We all just got back from spring break. It was wonderful. We all spent a full week without thinking about studying. And then, today, we got hit by a train.
Sometimes, in medical school, you feel like you're the little engine that could. As long as you keep at it, you're sure to get enough of the info down to pass. You will probably even get above and beyond passing and do well. At first, the mountain of material seems pretty intimidating, but you're sitting on top of that little engine. Slowly but surely, you learn what you have to and get through.
Sometimes, however, you take a break. Spring break. You are no longer on the medical school express. You got off the study train and relaxed. Rightfully so, too! Everyone needs some time off. The problem is that now, instead of being the little engine that could, you are sitting there on the train tracks about to get run over by that same medical school express that you were riding a week earlier. You show up at 8:00AM on Monday, and in 2 hours you watch as the lights on the train of 224 powerpoint slides from Dr. Hamill's infectious disease lectures blaze right toward you. Then, the pounding, grinding wheels of Dr. Kretzer's oration about the retina drill you into the earth as the train whisks right over your broken body.
It's not the end of the world, but we've all got busted skulls to mend and trains to catch.
I made an enormous mistake today, and I
wandered down a dark, ugly path. I saw it coming, and I did nothing to avoid
it. I suppose it was fairly inevitable. To be fair, it would have taken extreme
willpower and even courage in the face of peer pressure not to commit this
mood-souring blunder.
After my infectious disease exam, today, I
discussed my answers with a classmate.
Unless you're more laid back than I am or
you're smarter than I am, discussing the exam only leads to heartache. It
catalyzes the post-exam grieving experience. Without this nudge, you might have
remained forever in the wonderful beginning-stage of ignorant bliss. True,
there is a chance you are only prolonging the inevitable because, eventually,
you will find out your grade. The truth is, however, that by that time you will
probably be in a much calmer state. You will be better prepared to receive the
news, good or bad, of how you performed on the test. It’s also true, however,
that we’re all a bit obsessive compulsive in medical school. So, you can’t wait
until then. You’ve gotta find out now.
And so, today, I discussed my exam with a
friend, and I experienced the stages of post-exam grieving. You might have also
experienced it. It goes like this:
Stage
1: Ignorant Bliss
First, you walk out of the exam feeling
like you probably got all 122 questions right. It's hard to believe, but you
feel there's a good chance you actually aced it. You have never aced a test in
medical school, but you studied hard and this test might be the one. It’s
incredible! You now face the difficult choice of studying for your next test or
going home and celebrating.
However, a friend asks you about a question
on the test. One thing leads to another, and you discuss all the questions you
might have been a tad unsure about (but which, of course, you were originally sure
you guessed correctly).
Stage
2: Disappointment, anger, and revenge
A short conversation and several minutes
later, you are writhing about the stupid questions you missed and the
incompetent professor who wrote them. You reflect, thoughtfully, that out of
all the many professors who lectured you on this subject, all of the questions
you know you missed came from just one of them. You start scheming about what
you're going to say on the evaluation of that professor and dream about how
your well-placed words will stick it to him. Your insightful comments will
unmask both his lack of intelligence in addition to his ineptitude at teaching
to the rest of the faculty and the administration. Surely, they must not know
about this professor’s serious flaws; otherwise, he wouldn't be teaching. It's
your chance to make a difference. Oh boy oh boy, time to funnel this
disappointment into something that will benefit the rest of the student body
and, perhaps, the world.
Stage
3: Mellowing out and acceptance
You begin to write the scathing
aforementioned evaluation. But then, as you begin to write it, the feelings of
anger and resentment start to fade away. Truthfully, you want them back. It
felt good to be mad at the professor and to have an excuse for your shortcomings,
to have an excuse for the fact that you studied some of the wrong things too
long and some of the right things too little. But, writing it served the same
outlet that exercise or music or a number of other venues would have served,
and now you have released some of that negative energy and can only look to the
future.
What's done is done, and you start to accept
it. You accept that you didn't ace the test, you accept that you didn't get the
highest score in the class, and you accept that other students who probably
didn't work as hard as you did probably still did better than you. You accept
the ugly principle of diminishing returns and agree than maybe you won’t study
as much next time.
Then, you continue to move on.
Stage
4: Optimism
Your feelings morph from that of acceptance
into the higher level of optimism. It’s not just true that there are other
people in the class who did better than you, but it’s also true that you are
certain you passed. Not only did you pass, but you’re still confident that you
did pretty well. You’re not sure if it’s “AOA well”, but you don’t really care.
You realize that you’ve learned a lot of things that will help you on your rotations,
and you look forward to it. Looking forward to that day, you are reminded of
the medical school Bohemian Rhapsody parody (see below) and can’t resist but
hum along to yourself “grades don’t
really matter… to meeeeeee”. You know what? Life is actually pretty good.
