like the practice tests I took did. Interestingly, my best subject on Step 1 was micro/immuno, of all things. My worst? Yeah, it was anatomy. No surprise there. :-P
Once my alarm finally went off at 5:20 AM, I got up and went to the computer. I had left it on all night so that I could check for my score as soon as I woke up. My heart was pounding when I logged into the NBME website and saw that the score report was indeed there. I opened it up, and the first thing I saw was the word, "PASS." This caused an immediate resolution of my palpitations (pounding heart) and tachypnea (faster than normal breathing). Then I scrolled down a little farther and saw my actual scores. Total, utter relief. I have been trying so hard for the past three weeks not to think about the USMLE that I hadn't even realized how anxious I was about it subconsciously. I feel like such a huge weight has been lifted off me. I know that this one test score is not the end-all, be-all of residency applications. But I am just relieved to know that if I don't get the residency of my dreams, it won't be because I bombed Step 1.
The score report breaks down your performance by subject area, just like the practice tests I took did. Interestingly, my best subject on Step 1 was micro/immuno, of all things. My worst? Yeah, it was anatomy. No surprise there. :-P
Tuesday, July 22, 2008
Waiting on my Step 1 Score
Today is Tuesday, and the next batch of Step 1 scores should be coming out tonight at midnight. It has been exactly three weeks since I took the test, so it's possible that mine will come out tonight. I'm hoping it will, but I'm also trying not to get my hopes up too much, if that makes sense. At this point, I really just want to know how I did so that I can make whatever plans I need to retake, or study my butt off for Step 2, or plan the celebration, or whatever.
Yesterday, I had clinic in the morning and then another anatomy session on the extremities and pelvis in the afternoon. I was kind of annoyed about having to come all the way downtown to Main Campus for a 1.5 hour anatomy session. But it was required, so I went. Actually, it was really good. These ortho residents were much nicer about pimping us gently than the thoracic surgery residents were last week. The only bad thing was that the cadaver with the arm dissection was kind of sick looking, mainly because of how the skin was peeling off. It made me feel a little nauseated, and I had to take a quick break.
The preceptor I was supposed to work with this morning isn't here this week, so I wound up spending the whole day working with my afternoon preceptor. I haven't worked with him before, but he's pretty cool too. All the family docs have been cool. I screwed up a Pap smear today, mainly because I still don't have the knack of using these plastic speculums. I always have a hard time finding the cervix with them. Plus, this patient had a lot of discharge, and it was hard for me to see what I was doing. On the bright side, it looks like I'll be getting plenty of practice. There is another Pap on the schedule for my morning preceptor tomorrow. I definitely need to work on the neuro and musculoskeletal exams some more also. The doc today loaned me a physical diagnosis book that goes over these exams and told me to practice at home. It's a good book, actually, because it takes you through the exams step by step. Maybe this weekend I will talk someone into letting me practice on them.
Yesterday, I had clinic in the morning and then another anatomy session on the extremities and pelvis in the afternoon. I was kind of annoyed about having to come all the way downtown to Main Campus for a 1.5 hour anatomy session. But it was required, so I went. Actually, it was really good. These ortho residents were much nicer about pimping us gently than the thoracic surgery residents were last week. The only bad thing was that the cadaver with the arm dissection was kind of sick looking, mainly because of how the skin was peeling off. It made me feel a little nauseated, and I had to take a quick break.
The preceptor I was supposed to work with this morning isn't here this week, so I wound up spending the whole day working with my afternoon preceptor. I haven't worked with him before, but he's pretty cool too. All the family docs have been cool. I screwed up a Pap smear today, mainly because I still don't have the knack of using these plastic speculums. I always have a hard time finding the cervix with them. Plus, this patient had a lot of discharge, and it was hard for me to see what I was doing. On the bright side, it looks like I'll be getting plenty of practice. There is another Pap on the schedule for my morning preceptor tomorrow. I definitely need to work on the neuro and musculoskeletal exams some more also. The doc today loaned me a physical diagnosis book that goes over these exams and told me to practice at home. It's a good book, actually, because it takes you through the exams step by step. Maybe this weekend I will talk someone into letting me practice on them.
Friday, July 18, 2008
Friday Didactics
The last couple of days have been pretty crazy, but I'm really enjoying my family med rotation. The preceptors are really into teaching, the nurses are encouraging, and the patients have been a varied and interesting bunch. They've also been super about letting me interview and examine them. I think the key is to start by first asking the patient if they mind talking to you for a few minutes. I've never had a patient tell me no. What better thing do they have to do while they wait on the doctor anyway? Asking if you can talk to them first gives you a chance to build up enough rapport with the person to then ask if they'd mind letting you examine them. I've never had a patient refuse the exam afterward either, even after I've been asking them detailed questions about their sex lives or drug use.
Today I had class all day instead of clinic, and this will be the schedule for every Friday throughout the block. We started at 7 AM with a surgery morning report. One of the students in my group who is doing his surgery rotation right now presented a patient, and the group went through a differential, talked about what tests we should order, and evaluated the results. I didn't really know what I was doing a lot of the time, but it was fun to try to come up with a diagnosis and plan anyway. Afterward, one of the students on internal med presented a patient, and we did the same thing for the IM patient. The IM morning report ended at 9 AM, and then we went through two hours of acute renal failure cases. This was a seminar led by one of the internists, and it was a really good review of the material that we had covered back in May.
