MINDFUL OF MEDICINE

Happy almost-New Year everyone!

I remember spending so much time trying to figure out what shoes to wear on clerkships before starting. I felt like it should be so simple, but it actually turned out to be a little stressful. The truth is, third year is about many things but one stands out to me in particular: comfort over style. If your feet are in pain it will be hard to do your job. Even so, we all like to feel confident while working so while being comfortable is a priority we can also try to be a little stylish! It can be difficult to invest a lot of money on a pair of shoes especially on a med student budget so I would suggest shopping around and finding the best deals! I've put together some shoe ideas for clerkships and included the links below, I hope this helps!

1. Dansko Clogs: good for both hospital & clinic, and SUPER comfy. They can be hard to walk in at the beginning but you get used to them.

2. Cole Haan Wedges: I love these wedges - they're on my dream list for clinic shoes. I've seen so many people wear them and they look so classy and sleek, plus they're supposed to be really comfy.

3. Clarks flats: these are also on my list (I might have to give in soon since my Vince Camuto flats are on their last leg!). Clarks is known for their comfort and quality. These would be good for clinic, and the wards if you have a short shift.

4. Nike Free 5.0: I included these because I think they're really cute, but any comfortable athletic shoe would be ideal for long hours in the hospital when you're walking several miles in one shift. Surgery and ObGyn (as well as other surgical specialties) are known for allowing athletic shoes and scrubs, but we were allowed to wear them during call days on medicine too! Be warned, though, you might get bodily fluids on your shoes during some rotations and you might end up having to throw them away.

5. Clarks clog: I got these before starting internal medicine and I'm so glad I did. I didn't feel like committing to the Dansko clog at the time and these shoes came in handy. They're light, extremely comfortable, and work for both clinic and the hospital. If you follow me on instagram you've probably seen these a few times.

6. Vince Camuto Flats:  these flats are not only gorgeous, but really comfortable as well. They have a small heel so you're not completely flat when walking. They also feature a padded footbed that resists wear and tear. I bought these in black in June and I think they're the best flats I've ever purchased, plus I always get a ton of comments when I wear them. As a bonus, they're on sale at Dillard's for $58 - I might have to get the light pink and brown ones.

Pediatrics was my second clerkship of third year, roughly September through mid-October. Coming off of medicine I was confident that I knew so many things about management of sick patients and chronic care, you name it, but peds proved to be a whole new world of medicine. Interacting with the whole family unit is one of the biggest things that stood out to me about peds. The patients themselves were so diverse as well; from every socioeconomic class, many different cultures and every age in the peds spectrum. I really hope this post helps some of you budding pediatricians out there or just other MS3's looking for a little more insight!

CLERKSHIP OUTLINE:

• 6 weeks total: 3 weeks inpatient, 3 weeks outpatient (+ 1 week of newborn nursery in the AM during outpatient)


• Scheduled lectures at main campus throughout clerkship


• NBME shelf exam

CLERKSHIP WORK HOURS:

Inpatient: My inpatient weeks took place at the children's hospital. It was so nice actually working as a med student on the wards I that I had volunteered on for seven years in high school and undergrad. It felt very familiar, but different at the same time. Inpatient hours are more challenging from outpatient. I would arrive around 5:45AM in time for morning sign out from the night team. At around 6, the day would start. The day ends around 5:30PM when the team prepares for sign out to the night team again.

Outpatient: I worked mostly in a community clinic that is dedicated to uninsured or underinsured children for most of my outpatient experience. Here the hours were from 8AM to 5:30AM daily with about an hour for lunch.  I worked in the newborn nursery for 1 week during my outpatient experience. I would arrive at the newborn nursery around 7:00AM and leave a little after 12:00PM to return to my clinic in the afternoon. Overall, the hours on outpatient were predictable but definitely left me with less time to study than inpatient.

DAILY LIFE:

Inpatient: I completed the inpatient portion of my clerkship first. After arriving to my team room in the morning, my team and I got sign out from the night team. This includes any significant events from overnight, things that need to be done / ordered, or a simple update that things are going smoothly with our patients. As a med student, the night team isn't really directing the information at you but it's important to write down what's pertinent to patients that you're carrying (typically 2-3, or as little as 1-2 if the service is not as busy as usual) so that you can help your interns / residents during the day. Once sign out is finished, it's time to pre-round on your patients. My interns and residents preferred to join me while I pre-rounded in order to disturb the patient and their parents or families as little as possible. It was also nice to be able to get feedback and come up with a plan with my intern or resident so that what I presented on rounds was an accurate description of what we were really going to do with the patient. Pre-rounding typically happened by 7:30, giving me about an hour to do chart reviews and speak to the overnight nursing staff about my patients. Once pre-rounding was over, I usually had from 8:00AM to 9:00AM to prepare my presentations and a short clinical pearl presentation (Ex: asthma prediction index, short gut syndrome, acetaminophen overdose). Morning rounds last around an hour on peds (much shorter than IM) and the rest of the day is dedicated to following up with patients, getting some studying in, and helping the interns and residents. I always had time for lunch on peds which was really nice. Most days I could study for 2-3 hours throughout the day. On days when I didn't feel like studying I would find a baby to hold, feed, or change - the nurses appreciated it and often would sit and chat with me about their experiences or any advice they had for me. The down time on inpatient can be difficult for some students, but there's ALWAYS something you can be doing to help the team even if no one sees you doing it.

Outpatient: My day started around 8:00AM and the first patient was usually roomed and ready to go shortly after that. Unfortunately, around 80% of my outpatient experience was shadowing. However, many of my friends had amazing outpatient experiences where they were making and implementing care plans with supervision from their attendings. Most of the patients I saw on outpatient were well child visits, viral URI's or constipation. Well child visits can be a lot of fun because every stage of a child's life is characterized by different developmental milestones, nutrition/sleep/fluid requirements, and social implications. I especially enjoyed the well infant visits! The day ends when the last patient leaves on outpatient which is around 5:30pm. During my week in the newborn nursery (aka my FAVORITE week of peds) my role was very unique. I would arrive around 7:00AM and get a new baby to follow, usually one that was born overnight. Since we round at 7:30AM in the nursery, the attendings prefer that we all round together instead of prerounding - this makes it easier on the new moms & dads and, of course, the babies. After rounds, I saw my assigned babies with the residents and helped them with whatever they needed. I also gave "baby talks" to moms and dads that included things to expect when brining the baby home, safety, car seats, SIDS prevention, and reasons to bring the baby back to the hospital (i.e. fever over 100.4).

MOST MEMORABLE MOMENTS:

I loved my peds rotation and took away so many memories. One of my most memorable moments was when I had to mediate between a patient, the care team, and law enforcement regarding a very sensitive situation. My role was important because I was the only one on the peds teams who spoke Spanish. Never would I have thought that I would be discussing suicide and self-harm with a patient, in another language, in such a high-stress environment. It really pushed me to make sure I was helping to give the patient the best care while maintaining confidentiality, confidence and poise. Another memorable moment on peds was in the newborn nursery. I've always had a love and appreciation for infants and their seemingly magical physiology from womb through infancy. I always thought I would be a pediatrician and this clerkship solidified that.