You’re one step closer to being a doctor!!!
I am so lucky to go to a medical school that treats us to study snacks during exam time, including string cheese, snack packs, fruit snacks, cheddar crackers, chips, popcorn, etc...
It's enough to make anyone want to come to BCM, methinks!
It's test week. I try not to study on Sundays, so I was up at 5 to
study for today's test. We had the neuro written test at 8:30, and I have a
practical at 2:30. Tomorrow is ethics, Wednesday is infectious disease, and
Thursday is behavioral science. I think most students don't experience nearly
the degree of test anxiety that they used to. We're all just longing to get
this over with and move on.
I just checked my
email, and what do I find but a rejection email from theAnnals of Family Medicine.
Adding another one tothe
listmakes 3 rejections from
3 journals. As if they anticipated my depression, only aggravated
by the fact that it's exam time, they took the time to make their rejection
email a bit personal.
We are delighted that you took the time
and effort to reflect on and write about your experiences, and we encourage you
to keep writing. The Annals does not usually publish work related to
education and training, however. You might consider submitting your essay to a
journal with a greater focus on that area.
Thank you for considering the Annals for your work, and best of luck.
It's very arguable that a real human being over there took the time to write a bit of this email instead of signing a template rejection. Silver linings!
It's a total game changer. Now, when I make notecards to study, I use pen and pencil.
High tech infectious disease notes.
I'm not really sure how much more advanced I can get.
Yesterday I talked about being smart how you study. The thing is, different things work for different people. For me, writing stuff on notecards and looking at them frequently helps me memorize stuff. I figured out, though, that if I write the term or the bacteria in pen and then the information in pencil, it helps me organize things a bit better. It sounds so stupid, but this has really been very helpful for me.
Some people like to make hundreds (I know students who literally make thousands) of notecards, but I prefer to squeeze in more information on one card. It makes me feel like I'm being more efficient because I don't waste time flipping cards. All the high yield info is right there. In reality, I might just too stinking cheap to want to waste note cards. I hope that's not true because it sounds incredibly stupid. Other people use electronic flash cards, which are nice because usually you can use a set that someone else made and save time. Anyways, you just gotta find what works for you and do it. You don't have to be a genius to do well in medical school, you just gotta be focused.
In college, most people probably know students who studied all the time but still didn't get good grades. Maybe that was you. I rarely studied in groups in college, and the few times I did were never a good experience. When I did, it seemed like the people I studied with had the attention span of a gnat. Not only that, but they frequently seemed to study things that weren't important. I would tell them the things I was sure would be on the test, but they didn't really pay attention and missed those questions on the test. Nonetheless, they probably spent more time studying than I did.
I bring this up because I feel like a hypocrite. Sometimes I still hold on to what worked in college, and it turns out it doesn't always work that well in medical school. In other words, I've found it's difficult not to embrace low yield study habits (gasp!). It's tempting to think that, just because you're looking over notes, a book, or a powerpoint, that you are learning the material. That you're digesting it, absorbing it, and engaging it. In the back of your mind, you always know there might be more effective ways to study, but they take work. So, you don't do them.
For instance, you could actually draw out neuro pathways instead of staring at pictures of them. It's so easy to stare at pictures, and thinking of drawing a pathway sounds like a pain in the butt and, more often than not, you're just too lazy to do it. But you're still willing to spend hours staring at pictures.
Or maybe you're willing to read the teacher's syllabus several times, but you're not willing to actually think about the posted learning objectives.
Or maybe you do some practice questions, but you're not willing to think about why the incorrect answers are actually incorrect.
Or maybe you look for hours on the internet for anatomy pictures or information about a bacteria instead of actually checking your notes or actually going to the anatomy lab.
Or maybe when you're in a study group, you don't take advantage of the chance to quiz each other.
And so on.
And so it is that I've come to realize even more than before that someone who has good study habits doesn't necessarily study all the time. Some people are lazy because they don't spend any time studying, and others are just lazy because they study ineffectively. And some people are just a lot smarter than you and remember most things they read. That's life.
Anyways, to try and improve my studying, I actually drew out the neuro pathways recently, and it really helped. Yea for not being lazy.
I actually didn't know this before I came to BCM, but the global health department here is very strong. There is actually a global health track that you can enroll in, which utilizes BCM's school of tropical medicine. Two of the major requirements of the track are to do a 1 month rotation abroad and to also complete a 1 month course to get a certification in tropical medicine, which is apparently a pretty expensive and time consuming thing to do outside of medical school. If you're into tropical medicine, this is a great deal and opportunity, and BCM is probably a great choice for you.