There is a huge difference in how the surgeons run their morning report versus how the internists run theirs. Surgeons are much more formal and want everything done a certain way. The preceptor went around the table and asked everyone to answer a question. (I had to interpret the blood test results.) The internist, on the other hand, was much more laid back and informal. Unlike the surgery presentations, which have to be done with powerpoint, the internal med presentation was more like a group discussion. People could jump in and make comments or suggestions whenever they wanted instead of having to wait to be called on by the preceptor. I can see pros and cons to both methods. I like how organized and efficient the surgeons are, but at the same time, they don't seem to have as much room for individuality and creativity as the internists do.
This year, CCLCM has a new buddy program to pair up first years with upperclassmen. I went for lunch with my buddy, and we talked for about an hour until I had to go for my FCM class. Yes, FCM does continue on even after second year. The third year FCM class alternates with the third year POD class. (Note: POD is actually called ARM now.) We have all new groups for FCM that I think will stay together for the next two years. The groups are a mixture of third and fourth years. The thought had occurred to me last year that it would be interesting to have mixed-class PBL sessions. This isn't exactly the same thing, but now I'll have a chance to see what mixed groups are like. Most of the session was in a big group. We were asked to write a paragraph about one of our experiences at the end of it, and then several of us read our paragraphs out loud. I wrote mine about the last patient I saw at the end of second year. That was the one where I picked up an MI by going through the review of systems, which is the kind of experience that tends to make a lasting impression on you.
Today I had class all day instead of clinic, and this will be the schedule for every Friday throughout the block. We started at 7 AM with a surgery morning report. One of the students in my group who is doing his surgery rotation right now presented a patient, and the group went through a differential, talked about what tests we should order, and evaluated the results. I didn't really know what I was doing a lot of the time, but it was fun to try to come up with a diagnosis and plan anyway. Afterward, one of the students on internal med presented a patient, and we did the same thing for the IM patient. The IM morning report ended at 9 AM, and then we went through two hours of acute renal failure cases. This was a seminar led by one of the internists, and it was a really good review of the material that we had covered back in May.
There is a huge difference in how the surgeons run their morning report versus how the internists run theirs. Surgeons are much more formal and want everything done a certain way. The preceptor went around the table and asked everyone to answer a question. (I had to interpret the blood test results.) The internist, on the other hand, was much more laid back and informal. Unlike the surgery presentations, which have to be done with powerpoint, the internal med presentation was more like a group discussion. People could jump in and make comments or suggestions whenever they wanted instead of having to wait to be called on by the preceptor. I can see pros and cons to both methods. I like how organized and efficient the surgeons are, but at the same time, they don't seem to have as much room for individuality and creativity as the internists do.
This year, CCLCM has a new buddy program to pair up first years with upperclassmen. I went for lunch with my buddy, and we talked for about an hour until I had to go for my FCM class. Yes, FCM does continue on even after second year. The third year FCM class alternates with the third year POD class. (Note: POD is actually called ARM now.) We have all new groups for FCM that I think will stay together for the next two years. The groups are a mixture of third and fourth years. The thought had occurred to me last year that it would be interesting to have mixed-class PBL sessions. This isn't exactly the same thing, but now I'll have a chance to see what mixed groups are like. Most of the session was in a big group. We were asked to write a paragraph about one of our experiences at the end of it, and then several of us read our paragraphs out loud. I wrote mine about the last patient I saw at the end of second year. That was the one where I picked up an MI by going through the review of systems, which is the kind of experience that tends to make a lasting impression on you.
Tuesday, July 15, 2008
First Day of Family Medicine Rotation
I had my first day of family medicine clinic today, and it was terrific. I'm at Beachwood Family Health Center, which is one of the CCF suburban family health centers. I did two half-days with two different preceptors: one from 8 AM-12 PM, and then again from 1 PM-5:30 PM. Unlike the IM clinic I worked in for the last two years, the family med docs don't cut back their patient schedule to accomodate the medical students. So there were at least a dozen patients on the schedule for each half day, which is twice as many as there are in the IM clinics. Today I saw seven patients on my own, presented them all to my preceptors, wrote SOAP notes on each one, and logged them all. I also went into the rooms with my preceptors for three or four other patients.
I had expected family med to be fairly monotonous after hearing some of my classmates' experiences with their suburban longitudinal clinics last year, but my patients were surprisingly diverse and interesting. The very first patient I saw had been diagnosed by a specialist with an extremely rare disease that the doc had never even heard of before. I knew what the disease was, but only because I just took Step 1 and it was one of those ostensibly pointless things to memorize in First Aid (the Step 1 review book). Now I'm glad that I learned that info! After that, we had to send the second patient for an immediate specialist consult due to concerns that what she thought was a minor problem might be a medical emergency. (This turned out to be a false alarm, fortunately.) The rest of the patients weren't quite as exciting as these two, but they were still a varied lot, from kids with sports injuries to elderly people with twelve different comorbidities and two pages worth of medications. All in all, it was a really good day, and I'm excited about going back tomorrow.