STUDY RESOURCES:

As with all clerkships and NBME shelf exams there are many resources, but I will only speak to what I used. During inpatient I didn't want to be glued to my iPad doing questions and appear unavailable to my team so I used PreTest for Pediatrics. It has 500 questions that cover most areas of pediatrics. It was quick to go through, though significantly less difficult than UWorld. PreTest was a decent resource but it was really useful because I had a paperback copy that, I think, is easier to use on the wards because if your team sees you reading something they won't wonder what you're doing on an iPad or computer. I also used the Pediatrics High Yield PDF / Video by Emma Holliday Ramahi which was incredible at summarizing the most important concepts for the shelf. My favorite resource for the NBME shelf exam was UWorld, though. There just aren't any resources that compare to the level of difficulty and explanations that it offers. I think that mastering the ~380 peds questions on UWorld helped me the most out of all my resources to do well on the shelf.

THINGS I LIKED:

1. The patients. Though the hard days and unfortunate outcomes on peds can be extremely difficult, the good days and happy endings make up for this a hundred times over. I think that pediatrics is a specialty that offers incredible potential - helping a child can result in decades of happiness, smiles and a fulfilling life.

2. The happiness. During my time on peds everyone I worked with was happy doing what they do. From the nurses to the attendings to the overworked residents, they all enjoyed working with our patients. Plus, there were always fun things going on like miniature ponies and guide dogs on the wards, cookies and other treats or decorations just because.

ADVICE:

As with all clerkships, being a good team member and looking for ways to help your residents is essential. On pediatrics, I would recommend working extra hard to make sure the families are comfortable, cared for and made to feel like they are informed and a part of the team. By just sitting with the patients and their families you can learn a lot about more than just medicine. Some of the patients have spent more time in the hospital than at home and it's important that the time they spend with you is as positive as possible. Overall, being compassionate, patient, and hardworking go a long way.

 

 

To start off my series of clerkship overviews what better clerkship to start with than internal medicine! My hope is that this series will be of use to those of you looking to see what different clerkships are like, including things like hours, study materials, and generally how to be successful. I will also be sharing a few things from my own perspective. If you have any questions that aren't addressed by the post please leave a comment or email me!

This was my first clerkship of third year. I only had a week of vacation in between Step 1 and starting third year, which was both good and bad. The good thing was a lot of material was still fresh and burned into my memory which helps a ton on medicine. The only bad part was that I still hadn't fully recovered from the mental and physical aftermath of step 1, but this would have been the case regardless of which clerkship I started with. Overall I'm extremely grateful to have had medicine first, it really does make a difference going forward and sets a solid foundation for the rest of the shelf exams. I learned so much on medicine and enjoyed applying what I had learned during MS1/2 while settling into my new role as a student doctor.

Clerkship outline:

• 12-weeks, with three 4-week blocks for a total of 8 weeks of inpatient, 4 weeks of outpatient.


• Academic half-day once a week, each week.


• NBME shelf exam

Clerkship work hours:

Inpatient: I had two different inpatient settings. My first was at the university hospital and I arrived at 5:30am for morning sign out and left at 5:30 or 6pm after evening sign out. There was no call since residents are either on day shift or night shift. During my first month of inpatient I also had the opportunity to work on the heme/onc & BMT (bone marrow transplant) inpatient services. The hours here were very nice, usually 7:30am to 4:30pm. My second inpatient block was at the VA and the day always started at 7:00am but with a rotating schedule of call so I would get to go home around 2 pm for pre-call day, 7 or 8pm on long-call, 1pm post-call, 5 pm on day-call. No matter what, I was excused by noon for academic half days once a week, though. All inpatient weeks are 6-day work weeks; the day you get off is usually a post-call day. Or when I didn't have call due to a set 5:30am-6pm schedule, I got to pick one day of the week to have off as long as my senior resident was okay with it.

Outpatient: My outpatient experience consisted of mornings and afternoons at multiple university specialty clinics, often switching clinics at lunch. I requested to work in in heme/onc, BMT, and pulmonolgy and ended up doing most of my clinics in these specialities.. I also had one morning of primary care internal medicine. The hours for outpatient were great, almost always 8-12 for morning clinic and 1-5 for afternoon clinics. About once a week I had a free afternoon or morning, or even a cancelled clinic which was great for studying. I got every weekend off during outpatient.

Daily life:

Inpatient: As a med student your day typically starts with getting overnight updates on your patients and continuing to work with these patients or picking up new ones. Depending on the team I'd have 2-4 patients at a time. Rounds are usually around 9 or 10am so depending on when you get to the hospital you have plenty of time to round on your patients by yourself, discuss your plan with your intern or senior, work on your notes and prepare your presentation for rounds. After rounds the rest of the day is dedicated to helping your interns and residents with whatever they need to make things go smoothly, that can include calling different departments for consults, speaking with the nursing staff, running to ask patients a question, or, if you're lucky, a little studying. One of the nice things about the VA I worked at was that med student notes are valid documentation and can be copied by interns/residents and signed off as the progress note for the day (it's always nice to feel like your hard work is actually making a difference!). Your day will end at the end of your shift or when your resident says you may go home.

Outpatient: Your day will start as soon as the first patient arrives, though you should try to be there a few minutes before 8. My outpatient experience was a little unexpected in that 75% of my clinics were basically just shadowing. In the rest of my clinics I got to see my patients on my own, though. The nice thing about outpatient is that there is always protected lunch time so you have a more regular eating schedule or time to sit, study, or relax - that is unless you're spending your lunch driving to your next clinic, which is entirely possible. Your day ends when the last patient leaves.

Most memorable moments:

My most memorable moment on inpatient medicine was an older gentleman at the VA that had lost his hearing but definitely not his personality! Each time I spoke with him I had to print out a list of pre-written questions in large, bold font so that he could read and respond. Once he got going he wouldn't stop talking and he was hilarious, stubborn, and ultimately added a lot of fun to our morning rounds. Another moment I'll never forget was being on the care team of a very sweet and young patient that was losing their battle with esophageal cancer. I had gotten to know the patient and their spouse during their admission to our heme/onc unit for what we initially thought was an admission for pain control. Just a couple of days later the patient had deteriorated and we had a very difficult, heartbreaking conversation with their family about palliative care and hospice. The realness of the situation hit me hard and I'm grateful that the family allowed me to be a part of their care.

Study resources:

The internal medicine shelf exam is the most challenging exam of third year. Studying for it felt a lot like studying for step 1 because it encompasses almost everything you can imagine and requires you to go beyond simply recognizing a disease process, but going a step further to determine the best management and course of action. I approached the shelf holisically. I initialy got Step Up 2 Medicine but soon realized that, while it is a comprehensive review of internal medicine, I simply didn't have enough time to sit and study like I had in the past. I barely read a few pages of it before giving up on it entirely. The medicine section of UWorld for Step 2 is, in my opinion,  the ultimate resource for the medicine shelf. With 1400+ questions of high-yield material, it was the best use of my time. I completed about 20% of the medicine questions during the first 9 weeks of medicine, leaving me with another 80% to complete in the last 3 weeks. It was quite the task but I think it helped me be very successful on the self.

By leaving most of the questions until the end I was able to focus on learning from my patients & researching their pathophysiology and management on databases like UpToDate. You'd be surprised how much you learn but mindfully paying attention to how your patient's diseases are managed and being an active part of their care! Those last 3 weeks before my shelf I worked super hard to finish all of the medicine questions on UWorld. I also made a UWorld Journal by annotating key points from questions in a google doc to review before the exam. By doing most of my studying at the end of my clerkship the material was fresh in my mind on exam day. I'm glad I stuck to UWorld because the questions are much harder than the questions on the shelf exam, there are a lot of questions to review and explanations, and I could flip through questions on my phone/iPad while I was on the wards or in clinic which is really convenient when you hardly have time to sit and study.  Two days before the exam I watched the High Yield Internal Medicine presentation by Emma Ramahi which was an AMAZING review of IM and helped solidify the material.

I understand there are a lot of resources for medicine so keep in mind that this advice is simply my own. I would recommend the following resources: 1. UWorld, 2. MedEd Videos, 3. High-Yield Internal Medicine PDF/Video by Emma Holliday Ramahi - all of her reviews are amazingly helpful, definitely check them out!

Resources I would not recommend: MKSAP, CaseFiles, PreTest (too many questions that are too simple and don't add anything that UWorld doesn't already cover).

Things I liked:

1. I liked that medicine was my first rotation after taking step 1 because it gave me a real-life setting in which to use my knowledge in a very tangible way. This rotation also solidified my presentation skills. I was lucky to work with a great mentor during my first two years of med school that expected a lot of my presentation skills and it really paid off during medicine. Beyond showing up and doing your work, the way you show that you're competent and capable as a med student is essentially through your presentation skills - residents and attendings really place a lot of weight on this! Medicine gave me a great venue to practice and perfect my presentation. And hey, getting told you present like at an intern or 4th year level as a third year is pretty darn flattering.

2. Seeing the full spectrum of adult medicine, from treating sepsis secondary to IV drug abuse to discussing engraftment of a bone marrow transplant. It really gave me an appreciation for the immense scope of practice of internal medicine.

3. How brilliant the doctors I worked with are and their passion for the science of internal medicine and the way they genuinely cared for their patients.

Advice:

Internal medicine is long, challenging and your performance in the clerkship is weighted highly for residency, even more so if you're applying to more competitive specialties. My biggest pieces of advice for success in medicine are to be a good team member, do your best during presentations, and study hard for the shelf. It's important to remember than numbers aren't everything in third year. And though a high shelf exam score will help you qualify for high pass or honors, evaluations will make all the difference. Being genuine, helpful and compassionate goes a long way :).

 

Hello! It's been a little bit since I've posted. I feel like peds was even more busy for me than internal medicine, hence the slacking in the blogging department - oops. I'm now on family medicine and I can't believe I've only got 5 weeks left until the first half of MS3 is over!

I've wanted to share a post on being married in med school since it's one of the most frequent questions I get. Every marriage/partnership is unique so I'm not declaring myself an expert on the subject. But these words are from my own perspective and my hope is that they might apply to other couples out there as well! But first, a little background.

J and I met back when I was a sophomore in undergrad in February 2011. After just a couple of weeks of talking (we were long distance) we knew we wanted to spend our lives together. But, more importantly, we wanted to build a life together from the bottom up. He knew my vision, I knew his and soon they became one. That summer that followed we were married religiously (also known as a katb kitaab) at his parent's house in beautiful North Lebanon. A year later, we had our wedding and we moved in together right before I started med school and he started his masters program. I guess I'm sharing all this to give some background and to give an example that a marriage isn't built overnight, and that it takes years to achieve things; whether that's finally getting to be together after years spent half a world apart, or goals like higher education, career building, and even surviving med school.

As a couple, we are each other's best friend / support system / biggest fan / you name it. We are equal partners in life and have always tried to approach challenges and blessings in this way. Our approach to medical school has been no different. Since starting my first semester of med school, J has always encouraged me to do my best while going out of his way to help me find time to study. To be honest, he's a super competitive person (and pretty brilliant I might add!) so he's often more intense than I am, lol. First and second year were pretty relaxed in terms of time commitments, though I did have to study a lot. Still though, I made my own schedule (should have enjoyed it more when I had the chance!) leaving us with plenty of free time for ourselves. Then came Step 1, also known as a the most mentally brutal and intellectually challenging time of my life. J did his best to ensure that I had time to study and less things to worry about like cooking, cleaning, and running errands. And now I'm almost 6 months into my third year which has been a totally new dynamic for us. Third year entails a lot of hours, on good weeks that means 40 hours. That has forced us to accommodate two work schedules while keeping up with our other responsibilities. There's also less time for ourselves, which makes "us" time more special. Considering that my days of passively learning in a classroom are over, I'd say learning to juggle demanding schedules while maintaining balance has been valuable and will continue to be so for the rest of our careers. Through these years I've learned a few things about being married in med school, and so I'd like to share a few key thoughts.

- Foundation. A strong foundation is the basis to any relationship and even more so in a marriage. I think that it's crucial to talk about your goals early on and how you plan on getting there even if you don't have an exact plan. Even more important, however, is having common goals in the first place. Communication is absolutely vital in this area. Establishing yourselves as a strong duo early on is the most important thing about married in medical school. There will be hard days, weeks, and months but being there for one another no matter what is a beautiful thing. For some of us med students, medical school is the most challenging thing we've ever gone through. Having someone who makes it easier on you by supporting you, cheering you on, and helping you out is priceless.

- Priorities. This is something that will depend on your personal beliefs and desires in life. For me, second only to our faith, my little family is my highest priority. That means that just as I set aside time to study or figure out my rotation / study schedule I also make sure that there is "us" time set aside. It honestly keeps me grounded and is my happy place. I think it's important to discuss priorities early on so there are no surprises.  As a woman in medicine, the idea of priorities is a deeply complex and challenging concept. There are already so many expectations placed on women that adding the responsibility of a medical career may seem daunting. A supportive partner can make all the difference. Another issue that may arise in the realm of "priorities" is that of whose career is more important at any given time. This can be especially challenging when a couple has two high-powered careers. I think it's important to respect and admire each others accomplishments and make space for them. While medicine is a life-long commitment, so are other careers and they are no less important to those in them than medicine is to us.

- Balance. Medicine can be consuming; it may take more than you would expect from your mind, body, and soul. Going through something like that can be taxing, but it doesn't always have to be. That being said, the stress and difficulties you experience as a med student will inevitably be shared with your partner. Expressing how you feel and getting through it together is not only cathartic, but makes you stronger as a couple. Do not feel that you must give 100% of yourself to medicine, your partner, your responsibilities, your children, etc at all times because it is simply not possible; and while the areas you are focusing on thrive, others will suffer. Your focus and energy will often be shared among many things but remember that you have the power to choose which parts get the most of you. Self-care is often forsaken in medicine, but how can we heal others if we ourselves are withering? Taking care of yourself is so important, and will help keep your relationship healthy.