I had expected family med to be fairly monotonous after hearing some of my classmates' experiences with their suburban longitudinal clinics last year, but my patients were surprisingly diverse and interesting. The very first patient I saw had been diagnosed by a specialist with an extremely rare disease that the doc had never even heard of before. I knew what the disease was, but only because I just took Step 1 and it was one of those ostensibly pointless things to memorize in First Aid (the Step 1 review book). Now I'm glad that I learned that info! After that, we had to send the second patient for an immediate specialist consult due to concerns that what she thought was a minor problem might be a medical emergency. (This turned out to be a false alarm, fortunately.) The rest of the patients weren't quite as exciting as these two, but they were still a varied lot, from kids with sports injuries to elderly people with twelve different comorbidities and two pages worth of medications. All in all, it was a really good day, and I'm excited about going back tomorrow.
Monday, July 14, 2008
CCF Core I Orientation
Today was technically the first day of my Core I rotation, but it was another orientation day. For some reason, we had to be at the Clinic at 7 AM. First, the faculty who are running Core I told us about each rotation in the block. These include family medicine, outpatient internal medicine (IM), surgery, and inpatient IM. I will be starting my actual rotation (family medicine) in the morning. Then the IT people taught the UP students how to use our portal, and one of the librarians told them about the CCF library resources.
We were finished around 10:30 AM, and then we had to wait until our anatomy session began at 3 PM. I spent the time working on my schedule for the winter block, which will begin in November. It's a good thing that I started planning my schedule this early, because it turns out that the block that runs during Christmas and New Years isn't a four week block for Case. So now I'm going to do my research month in December, after I do my geriatrics rotation in November. Have I mentioned lately how difficult this clinical block system makes scheduling electives and other rotations?
The anatomy session was really good. There were only 14 of us, so we were in really small groups for our prosection stations. This was like a normal anatomy seminar for us, but it was a new experience for the UP students. (They do traditional dissection of embalmed bodies.) The UP students in my group seemed to like the prosections. I had spent some time over the weekend reviewing the anatomy of the neck, thorax, and abdomen, but I still am going to need a lot more review before I'm surgery-ready. We have one more of these anatomy sessions next week to go over the limbs and pelvis.
My schedule for Core I is the following: three weeks of family medicine, then three weeks of outpatient IM, followed by five weeks of surgery, and ending with five weeks of inpatient IM. I will be out at Beachwood for my family medicine rotation. Then I come back to the main campus for my outpatient IM, which consists of general IM clinics in the morning and specialty clinics in the afternoon. My three specialty clinics are a week each of outpatient pulmonary medicine, gastroenterology, and cardiology. My first week of surgery will be outpatient specialty clinics as well, and then I have four weeks of inpatient surgery where I will be assigned to one of the surgery services. For inpatient IM, I will have two or three weeks of general inpatient IM followed by two or three weeks of inpatient cardiology. I'm really looking forward to that last bit, because cardiology at CCF is just awesome.
We were finished around 10:30 AM, and then we had to wait until our anatomy session began at 3 PM. I spent the time working on my schedule for the winter block, which will begin in November. It's a good thing that I started planning my schedule this early, because it turns out that the block that runs during Christmas and New Years isn't a four week block for Case. So now I'm going to do my research month in December, after I do my geriatrics rotation in November. Have I mentioned lately how difficult this clinical block system makes scheduling electives and other rotations?
The anatomy session was really good. There were only 14 of us, so we were in really small groups for our prosection stations. This was like a normal anatomy seminar for us, but it was a new experience for the UP students. (They do traditional dissection of embalmed bodies.) The UP students in my group seemed to like the prosections. I had spent some time over the weekend reviewing the anatomy of the neck, thorax, and abdomen, but I still am going to need a lot more review before I'm surgery-ready. We have one more of these anatomy sessions next week to go over the limbs and pelvis.
My schedule for Core I is the following: three weeks of family medicine, then three weeks of outpatient IM, followed by five weeks of surgery, and ending with five weeks of inpatient IM. I will be out at Beachwood for my family medicine rotation. Then I come back to the main campus for my outpatient IM, which consists of general IM clinics in the morning and specialty clinics in the afternoon. My three specialty clinics are a week each of outpatient pulmonary medicine, gastroenterology, and cardiology. My first week of surgery will be outpatient specialty clinics as well, and then I have four weeks of inpatient surgery where I will be assigned to one of the surgery services. For inpatient IM, I will have two or three weeks of general inpatient IM followed by two or three weeks of inpatient cardiology. I'm really looking forward to that last bit, because cardiology at CCF is just awesome.
Friday, July 11, 2008
Bridge Week Day 4
Today was the last day of Bridge Week. We had to come in at 7:30 AM to take a practice Step 2 test for five hours. Taking a practice Step 2 test a week and a half after I took Step 1 (and before I have even done a single rotation!) did not exactly thrill me, but I have to admit that I was curious about what the questions would be like. That's why I stayed the entire five hours and tried to do my best to answer the questions, even though the temptation to mark them all with "As" did cross my mind a few times. I was surprised to find that the test was remarkably doable. I knew the answers to quite a few questions. I'm not saying that I passed necessarily (we'll find out in a couple of months), but I don't think I totally embarrassed myself, either. We have to take three more of these exams: one after Core I, one after Core II, and then one more that we schedule on our own with the administration staff.
In the afternoon, I ordered some books for my rotations, and I registered for two of the electives that I'll be doing at CCF this winter. It turns out that we are allowed to do some of the advanced core rotations with only Core I as a pre-req after all. So I will be doing my geriatrics core rotation this winter. I wasn't expecting to be able to get it done before I take Step 2 for real, so this is a welcome surprise.
In the afternoon, I ordered some books for my rotations, and I registered for two of the electives that I'll be doing at CCF this winter. It turns out that we are allowed to do some of the advanced core rotations with only Core I as a pre-req after all. So I will be doing my geriatrics core rotation this winter. I wasn't expecting to be able to get it done before I take Step 2 for real, so this is a welcome surprise.
Thursday, July 10, 2008
Bridge Week Day 3
Today was a long day of hurry up and wait. We had to be at CCLCM by 7 AM, but it was mainly so that the UP students who are rotating at the Clinic could get their IDs, parking assignments, and white coats. I did get two sets of scrubs that I don't really need, and then three of my classmates and I went for breakfast. We spent the rest of the morning learning how to use EpicCare. This is the Clinic's electronic medical record, which we've been using for the past year in our longitudinal clinics. To be fair, I did learn how to do some things that I didn't already know how to do, but all in all, this morning left me feeling kind of grumpy about having to get up so early for not much value in return. At least the power was back on in the Education Building when we got there this morning.
The afternoon session was better. We got to skip the first hour, which was about the grading policy for the UP students. (The CCLCM students don't get graded, although we do get evaluations.) Afterward, we had a session to learn how to use the Clinical Assessment System (CAS) to log our patients during rotation and research blocks. I was playing around with it later, and amazingly, it's extremely easy to use. It will allow me to document all of my clinical experiences so that I can keep track of how many patients I see with various diseases, procedures I perform, and so on. We also use it to submit forms for the faculty and housestaff to evaluate us. The last event was a student panel with half a dozen fourth years from the UP. About the best advice that I heard today was to treat every rotation as if it were the specialty that I was planning to enter. I thought that was very good advice.
The afternoon session was better. We got to skip the first hour, which was about the grading policy for the UP students. (The CCLCM students don't get graded, although we do get evaluations.) Afterward, we had a session to learn how to use the Clinical Assessment System (CAS) to log our patients during rotation and research blocks. I was playing around with it later, and amazingly, it's extremely easy to use. It will allow me to document all of my clinical experiences so that I can keep track of how many patients I see with various diseases, procedures I perform, and so on. We also use it to submit forms for the faculty and housestaff to evaluate us. The last event was a student panel with half a dozen fourth years from the UP. About the best advice that I heard today was to treat every rotation as if it were the specialty that I was planning to enter. I thought that was very good advice.
Wednesday, July 09, 2008
Bridge Week Day 2
We had to go back to the Sim Center this morning for another four-hour session. Again, we were divided into four groups and we went to four different stations for an hour each. The first station was to practice presenting a patient to an attending. Of course, we all suck at it, but I got the message that we'll get very good at doing this in short order.
The second station was to start IVs and draw blood. It was run by the same anesthesiologist who taught us acid-base first and second year, the one who is really awesome. It was kind of a weird station because we had these rubber mannequin arms with veins, and we were supposed to put the venipuncture needles into the veins. When you got it in right, you would see a little bit of fake blood come up into the needle. What was funniest is how PC the whole thing was. There were some white (Caucasian) mannequin arms, and also some black arms.
The third station was to practice the female exam and deliver a baby. Again, this was all done with rubber bodies. Delivering the rubber baby from the rubber pelvis (complete with a rubber placenta that could be stuck to the inside of the uterus with velcro) was pretty bizarre! Then we had foam breasts with lumps in them, and we practiced doing the breast exam on those. I did a lot of breast exams in clinic with my preceptor, and these foam breasts aren't anything like real breasts! We also did a practice pelvic exam on, you guessed it, a rubber woman's pelvis. The os was amazingly easy to find, much easier than on a real woman. Each time I have done this exam for real, I have never been able to palpate the ovaries, and today was no different. But at least this time I had a good excuse, because the rubber pelvis didn't have any ovaries, just a uterus. :-P
The last station was for the male exam. We did practice rectals on rubber male rear ends. There were four of them set up, one with a normal prostate, one with benign prostatic hyperplasia, one with an early tumor (which I wouldn't have been able to palpate if I hadn't known it was there), and one with an advanced tumor (which was so obvious by palpation that the only way you could miss it was by not doing the rectal exam at all). Then we practiced catheterizing rubber male and female urethras. When you got the catheter in far enough, it would dribble fake urine. Since men have a long urethra, you really have to push the catheter a long way to get to the bladder. I went to catheterize the female model afterward, and got the catheter into the bladder immediately. This is the difference between having a 20 cm long urethra (men) versus a 4 cm long urethra (women).
This was the end of our session at the Sim Center. We went back to the Clinic, and a bunch of us had lunch with the new first years. The power was out in the Education building (I guess because of the storm last night), so it was really hot, humid, stinky, and dark inside. After the lunch, the first years went off to do whatever they had to do, and we had a class meeting about rotation and research requirements. I have already met with Dean Franco about how I want to schedule my last three years of med school, and she thought my plan was fine. My research PI was also ok with it. I'll mention more about it in another post, but briefly, I will be alternating back and forth between clinics and research over the next three years.
After the class meeting, we were done for the day. I went over to Case to get my PPD test done, then went home. I have to be back at 7 AM tomorrow morning, so this is going to be it for tonight.