- Reward. How special is it to become a doctor alongside the person you love? It is a privilege and should be treated as such. Being able to tell my husband about all the cool and fascinating stuff I learn, the memorable patients I meet and my ever-changing specialty interests is pretty special. Med school is hard, but it is temporary. And, as in life, there are hard times. But try to appreciate them,  they often teach us more than the easy ones and let us learn new things about ourselves and our partners. Celebrate your successes with your partner, recover from your failures together and appreciate the little rewards along the way, there are many.

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I've learned so much in these last few years in med school that goes beyond facts and clinical pearls and I'm grateful to go through every step alongside my husband. In the end, a partner should make the hard things in life easier. Med school is a big feat, but it's not the impossible mountain for relationships that some make it out to be.

I'm excited to share an interview I did for my fellow med student and blogger Anum who blogs at whatmedstudentsfeel.wordpress.com.

Our presence as women in medicine continues to grow and I'm proud to be part of a community of fellow female med student bloggers working hard to empower and inspire women at all stages of their medical career. Click the link below to see some of my honest answers on marriage, motivation, faith, feminism and discrimination.

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I think that those of us who've dreamed of being a physician do so for one overarching reason: to help people. The desire to genuinely improve the lives of others often serves as motivation to get through all of the challenges that come along with working towards a career in medicine. I often hear about third year medical students allegedly becoming "jaded" as they go through their clerkships, losing parts of their humanism and ability to empathize as long hours, difficult interactions and the nuances of working become the norm. This is something I heard about almost as soon as I started med school. And, from the sound of it, it seemed inevitable. It also seemed to be met with a dichotomy of opinions: some people saw this potential disillusionment as a badge of accomplishment to be praised along the road to becoming a bonafied physician; while others (myself included) saw it as something worrisome, unreal and (hopefully) avoidable.

 



 



 


 

Thanks for reading!

 

 



 


 


 

From left to right: my sister, my mom, my youngest sister, and me.

Happy October!

Fall fashion is my favorite. It's cozy, sophisticated and usually modest which makes this season a good time to stock up! Since I started third year I've learned the value of a good work wardrobe. With limited time to go shopping these days it's been hard to add pieces to my closet but thankfully I found a wonderful store that has a ton of clothes I love all in one place: Loft. This isn't a sponsored post, I just wanted to share some of my favorite Loft finds in case anyone needs some cute, sophisticated work clothes (most of which I've actually purchased!).

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Button back sweater || Everyday blouse || Feminine tunic

       

Cozy cardigan 1 || Cozy cardigan 2 || Cozy cardigan 3

 

I'm officially four months into third year which is totally crazy to me. This is the year we all look forward to as med students, but I often find myself looking back on my first two years with nostalgia. That's not to say MS3 isn't exciting, just that I wish I had enjoyed those first two years a little more. So here are 5 things I wish I knew as an MS1!

1. Don't buy all those books! Starting first year the biggest questions on my mind were "how do I study, and what resources do I need?" I was so accustomed to undergrad where the resources were concrete: lecture slides, notes, and sometimes a course textbook. I rushed to buy textbooks during my first block that I never ended up opening. Don't feel the need to buy every book or resource that's thrown at you. Take the first couple of blocks to understand how you learn best because the amount of knowledge you need to amass and commit to memory is unbelievable so being honest with yourself is a necessary skill. Honestly, I didn't figure out how I learned best until the middle of my second year. It's all about being honest, being flexible and listening to your needs! If I could go back I would take a more minimalist approach in terms of resources and ask for advice from upperclassmen more often.

2. Relax, you have more time than you think. One of the biggest differences between my undergrad experience and the first year of med school was how much time I had. Whereas I was struggling with juggling multiple majors, volunteering, work and my personal life during undergrad, my med school schedule was a lot more simple because the scheduling was done for me. I actually had way more time the first two years of med school than I ever expected. If I could go back I would tell myself to take advantage of that time. Besides studying I would spend more time on myself and less time worrying about not having enough time!

3. Shadowing is important. I think I greatly underestimated the value of shadowing. I was wrong to think I would be "in the way" and wish I would have taken more advantage of the free time I had my first two years to shadow. If I could go back I would tell myself to shadow in every single specialty I find even a little intriguing. I think it would have helped me shape my vision of a career sooner and with more confidence. Plus, shadowing in medical school is so much better than shadowing as an undergrad. Physicians are incredibly receptive to med students shadowing and some will even let you actively participate.

4. Spend more time with ones you love / doing what you love. It was easy to get caught up in the "I need to study 16 hours a day to be a successful med student" mentality when I was surrounded by my competitive classmates. My second semester of MS1 I decided to podcast from home and only attend required lectures and it did wonders for my sanity, lol. I think it's super important as a med student to keep parts of your life separate from medicine, and I have a feeling this will remain true during my career! If I could go back I would tell myself to slow down and take more time for J & Melo, my family, my interests and my inner peace overall.

5. Enjoy it. It is such a privilege to be able to study medicine. I often think of all of the factors that have lead to my ability to pursue my dream and it helps me to put things into perspective. I always try to keep a positive outlook on life and the last two years have been no exception. This is a point I would recommend to anyone, even if you're not going into medicine. If you're doing what you love, why not just enjoy the process and do good along the way?

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I spent the last month of internal medicine at the VA medical center. I had a wonderful team that made my time there a little more fun.  My team consisted of a senior resident, two interns, a podiatry resident rotating through, and two med students (myself included). Though having outpatient (clinic) hours at the end of my rotation would have made it easier to study for my shelf exam, having inpatient hours at the VA wasn’t bad at all. Things run a little slower at the VA and it made it a good place to get a lot of studying done when things got really slow. During my last week I picked an on-call day to keep track of so I could share what a day on the wards is like!

(Some details may have been changed to protect patient privacy)

6:00am. J and I wake up and start our day. He gets ready to go to the gym and I get Melo ready for his walk.

6:25am. I feed melo and start getting ready. I stare at my elliptical and yoga mat in my study room and regret not having time to exercise before work but console myself with the fact that tomorrow is post-call and I’ll get out early enough to get a great workout in.

6:45-7:00am. I grab my salad, overnight oats and apple out of the fridge and hop in my car. I’m lucky that it only takes me 6 minutes to get to work! When I arrive at the VA I stealthily find a parking spot close to my building (it’s a bit of a challenge avoiding security to be able to park in the lots closer to the hospital since students don’t have anywhere safe to park).

7:10-8:30am. When I arrive in the team room I get settled and check to see if both of my patients are stil on the board and they are. I check with my interns to see if they need me to see anyone else and they don’t. I grab my breakfast and go to the conference room where there are extra computers. I go through each patients' chart and check new labs, imaging results, and see if there are any notes from the night team. Once I’ve written down all of the pertinent results and have started a draft of my daily progress notes, I get ready to go see my patients - also known as pre-rounding.