The second station was to start IVs and draw blood. It was run by the same anesthesiologist who taught us acid-base first and second year, the one who is really awesome. It was kind of a weird station because we had these rubber mannequin arms with veins, and we were supposed to put the venipuncture needles into the veins. When you got it in right, you would see a little bit of fake blood come up into the needle. What was funniest is how PC the whole thing was. There were some white (Caucasian) mannequin arms, and also some black arms.
The third station was to practice the female exam and deliver a baby. Again, this was all done with rubber bodies. Delivering the rubber baby from the rubber pelvis (complete with a rubber placenta that could be stuck to the inside of the uterus with velcro) was pretty bizarre! Then we had foam breasts with lumps in them, and we practiced doing the breast exam on those. I did a lot of breast exams in clinic with my preceptor, and these foam breasts aren't anything like real breasts! We also did a practice pelvic exam on, you guessed it, a rubber woman's pelvis. The os was amazingly easy to find, much easier than on a real woman. Each time I have done this exam for real, I have never been able to palpate the ovaries, and today was no different. But at least this time I had a good excuse, because the rubber pelvis didn't have any ovaries, just a uterus. :-P
The last station was for the male exam. We did practice rectals on rubber male rear ends. There were four of them set up, one with a normal prostate, one with benign prostatic hyperplasia, one with an early tumor (which I wouldn't have been able to palpate if I hadn't known it was there), and one with an advanced tumor (which was so obvious by palpation that the only way you could miss it was by not doing the rectal exam at all). Then we practiced catheterizing rubber male and female urethras. When you got the catheter in far enough, it would dribble fake urine. Since men have a long urethra, you really have to push the catheter a long way to get to the bladder. I went to catheterize the female model afterward, and got the catheter into the bladder immediately. This is the difference between having a 20 cm long urethra (men) versus a 4 cm long urethra (women).
This was the end of our session at the Sim Center. We went back to the Clinic, and a bunch of us had lunch with the new first years. The power was out in the Education building (I guess because of the storm last night), so it was really hot, humid, stinky, and dark inside. After the lunch, the first years went off to do whatever they had to do, and we had a class meeting about rotation and research requirements. I have already met with Dean Franco about how I want to schedule my last three years of med school, and she thought my plan was fine. My research PI was also ok with it. I'll mention more about it in another post, but briefly, I will be alternating back and forth between clinics and research over the next three years.
After the class meeting, we were done for the day. I went over to Case to get my PPD test done, then went home. I have to be back at 7 AM tomorrow morning, so this is going to be it for tonight.
Tuesday, July 08, 2008
Bridge Week Day 1
Today was the first day of the clinical part of my third year. This week is Bridge Week for Case UP and CCLCM students who are doing clinical rotations this year. We only had a half-day of orientation today, although I went over to school early to do some required online modules and run other errands. Tomorrow I absolutely must get over to the Case student health center to get my PPD (tuberculosis skin test) done. I won't be allowed to start my rotation next week if I don't get this done.
Our orientation session today was fun. We went over to the Mt. Sinai Simulation Center on the Case campus. Probably about 50 or 60 students were there, mostly Case and CCLCM third years and some CCLCM fourth years who did research last year. There were four stations: one for reviewing how to read EKGs, one for tying surgical knots, one for reading chest x-rays, and one for stitching cuts. We were divided into four groups, and we spent about an hour at each station. The doc at the EKG station was the same one who taught us about EKGs during our cardio blocks at CCF. I had to be reminded how to tie the surgical knots at the second station, but after I did it once, it came back quickly. I am very glad that I went to that Surgery Interest Group knot-tying session last year. The chest x-ray station was run by an emeritus doctor who was absolutely hysterical. Now I will always remember that alveolar lung infiltrates are patchy, while interstitial lung infiltrates are grainy! The last station was fun too. First, we stitched a quilt, and then we stitched cuts that had been made into mannequin arms. That was pretty weird. The mannequins even had red interiors when the rubber skin on their arms was cut, although they didn't actually bleed!
I had a really good time today, and I am more excited than ever about starting my rotations.
Our orientation session today was fun. We went over to the Mt. Sinai Simulation Center on the Case campus. Probably about 50 or 60 students were there, mostly Case and CCLCM third years and some CCLCM fourth years who did research last year. There were four stations: one for reviewing how to read EKGs, one for tying surgical knots, one for reading chest x-rays, and one for stitching cuts. We were divided into four groups, and we spent about an hour at each station. The doc at the EKG station was the same one who taught us about EKGs during our cardio blocks at CCF. I had to be reminded how to tie the surgical knots at the second station, but after I did it once, it came back quickly. I am very glad that I went to that Surgery Interest Group knot-tying session last year. The chest x-ray station was run by an emeritus doctor who was absolutely hysterical. Now I will always remember that alveolar lung infiltrates are patchy, while interstitial lung infiltrates are grainy! The last station was fun too. First, we stitched a quilt, and then we stitched cuts that had been made into mannequin arms. That was pretty weird. The mannequins even had red interiors when the rubber skin on their arms was cut, although they didn't actually bleed!
I had a really good time today, and I am more excited than ever about starting my rotations.
Monday, July 07, 2008
CCLCM Step I Timeline
This timeline will be most useful for CCLCM students, but some of it might be helpful for students from other schools too.