8:30-9:00am. My first patient is asleep and I wake her up to do a focused physical exam that includes heart, lungs, abdomen and checking for edema. She looks much better today and I think she’ll get to go home soon. My second patient is doing well, too, but is having a hard time coming to terms with the changes that will come when he gets bilateral nephrostomy tubes. I spend some extra time with him and let him talk. At the same time I feel sad because I know that this year is the last time in my medical career that I will have time to chat with patients like this.

9:00-9:10am. After seeing my patients I go find my patients’ nurses to see if anything important happened overnight (sometimes even bowel movements are important overnight events!). Then I wait for my intern in the team room so we can discuss the plan for each of my patients. The plans are pretty straightforward and include routine labs and watchful waiting so I don’t have to make any phone calls today.

9:10-9:45am. Our attending is set to arrive around 9:45 for rounds which gives me a solid half-hour to get some UWorld questions done. My team understands that our shelf exam is coming up so they don’t mind us studying whenever we get a chance.

10:00-11:30am. The attending arrives and suggests we do “table rounds” today (we discuss each patient in the room instead of at bedside) since our team is on-call and will start admitting patients from the ED at 2pm. This gives the team some time to write notes and orders before we get really busy. After we finish table rounds me and the other med student eat our lunch and do more questions until we start admitting.

2:00pm. The day-call team drops off the admission pager exactly at 2’oclock and my team gets a new admit almost immediately. I volunteer to take this patient and proceed to do a chart review before going down to the ED to do a full H&P (history & physical exam). My patient’s chart history is extensive and I have to sort through hundreds of old notes to get a good picture of what my patient’s medical history is.

2:30pm. My intern and I have finished our chart review and we head down to the ED with our senior resident to talk to the patient. When my intern and resident have finished asking their questions they give me a chance to ask my own. We then go on to do a complete physical exam.

3:00pm. After the H&P, my intern and I sit down to talk about the plan for our patient. Since this is a new patient we have to have a holistic approach and do a comprehensive workup. I start to work on my admission note (at this VA medical student notes are considered valid and it really helps out the team workload) and it takes me a little over an hour to make sure I’ve written a good note.

4:30pm. A code blue comes through our teams “code pager” and we rush down to the chemo infusion suite (the team on call carries the code pager all day and responds to any code). By the time we arrive, the anesthesia and cardiology code teams have already arrived and there isn’t much for us to do. Once the patient is stabilized, my team heads back up to our team room.

5:00-6:45pm. I go over my note with my intern and get some feedback. Once my note is finished I ask my team if they need me to do anything. I go check on my patients before I sit down to do some UWorld questions.

7:00pm. This is technically the end of our call day and our resident lets me and my co-med student go home. I feel a little guilty knowing that the team will likely stay working at least a couple more hours but I’m really excited to go home, eat and spend time with J & Melo.

Hello!

I just finished my first clerkship of third year - internal medicine! It was 12 weeks long and thankfully every clerkship from now on will be 6 weeks, except for neurology, psych, and my surgical subspecialty elective (anesthesia) which are 3 weeks. Studying for the internal medicine shelf exam (we have national NBME exams at the end of each rotation) felt a lot like studying for step 1 and brought back a lot of memories. Now that it's been three months since I took step 1 I feel like I can share some honest study advice, particularly in terms of scheduling and what resources I used. I think that the emotional struggle of step 1 prep is worthy of a post of its own so I won't be focusing on that just yet.

There are many resources available and it really just depends on what works for you. Personally I used five:  1)  Firecracker, 2) Pathoma, 3) First Aid, 4) Picmonic, and of course 5) UWorld.  I used a combination of these during my first and second year. When I started second year I tried to be more proactive and began going through approximately 300 Firecracker questions every day when I started  to to supplement what I was learning in the current block and to help me remember older topics. By the time winter break of MSII rolled around I started to get nervous about the huge challenge of studying for step 1 even though the actual exam was 6 months away at the time. Making a schedule helped me plan my time and set goals for myself. I officially started studying for Step 1 at the beginning of my last semester of MSII. Since my dedicated 6-week study period started at the beginning of May, I had January through April to set a good foundation for myself. 

At the beginning of January, we took a practice NBME (NBME 12) through our school. I used my score as a starting point for my studying and as well as source of motivation for improvement. From January to the end of April I went through all of First Aid once. I did this by covering one section a week, which was tough since some were much longer than others! I would start by flagging all of the corresponding topics on Firecracker and reviewing them as I read through & annotated First Aid (annotating was really important since it helped me make a better mental map of the material!). I also watched the associated Pathoma videos for each section if there was one. As you might imagine, the Firecracker questions really piled up. I often struggled to get through my sometimes massive number of questions per day but I think it was worth it in the end. I have friends who stopped using Firecracker at this stage because it was too much, and they did just fine. I used Picmonic religiously for the microbiology section, particularly the bacteria and parasites.

In order to get through all of the studying I had to do during those three months I had to prioritize step 1 over my block studying. In order to do this I scheduled the First Aid sections that matched my block material a week before the block exam so I could multi-task. Personally I found that First Aid and my other resources highlighted what was actually important whereas block material can be more broad. In the end, I did better than my personal average on those last two blocks without even looking at class notes or listening to podcasts. This approach worked for me but remember to stick with whatever works for you!

By the end of April I had finished Pathoma, First Aid, Picmonic (the microbiology specifically) and Firecracker. I had also done about 693 UWorld questions sporadically throughout. Before I entered into my 6 week dedicated study period I re-evaluated by resources and made my official step 1 study schedule. Firecracker had been a foundation for my learning in the blocks and during my first pass review of everything. I decided to stop using it during by 6 weeks, however, because I didn't have time for it anymore. I also officially added UWorld to the mix. UWorld is indispensable as far as step 1 studying goes. Looking back, I learned more from it than anything else.  One of the most challenging topics for me was pharmacology - there are SO many drugs you need to know! - and I found the pharmacology flash cards by Lange to be extremely helpful. I got mine from an upperclassman and they had already written important additional information on them which was very useful.

Scheduling my 6 weeks seemed like a daunting task but thankfully there was an excel sheet circling around my class from a third year at the time. Using it as an example was so helpful and I was able to tailor it to fit my personal needs. I've linked it here and at the bottom of this post! Using this schedule I was able to get through approximately 1 section of First Aid with the associated Pathoma & pharm flash cards, and a few sets of 44 UWorld questions per day four the first four weeks.  One of my goals for the first four weeks was to get through all of UWorld once, so some days I did more questions than others. During this time I did questions according to what section I was reviewing. Overall, this was a time of heavy review and solidifying high-yield concepts. The last two weeks were dedicated to reviewing the material once more while getting through as many timed-tutor "random" sets of UWorld questions as a I could. I purposefully scheduled sections that I thought were difficult towards the end so that I would see them closer to my test date. For me, these were neuro, biochem and micro.

In terms of practice tests, I used four: NBME 13, 17 and the UWorld Self-Assessment Forms 1 & 2. I scheduled these at different points during my 6 weeks. The UWSA are famed for being difficult but having a very generous curve so UWSA 1 was the first one I took. It helped my confidence but also showed me my weaker areas. I took NBME 13 and NBME 17 next. These had a different question style than UWorld and had no curve. They were hard and definitely didn't give me confidence boost like UWSA 1, lol. I think NBME 13 and 12 (which I took in January) were a lot more realistic than NBME 17. I finished off with UWSA 2. Overall I think Step 1 was much more like UWorld in terms of question style and difficulty than the NBME exams.

Throughout my 6 weeks I kept a "UWorld Journal" in the form of a Google doc as well as handwritten notes. I would go through each completed quiz and write down the key facts that I was asked about. I think this was the single most helpful thing I did. I was able to review these notes throughout my study period and commit tons of high-yield material to memory.

Compared to my NBME 12 practice exam score in January, my actual step 1 score improved 68 points overall. Step 1 studying will be a very challenging time in your life but use it as an opportunity to grow and surprise yourself. It was honestly the hardest I've ever worked and it challenged me in ways that go beyond intellect. The only thing I would have changed about my approach is I would have started going through First Aid during first year.  If I could offer one piece of advice about this entire process from the bottom of my heart it would be to try your best every single day even if you feel like you can't because you want to be able to look back on this fragile time without any regrets.

Below is a dropbox link to my 6-week schedule complete with a sheet called "checklist" which helped me track what I was doing and what I needed to complete next. Feel free to download it, share it and edit it to fit your needs!

https://www.dropbox.com/s/ffv6f9qpnfsjid5/Step%201%20Study%20Schedule%20Blog.xlsx?dl=0

If you have any questions please leave a comment below or email me!

Hi everyone!

I've been pretty busy these days since I'm currently on my last few weeks of internal medicine. It honestly feels like I've been on this rotation forever and that's because it's a whopping 12 weeks long! I've learned a lot during medicine and as my knowledge base has grown, so have the contents of my white coat pockets. Now that might sound comical (it is) but it can also be really heavy on the shoulders. So to optimize my pocket contents I've narrowed it down to a few essential things!

 


 


 


 


 



 




          

 

Happy Sunday!

One of the most common questions I get is how to be organized, and rightly so. Getting and staying organized is a continuous process. As life changes, so do our priorities and responsibilities. Now as a professional student, organization is an absolute necessity.

We all remember grade school when we first learned how to write in our planners, right? Well, I'll be honest, that was one of my favorite things ever #NerdSinceDay1. Opening up a fresh planner and filling it with tasks was so exciting for me.  Granted, the tasks back then were much simpler and now sometimes cringe at all that I have to do. Nevertheless, a system that keeps you organized like a calendar, planner, or both is priceless. My favorite calendar to use is iCalendar. It links to my macbook, iPad, and iPhone so I can check it on whichever device I have on me. It's not a special app, but it's practical and accessible. Plus, I can set alerts a day ahead so I don't forget about important events - this is totally necessary, I can't tell you how many meetings I would have missed without my calendar alerts. Here's a snapshot of my calendar from back in June when I had a week of meetings, required school sessions, and appointments before starting clerkships. I don't get too fancy with the color coding, but I do use purple for personal events, green for extra-academic tasks, and blue for school-related things.

I still love a good planner, though. Even though I mostly used to-do lists during the first two years in addition to my iCalendar, I totally believe that a planner would have substituted nicely for both of those things. There are some great planners out there, in a wide variety of styles to fit any schedule. These are some of my favorites (click the pictures for links)!

        

     

So after you've got some visual tools like a calendar, an app, or a planner (or all three!) to organize your responsibilities, the next step is staying organized.  I think the two most important elements to staying organized are flexibility and accountability. 

Things change, often unexpectedly, so whatever plans we make must be flexible enough to be rearranged. That can seem as simple as erasing a task in your calendar but it's really more than that. A calendar and planner are tangible things, but the stress of altered plans or additional responsibilities can lead to internal stress. But expecting change can be a great tool in mindful organization. Personally, it helps me stay flexible and less stressed when things do change.

Accountability is another timeless component. At the end of the day you should decide what your goals are for staying organized. Are you trying to do a stellar job in undergrad to get into med school? Are you a med student just trying to get through the craziness of juggling academics and things like research, volunteering,  and clerkships? Or are you someone who has multiple roles like being a spouse and a student? Understanding your goals is important because it is what shapes the trajectory for your success. At the same time, not holding yourself accountable can hurt you greatly. For example, replying to and keeping track of emails is something I'm constantly working on. I've missed a meeting just because I didn't check my email again to make sure when it was taking place and it looked bad. I'm far from perfect but I'm constantly holding myself accountable and identifying areas of improvement and I like to think it's helped me grow.

I hope this post was helpful to those wondering about organization. The best way to organize your life is to use things that work for YOU. No one's schedule, goals, or responsibilities are the same so tailor your organization strategy to your own needs and don't be afraid to reassess and change things up.

Thanks for reading  

Happy Friday!

One of my all-time favorite dishes is my mom's green chicken enchiladas, and they've quickly become one of J's favorites too! I don't know what it is about tortillas, chicken, and salsa verde blanketed with cheese but when they come together it's magical. Top the fresh-out-of-the-oven enchiladas with fresh onion and sour cream and you have yourself a bonafide flavor explosion. I also love enchiladas for breakfast with an over-medium egg. I just love enchiladas, can you tell?

Since I find myself craving my mom's enchiladas more often than I'm proud of, I started experimenting with my own salsa verde recipe. My mom doesn't write down any of her recipes so she just gave me some basic instructions and told me to play around with the ingredients. Sounds easy right? Well it wasn't. I'll be honest, the first two..or three times the salsa didn't turn out very good (something J wasn't afraid of pointing out, lol!), but I think I've finally figured it out.

What you'll need:

12 tomatillos (medium-sized) - remember to peel them and wash them well if this is your first time working with them

1 jalapeño or serrano (add more if you want it spicier!)

1 hatch chile

1/2 white onion

2 cloves of garlic

1 bushel of cilantro - chopped

1/4 tablespoon sea salt

A saucepan, an oven & a blender

Directions:

1. Turn the oven to broil and place the hatch chile on a baking sheet. Make sure to turn it every two minutes. Don't let it burn! When it has toasted, pull it out and let it cool.

2. While the hatch chile cools, add tomatillos and jalapeño/serrano peppers to a saucepan and cover with water. Turn the heat on high and wait until the tomatillos turn from their original green to a lighter color. As soon as this happens remove the pan from the heat and drain the water - if you cook the tomatillos too long the skin will burst and you'll end up with a sour salsa.

3. Peel the hatch chile once it has cooled.

4. Add the cooked tomatillos & jalapeño to a blender along with the onion, garlic, cilantro, and salt.

5. Blend the ingredients until the mixture is an even consistency.

6. Serve and enjoy!

All in all, preparing and making the salsa verde takes less than 15 minutes. I use it on enchiladas, for dipping tortilla chips, on eggs, and even as a sauce for chicken breast.