Late October to Early November 2007:
I registered for Step 1 at the NBME website. This is when the UP students register since they take the test in early March, so we have to register at this time too even though we'll be taking it at the end of June. Registrants pick a three month window, which for CCLCM students should be June-July-August. We are then able to register for any day within that three month period, assuming that there is an open slot at that test site. We paid $480 to register for the 2008 test, but they'll probably charge more in future years, so check on the NBME site.
Late November to Early December 2007:
Time to pick a test site and date on the Prometric website after you get permission to register from the NBME. Don't procrastinate on doing this, because the testing sites will fill up and you might not get the date and location that you want. There aren't any Prometric sites closer than a 45-minute drive away from CCLCM. Some of my classmates took the test in Strongsville or Mentor, which are the closest locations. But I am going to study here for five weeks and then go home to take the test. My date is July 1, which is the last Tuesday of our six weeks off. I think most people are taking it a week or two earlier than I am, but I'm waiting longer so that I can have the Memorial Day weekend off.
December 2007:
I took the NBME Comprehensive Basic Science Exam (CBSE) in mid-December. This exam lasts four hours and covers all of the basic medical sciences. It can only be taken through the school, and it is optional for CCLCM students. Some of my classmates took it last month with the Case students, but I couldn't take it that day. So I asked Wilma (the school administrator) about a makeup, and she was generous enough to arrange a second date just for CCLCM students.
Even though most CCLCM students will fail since we are so early in our second year, it's still worth taking the test. Med students at many other schools are required to take the CBSE as part of their normal curriculum in order to assess their preparation level in the basic medical sciences. The test is by the same people who write the real USMLE, and it gives you a valuable preview of what the real test is like, as well as feedback about your individual strengths and weaknesses. I would guess that about 3/4 of the people in my class took it. If you do sign up to take the test, don't back out later if you can help it. The school has to pay for each student who signs up to take it, including anyone who winds up not taking theirs.
March 2008:
I took my first NBME CBSSA (Comprehensive Basic Science Self-Assessment) over spring break just to get an idea of where I was at that point. This was the first time that I passed the test.
May 2008:
I began studying part time for Step 1 for the last few weeks of school, then full time afterward. Many of my classmates started studying much earlier than this. I took all five of the other NBME practice exams. The school gave us vouchers so that we didn't have to pay for Tests 3 and 5.
Late June to Early July 2008:
Usual time for CCLCM c/o 2011 students to take USMLE Step 1.
Late October to Early November 2007:
I registered for Step 1 at the NBME website. This is when the UP students register since they take the test in early March, so we have to register at this time too even though we'll be taking it at the end of June. Registrants pick a three month window, which for CCLCM students should be June-July-August. We are then able to register for any day within that three month period, assuming that there is an open slot at that test site. We paid $480 to register for the 2008 test, but they'll probably charge more in future years, so check on the NBME site.
Late November to Early December 2007:
Time to pick a test site and date on the Prometric website after you get permission to register from the NBME. Don't procrastinate on doing this, because the testing sites will fill up and you might not get the date and location that you want. There aren't any Prometric sites closer than a 45-minute drive away from CCLCM. Some of my classmates took the test in Strongsville or Mentor, which are the closest locations. But I am going to study here for five weeks and then go home to take the test. My date is July 1, which is the last Tuesday of our six weeks off. I think most people are taking it a week or two earlier than I am, but I'm waiting longer so that I can have the Memorial Day weekend off.
December 2007:
I took the NBME Comprehensive Basic Science Exam (CBSE) in mid-December. This exam lasts four hours and covers all of the basic medical sciences. It can only be taken through the school, and it is optional for CCLCM students. Some of my classmates took it last month with the Case students, but I couldn't take it that day. So I asked Wilma (the school administrator) about a makeup, and she was generous enough to arrange a second date just for CCLCM students.
Even though most CCLCM students will fail since we are so early in our second year, it's still worth taking the test. Med students at many other schools are required to take the CBSE as part of their normal curriculum in order to assess their preparation level in the basic medical sciences. The test is by the same people who write the real USMLE, and it gives you a valuable preview of what the real test is like, as well as feedback about your individual strengths and weaknesses. I would guess that about 3/4 of the people in my class took it. If you do sign up to take the test, don't back out later if you can help it. The school has to pay for each student who signs up to take it, including anyone who winds up not taking theirs.
March 2008:
I took my first NBME CBSSA (Comprehensive Basic Science Self-Assessment) over spring break just to get an idea of where I was at that point. This was the first time that I passed the test.
May 2008:
I began studying part time for Step 1 for the last few weeks of school, then full time afterward. Many of my classmates started studying much earlier than this. I took all five of the other NBME practice exams. The school gave us vouchers so that we didn't have to pay for Tests 3 and 5.
Late June to Early July 2008:
Usual time for CCLCM c/o 2011 students to take USMLE Step 1.
Sunday, July 06, 2008
USMLE Step 1 Resources (Organized by Subject)
General
-First Aid for the USMLE Step 1 (had a love/hate relationship with this book (mostly hate), but it is good as an outline and for tips and mnemonics)
Anatomy
High Yield Gross Anatomy (good for people like me who need extra review, but probably not a very high yield subject for most people)
Behavioral Science
-High Yield Behavioral Science (great, concise book and I highly recommend it)
Biochemistry
-Lippincott's Illustrated Reviews: Biochemistry (strong subject for me, so I only read the 40-page review at the back of this book)
-If I had more time, I would have read Rapid Review Biochemistry
Cell Biology/Molecular Biology
-Didn't study anything specific for this, mainly because I ran out of time and this was one of my stronger areas.