Happy Wednesday, everyone!

I can't believe this week is halfway over - time is really flying by (or maybe I'm just dreading being back on inpatient hours in a couple of weeks). I want to share an interview I did for accepted.com. I had a chance to answer some questions about medical school admissions, clerkships and a little bit about me.

Enjoy  

Hi everyone. I'm currently on outpatient medicine (i.e. clinics) and while it's a lot slower than inpatient, I'm enjoying the laid-back hours and much-needed time to study. I've been thinking of doing something fun on the blog for a while now, and I'm happy to announce a book giveaway!

Back in June I got an opportunity to read and review "So You Got into Medical School...Now What? A Guide to Preparing for the Next Four Years," by Dr. Daniel Paull. Being so busy with Step 1 and and the start of clerkships it took me a few weeks to get through, but I found it to be an entertaining and insightful read. As I've gone through these last couple years of med school it's become clear that oftentimes students, including myself, are unaware of what big milestones are coming up and how they all fit into the big picture.

In his book Dr. Paull does a wonderful job of providing this much needed information while including funny, relatable stories of med students in relevant situations. Half the battle of medical school is figuring out what you should be doing next, and this book is a great resource for navigating medical school milestones. Though detailed and insightful, the first and second year-relevant topics were no longer applicable to me. I was lucky to have read the book before starting clerkships since the third and fourth year topics were a great resource for how to tackle the clinical years and applying for residency!

I only wish I had been able to read the book before starting first year - it would have cleared so many things up for me. Med school is a challenging time, but it goes beyond academics. I've often felt like I was just fumbling along trying to keep up with logistical details like planning for board exams, clerkships, letters of recommendations, and most importantly - residency. As a first year some of these things seemed so far away and I assumed they would just fall into place by themselves. That's just not the way things go, and I had to learn the hard way.

I believe that the best tool a new medical student can have is an idea of what to expect. As such, I would like to share what this book has to offer with a few of my followers. Dr. Paull has been gracious enough to provide me with three copies.

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Contest Details

- How to Enter:

1) Subscribe to my blog on the left sidebar with an email address to receive future blog posts via email.

2) Follow me on instagram and repost the giveaway picture posted on my instagram page using the hashtag #mindfulofmed. For an extra entry you may mention a friend in the comments section of the original giveaway picture on my page!

- I will choose (1) winner from new blog subscribers and (2) from instagram.

- The contest is open to US residents only - sorry international friends!

- The contest will run for two weeks. You can enter anytime between August 7th, 2015 - August 20th, 2015.

- I will choose the three winners on August 20th and will contact them shortly afterwards.

Good luck!

Disclosure: I received a complimentary copy of the book from the author.

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For more about the book and the author visit Dr. Paull's website.

Hi guys! A few weeks ago I shared some of my thoughts on the first week of my internal medicine rotation. A lot has happened since then, including finishing my first month.

The first month has been all inpatient medicine, that means it has all been in the hospital. I spent the last two weeks on the inpatient Hematology/Oncology & BMT (blood and marrow transplant) services. I was getting pretty tired during my first two weeks of general inpatient medicine since the schedule was a grueling 6am-6pm (might have been harder since I was fasting) with only one day off each week, but the Heme/Onc and BMT services both featured an amazing 7:30am-5pm schedule with weekends off - gasp! I started with a week of Heme/Onc and then switched with the other med student on the service and finished off with BMT.

HemeOnc. Transitioning from patients with a seemingly endless list of problems on general inpatient medicine to patients whose main problem is their cancer was interesting, and it also made presenting to my attending surprisingly more challenging (in medicine, interns, med students, residents and fellows are all expected to present their patients to their attending during morning rounds). Whereas I was presenting a bunch of problems on general medicine, my Heme/Onc patients have a very specific problem for which they've been admitted to the hospital - this is usually for induction chemotherapy (the first part of their chemotherapy), management for side effects, or other problems that general medicine teams feel more comfortable referring to the Heme/Onc service. In order to understand my patients, let alone present them, I had a lot of learning to do in a short amount of time. This is because Heme/Onc is a vastly research-based field where new treatment regimens can come into practice at any time. Therefore it's crucial to read up on the latest chemotherapy treatments for each patient, as well as other treatments like radiation that may be helpful in their overall management and comfort. Even though the hours were more relaxed, Heme/Onc was really intellectually challenging. More importantly, the patients themselves were also extremely special people. All of the patients on the service were so wonderful to work with - it says a lot about a person when they've been handed a difficult diagnosis yet they stay kind, cooperative and easy-going. This service was also a sad one, however. My most memorable patient of the week is one I probably won't ever forget. The patient was for pain secondary to metastatic esophageal cancer. It felt like a routine admission for pain control; one that would surely be discharged in a day or two. He was so kind even while he was in so much pain. I also got to know his wife, a hopeful woman who loved her husband very much. He quickly deteriorated and what seemed like a small problem on admission spiraled out of control just days later. It was heartbreaking, and I can't even begin to understand what it would feel like to be in the shoes of any family that has experienced something like that.

My week on Heme/Onc was great. Morning rounds were usually done by 11am and the rest of the day was dedicated to orders and management of whatever came up during the day, which generally wasn't much. It was a pretty quiet service. Some days, however, the Fellow and I would venture down to the pathology department where we would discuss certain patients or odd diagnoses with the Heme Path team - that was pretty fun. Overall, I learned that although Heme/Onc is very intellectually stimulating and a scientifically pioneering specialty, it is also very emotionally demanding.

BMT. Getting comfortable with the jargon (there are SO many acronyms in oncology!) and work flow of the Heme/Onc service made my transition to BMT a little easier. The BMT service is dedicated to treatment of "fluid" cancers like leukemia, lymphoma, myeloma, etc. In many ways it is more specialized than Heme/Onc. BMT also involves some pretty cool procedures like BMT harvest, biopsy and transplant. As a med student on clerkships you're pretty much useless after rounds (when you present to your attending) so the rest of the day is usually what you make of it. Since the BMT service had significantly less patients to take care of I got to know them all pretty well. While my Fellow and the PA on our team fielded orders and other nuances, I had the option of either studying or going to see patients. Most days I chose to study (third year is basically working on top of the same study load I had during MS1 & MS2), but other days I would visit patients and just sit to talk with them. They seemed to enjoy the company, and I really enjoyed getting to know them as a person instead of just a patient. Oftentimes it's easy to see a patient as a set of problems, orders and scheduled procedures since that's what keeps you busy, but I feel lucky to be a med student with significantly less responsibilities than the interns/residents/fellows because I can use my time to get to know the patients. It always amazes me how interesting patients are once you're able to chat with them. Unfortunately I know that I won't always have the time to spend with patients like that so I'm taking advantage of it now!