-A lot of people like to use High Yield Cell and Molecular Biology.
Embryology
-High Yield Embryology (cannot say enough about how much I loved this book. Finally felt like I understood embryo, and I wish I had used it during my embryo sessions last year)
Immunology
-Review of Medical Microbiology and Immunology (immuno section only, which I highly recommend)
Microbiology
-Clinical Microbiology Made Ridiculously Simple (good mnemonics and funny drawings to help you remember the bugs and drugs)
-Lippincott's Illustrated Reviews: Microbiology (mainly just read the earlier sections on lab tests for the pictures)
Neuroanatomy and Neurobiology
-Clinical Neuroanatomy Made Ridiculously Simple by Stephen Goldberg (short, easy to read review of neuroanatomy)
-Some of my classmates liked Roadmap Neuroscience, but I found it to be dense and too tough to get through during my study period.
Pathology
-Rapid Review Pathology by Goljan. (Got through this once and most of a second time. Best to use it along with his lectures, but start early if you're going to do this)
Pharmacology
-Lippincott's Illustrated Reviews: Pharmacology (intensive 500 page book with questions; start early if you're going to use this one!)
-High Yield Pharmacology (short, outline format, good later review)
Physiology
-BRS Physiology (looks long and hard, but it's a quick read, especially if you don't do the questions!)
Question Books
-Robbins Review of Pathology (great book for reviewing path, although the questions are easier than the real USMLE)
-Kaplan USMLE Step 1 Qbook (used this to review after I finished studying each subject)
Question Banks and Practice Tests
-Kaplan Step 1 Qbank (used about half of this earlier on in my studying)
-USMLE World Step 1 Qbank (used about half of this toward the end of my studying)
-NBME CBSSA Exams 1-6 (best way to monitor your studying progress. Test 5 was the most predictive for me. CCLCM students get two free tests paid for by the school.)
-First Aid for the USMLE Step 1 (had a love/hate relationship with this book (mostly hate), but it is good as an outline and for tips and mnemonics)
Anatomy
High Yield Gross Anatomy (good for people like me who need extra review, but probably not a very high yield subject for most people)
Behavioral Science
-High Yield Behavioral Science (great, concise book and I highly recommend it)
Biochemistry
-Lippincott's Illustrated Reviews: Biochemistry (strong subject for me, so I only read the 40-page review at the back of this book)
-If I had more time, I would have read Rapid Review Biochemistry
Cell Biology/Molecular Biology
-Didn't study anything specific for this, mainly because I ran out of time and this was one of my stronger areas.
-A lot of people like to use High Yield Cell and Molecular Biology.
Embryology
-High Yield Embryology (cannot say enough about how much I loved this book. Finally felt like I understood embryo, and I wish I had used it during my embryo sessions last year)
Immunology
-Review of Medical Microbiology and Immunology (immuno section only, which I highly recommend)
Microbiology
-Clinical Microbiology Made Ridiculously Simple (good mnemonics and funny drawings to help you remember the bugs and drugs)
-Lippincott's Illustrated Reviews: Microbiology (mainly just read the earlier sections on lab tests for the pictures)
Neuroanatomy and Neurobiology
-Clinical Neuroanatomy Made Ridiculously Simple by Stephen Goldberg (short, easy to read review of neuroanatomy)
-Some of my classmates liked Roadmap Neuroscience, but I found it to be dense and too tough to get through during my study period.
Pathology
-Rapid Review Pathology by Goljan. (Got through this once and most of a second time. Best to use it along with his lectures, but start early if you're going to do this)
Pharmacology
-Lippincott's Illustrated Reviews: Pharmacology (intensive 500 page book with questions; start early if you're going to use this one!)
-High Yield Pharmacology (short, outline format, good later review)
Physiology
-BRS Physiology (looks long and hard, but it's a quick read, especially if you don't do the questions!)
Question Books
-Robbins Review of Pathology (great book for reviewing path, although the questions are easier than the real USMLE)
-Kaplan USMLE Step 1 Qbook (used this to review after I finished studying each subject)
Question Banks and Practice Tests
-Kaplan Step 1 Qbank (used about half of this earlier on in my studying)
-USMLE World Step 1 Qbank (used about half of this toward the end of my studying)
-NBME CBSSA Exams 1-6 (best way to monitor your studying progress. Test 5 was the most predictive for me. CCLCM students get two free tests paid for by the school.)
Saturday, July 05, 2008
My General Advice for Step 1
One thing I will warn you about ahead of time is that everyone you ask will tell you to do something different to ace the boards. I found this out for myself very quickly when I started asking some of the CCLCM upperclassmen what they did to study. Get two of them together in a room, ask them one question, and they'll give you three contradictory opinions. At some point, you need to think about what learning style works best for you, and just trust yourself. You didn't get halfway through med school without developing effective study habits. So use that knowledge to help you develop a plan that will be effective for you.
First, you should decide if you are a group studier or a self-studier. There are pros and cons to working with other students, and I think if you get the right partner or group, then studying with others can be extremely effective. That being said, I'm definitely a self-studier. A lot of my classmates worked together in groups, and I'm not inherently averse to doing that. But I have always been more of a self-studier. I studied on my own for the MCAT, and it worked out very well. So I decided early on not to study with other students. For me, the downside of being around other stressed people when I'm stressed myself far outweighs the benefit to be gained by bouncing ideas off other people.