All in all, Heme/Onc and BMT were extremely interesting and I learned a ton. While this wasn't my first exposure to BMT (I volunteered in the pediatric BMT unit in high school), it was my first exposure to Heme/Onc, and my first time seeing adult patients in either field and I enjoyed it more than I thought I would! Also, both the Fellow and the PA on my BMT team complimented by presentation style and said they both wish they could present more like me - which obviously made me feel so cool lol.

Tomorrow I start my month of outpatient clinics. I'll be working in our cancer center, as well as the infectious disease, pulmonary, and endocrinology clinics. It should be more laid-back than inpatient medicine, and I'm excited to be able to study more often for our Internal Medicine Shelf Exam coming up in September which is famously difficult.

Have a great week everyone!



Happy Friday, everyone!

I just finished the first week of my internal medicine clerkship. This clerkship is 12 weeks long, with 8 weeks of inpatient medicine as well as 4 weeks of outpatient (clinics). I started off with two weeks of inpatient medicine and will finish off my first month with another two weeks of inpatient hematology/oncology (so excited). Starting third year has been quite the whirlwind. I chose to start with internal medicine because I recently took Step 1 and the material is still pretty fresh in my mind. It’s also supposed to be a great foundation for the rest of clerkships. So not only is internal medicine the longest clerkship, it also seems to be the most important in terms of how residencies look at your third year performance!

Monday started off with a morning orientation and then I had to report to my assigned team that afternoon. My team consists of two interns (PGY-1), a second year resident (PGY-2) and a senior resident (PGY-3). The residents were informed that we were brand new third years and that this was our first day ever. So basically they knew not to expect a whole lot from us the first day. That afternoon I followed my resident as we saw some patients in the ICU that were being downgraded to our service and even got to translate for a patient, something my team was super grateful for (apparently having a Spanish-speaking med student is quite the luxury!). I stayed at the hospital until 6pm for sign-out to the night team. At sign out the day’s patient’s are discussed, including any significant changes to their management so that the night team knows what to expect.

Tuesday was what I would consider a “typical day” on inpatient medicine. The morning started bright and early at 5:45 am. I was assigned my very first patient who was in the ED (emergency department) and was being admitted to our service. I performed a full H&P (history and physical) and then prepared my presentation before rounds. Rounds typically occur around 9am for us, so I had a couple of hours to get familiar with the patient’s history and fine tune my presentation. As we walk from room to room, patients are presented to the attending and we discuss any important things that happened over night. We also decide what needs to be added or changed to the patient’s management, what other specialties need to be called for a consult, and what labs or imaging needs to be done. Rounds are a great time to learn new concepts or realize that you don’t know something. My attending will ask me a few questions here and there, this is something called “pimping.” Pimping can be pretty stressful but I’m lucky to have a very kind attending, though I’m sure I’ll encounter many other attendings with different personalities along the way.

Rounding can last until 12 pm at which point the attending goes on to do his own thing and the patients are left in the care of the rest of the team. While the residents and interns deal with patient orders and procedures, my job is to help them do their job the best I can. This can include anything from calling for a consult, scheduling a specialty appointment, requesting records, or even translating. By 6pm the night team has arrived for sign out it’s time to go home. My senior residents have been really nice and I’ve been pretty fortunate to be excused a few hours early each day, which has been a treat since I’m fasting and being on my feet all day can be somewhat challenging.

One thing I noticed about internal medicine on my rotation, beyond the fact that everyone works extremely hard is that there is a genuinely kind and enthusiastic culture to it. I’m actually enjoying internal medicine a lot more than I thought I would and learning a lot about the physician I ultimately aspire to be.

Have a wonderful weekend!  

Hi everyone!

I'm currently busy doing a week of "transitions" to third year and will start my internal medicine clerkship on Monday! I'm nervous but mostly excited to not be in lectures any more and to actually get out of my comfort zone and learn some real, hands-on doctoring. I'm still mentally recovering from Step 1 and I hope I'm ready to begin studying for the medicine shelf / Step 2 next week. Although I have yet to receive my score for Step 1, I've been trying to figure out what worked for me and what didn't. And in the midst of this thought process I keep coming back to my study approach for the MCAT. So I wanted to share a few things I would have done differently.

1. Find the right resources.

Being a first-generation college student can be really challenging in all kinds of ways, and preparing for the MCAT was no different. Often times there are resources that go undiscovered simply because we don't know where to look or that there even are resources available. In retrospect, I didn't talk to enough people who had taken the MCAT before me for advice and I wish I had. Your peers are great resources, use them! But don't get stressed out when someone else's approach is a lot different from your own, just use their advice and modify it to what works best for you.

I didn't take a course prep course. At the time, I couldn't afford it and resented it. But after getting feedback about it from a few of my friends I'm glad I didn't take it because it really sounded like a waste of time and money. Granted, if you're the type of learner that needs to be guided through different subjects then it might work for you. But if you're a more self-guided learner then I wouldn't recommend it, but that's just my two cents.

In order to ensure you're getting the right resources make sure to ask around because people who have been through it will give you some great insight. Also Tumblr and Reddit have great MCAT and premed sections - but be careful, these forums can be a little neurotic so try to not stress yourself out unnecessarily. Do your research, decide what works for you, and stick with it.

2. Be organized.

Looking back at my schedule for dedicated Step 1 study I wished I had done the same for my MCAT. Even though you don't get dedicated time off to study (unless you take a summer to study or another break), I think I could have easily incorporated some structure into my undergrad schedule. I would recommend laying out a schedule of classes, work, volunteering, etc and adding dedicated study hours to it. You will be able to track your progress and it will also be satisfying to see how much you've accomplished.

2. Start early. 

I took my MCAT in April 2012 and started studying that January. I started early, but I was also very passive with my learning which had its consequences. At the time I didn't know what practice question resources were available or how helpful they would be. I wish I had done more questions and been more of an active learner overall. After studying for Step 1 I learned the value of practice questions and saw how most of the material I've retained came directly from these questions. They're also a great way to gauge how well you're progressing and if you're ready to take the exam. Starting early can give you ample time learn a lot of material, but also redirect your studies if you find something that is or isn't working.

3. Be honest.

One of the biggest mistakes I always made when studying in undergrad was not being honest with myself about knowing a concept. I think it's really easy to assume you'll just remember something and move on. When in reality you won't remember and you'll wish you had spent a little extra time on that concept. So be honest with yourself! If a concept is hard, it's tempting to skim it and never come back to it. I can't tell you how many times in undergrad I thought to myself "Wow, that's a little confusing, it can't be on the test" - and it was ALWAYS on the test! So I fixed my approach for med school and it carried me through Step 1. By forcing yourself to be honest with what you truly do not know and committing yourself to taking a little extra time to learn something you set yourself up for success. In the end the only person you're cheating is yourself, so it's definitely worth it to be honest and power through.

4. Be confident. 

Going into Step 1 I was confident. I was confident that I knew all I could know in the amount of time I had to know it in. It was a reassuring feeling. And I consciously reminded myself to be confident during the test. I don't remember feeling confident about the MCAT. At all. Whether it's a practice test at home or the real thing, confidence is a huge factor in performance, at least for me. So be confident, because you always know more than you think you do!

 

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