Second, you need to decide what method helps you retain information best. A few people learn well just by reading, or by attending review sessions and having the info presented to them. Some people learn well using audio lectures. I think that many people learn well by doing a lot of practice questions, and that was the approach I took. I find that it is easy for me to kind of skim through stuff without really understanding it thoroughly if I just read it and don't try to apply what I've read to practice problems. I've always done well in math classes, but I have to work problems. I can't read a math book like it's a novel and hope to retain anything. Ditto for the USMLE.
Here's my general philosophical approach to studying for the boards (or any other exam): You start by figuring out what your weaknesses are, and you work on those first. That's how you get better and ultimately score higher. Plus, every school has certain subjects that are covered very well (cardio at CCLCM is, unsurprisingly, very thorough) and others that aren't as good. (I would say that our micro, pharm, and neuro are not as well-done.) You will need to put more time toward filling in the specific knowledge gaps that your school's curriculum has left. In my case, I needed a lot of work in neuro and micro, and I wasn't familiar with a lot of the drugs for pharm. In addition, since physiology and path are two of the highest yield subjects for the boards, I wanted to make sure I had them both down cold.
People often wonder how long to spend studying. Again, this is something that each person has to decide for themselves. Some of my classmates were already doing board review stuff during our first year. Others basically did nothing until spring of second year. I didn't start studying really hard until May of second year. It's hard to review path much earlier than that because you won't have covered the material in school yet. For CCLCM students, two really good subjects to start reviewing early on in second year are micro and immunology, because we cover those during first year but don't come back to them again second year. Neuro is also a good early subject because that's our first block during second year.
The final piece of advice that I have for you is not to go too crazy buying all kinds of resources. You won't have time to use them all. Pick a few good review books, and go with those (and your practice questions). Most importantly, don't give up. It's hell while you're going through it, but make sure that you work hard during your second year and study hard during your study break. If you do those things, everything will work out in the end.
First, you should decide if you are a group studier or a self-studier. There are pros and cons to working with other students, and I think if you get the right partner or group, then studying with others can be extremely effective. That being said, I'm definitely a self-studier. A lot of my classmates worked together in groups, and I'm not inherently averse to doing that. But I have always been more of a self-studier. I studied on my own for the MCAT, and it worked out very well. So I decided early on not to study with other students. For me, the downside of being around other stressed people when I'm stressed myself far outweighs the benefit to be gained by bouncing ideas off other people.
Second, you need to decide what method helps you retain information best. A few people learn well just by reading, or by attending review sessions and having the info presented to them. Some people learn well using audio lectures. I think that many people learn well by doing a lot of practice questions, and that was the approach I took. I find that it is easy for me to kind of skim through stuff without really understanding it thoroughly if I just read it and don't try to apply what I've read to practice problems. I've always done well in math classes, but I have to work problems. I can't read a math book like it's a novel and hope to retain anything. Ditto for the USMLE.
Here's my general philosophical approach to studying for the boards (or any other exam): You start by figuring out what your weaknesses are, and you work on those first. That's how you get better and ultimately score higher. Plus, every school has certain subjects that are covered very well (cardio at CCLCM is, unsurprisingly, very thorough) and others that aren't as good. (I would say that our micro, pharm, and neuro are not as well-done.) You will need to put more time toward filling in the specific knowledge gaps that your school's curriculum has left. In my case, I needed a lot of work in neuro and micro, and I wasn't familiar with a lot of the drugs for pharm. In addition, since physiology and path are two of the highest yield subjects for the boards, I wanted to make sure I had them both down cold.
People often wonder how long to spend studying. Again, this is something that each person has to decide for themselves. Some of my classmates were already doing board review stuff during our first year. Others basically did nothing until spring of second year. I didn't start studying really hard until May of second year. It's hard to review path much earlier than that because you won't have covered the material in school yet. For CCLCM students, two really good subjects to start reviewing early on in second year are micro and immunology, because we cover those during first year but don't come back to them again second year. Neuro is also a good early subject because that's our first block during second year.
The final piece of advice that I have for you is not to go too crazy buying all kinds of resources. You won't have time to use them all. Pick a few good review books, and go with those (and your practice questions). Most importantly, don't give up. It's hell while you're going through it, but make sure that you work hard during your second year and study hard during your study break. If you do those things, everything will work out in the end.
Tuesday, July 01, 2008
Done with Step 1!
I took Step 1 today, and I honestly have no idea how I did. I feel like I passed, but I'm not sure if I just barely passed or I totally killed it. I know there is at least one question that I definitely missed, and another one that I think I missed except that I can't remember the specifics any more to be sure. There are also a couple of questions I guessed on that I know I got right. I should be getting my scores in 3-6 weeks.
In the meantime, there's not much I can do but relax for the rest of this week and get ready to start my Bridge Week on Tuesday. I'm really looking forward to starting rotations, and also glad that I never have to read First Aid again. (Have I mentioned lately how much I hate that book???)
In the meantime, there's not much I can do but relax for the rest of this week and get ready to start my Bridge Week on Tuesday. I'm really looking forward to starting rotations, and also glad that I never have to read First Aid again. (Have I mentioned lately how much I hate that book???)
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