Today I attended the last lecture of an introduction to global health elective. Although not all lectures have been amazingly exciting, some of them have been inspiring in both content and lecturer. One of the lecturers was Dr. Mark Cline, who happens to be the chair of pediatrics at Baylor. He also happens to have started what might be the world's most renowned and accomplished international AIDS program called the Baylor International Pediatric Aids Initiative. Hearing him personally tell his story was pretty neat. He went to Romania over 10 years ago, found hundreds and hundreds of kids dying of AIDS, and decided to do something about it. He returned to the US, visited pharmaceutical company after pharmaceutical company seeking anti retro viral medicine donations, and sought donations and grants to open a facility in Romania. A relatively short period later, he opened up a clinic in Romania and literally saved hundreds of children's lives. He also did this in the midst of doubt and even ridicule from the American global health community. He didn't stop there, though, and continued to open clinic after clinic in different countries.
Because of dedicated professors like him, BCM has many international connections with other institutions and clinics around the world. Some of the more organized are listed here, but that is by no means exhaustive. I know two fourth year students who did an away rotation in Shandong, China this past summer, and it was with an institution that BCM has a contract with. This means they didn't have to pay any tuition. I believe they even got a scholarship to go. I am also planning on doing this.
I will mention, however, that I'm actually not that into tropical medicine, and tropical medicine is definitely the core of BCM's global health program. I am pretty tied to China, and most of China isn't really tropical or poor enough to fit the mold of traditional tropical medicine. BCM is in the midst of restructuring the program to allow more flexibility in how you complete the global health track, and I'm hoping it allows for me to do something with a focus on China.
Which reminds me, I need to write that email to the director of the BCM's Center for Globalization. It is through this program that BCM is really trying to extend its influence and ability to help others around the world, and I want to get involved with it.
We had our last 2 lectures from David Eagleman yesterday. As I previously mentioned, that guy is a lot of fun. A subject that is so interesting and seemingly unknowable as how our brain works combined with a charismatic and interesting lecturer is a winning combination.
One of the things we talked about is what happens to the brain of someone who goes blind. The back of our brains houses an area we label the occipital lobe. All the input from our eyes goes there to be processed in a way that lets us turn the electrical input into our perception of vision.
This is the area where all of our vision input goes. After class, I went to the bottom of the auditorium to ask him a question. I had to wait in line, because 10+ other students also had burning questions.
A comparison of Corynebacterium diphtheriae and real Chinese "letters".
If you can read the Chinese then you are in for a treat.
Coreynebacterium diphtheriae used to be very common before we started vaccinating for it. In the United States, every child gets the DPT vaccine that protects them from diptheriae, pretussis, and tetanus. When everyone takes it, it's extremely effective. We haven't had a case of it in the United States since 2004.
What is funny about diphtheriae is that the scientists who studied it long ago looked at it under a microscope said that it looks like "Chinese letters". To me, this is funny on many levels, one of the more obvious being that there are no letters in Chinese. They use characters, where each character represents a word. In English, @#$% are examples of characters. Silly, uncultured westerners.
Last Tuesday I went to an evening dinner event sponsored by the Baylor Pediatric Student Association (BPSA). I had reservations about going, but I'll say upfront that it was great.
Just so you know, I don't go to many of the extra activities that various student clubs host. There are lots of them, and you could probably fill a majority of your evenings at various events if you wanted to. If I was single and lived by the medical center, I might do this. Free food, other single students to get to know, interesting topics, etc. However, I'm married with kids and it's a 20+ minute commute to the medical center (assuming I drive, plus parking $$). For me, it thus becomes a big decision about whether or not I want to do anything extra that takes me away from my family time.
I had a hunch that this activity would be worth it, and I was right. 7 tables were set up in one of the conference rooms of Texas Children's Hospital, and each table had about 3 different physicians at it. One table had pediatric residents, one had primary care pediatricians, and other tables had various sub specialists such as urology, dermatology, hematology and oncology, psychiatry, hospitalists, behavioral development, infectious disease, cardiology, etc. About 4-5 students spent 15 minutes asking questions and talking with the doctors at each table, and then we would rotate to the next table. We ate dinner afterwards, which was surprisingly good lasagna. I even took a big plate of leftovers home for my family's dinner the next day.
The activity was great because it gave me a wonderful chance to talk with and interact with lots of different types of doctors. A chance like this is harder to come by then you might imagine. As a preclinical medical student, I am taught by medical doctors every day, but there is usually a bit of formality at school that makes it difficult to ask more personal questions. Most professors are eager and happy to talk to students, but it can still be difficult to approach and talk to them. The entire point of this event was to allow students to interact with and ask the doctors questions, so it really freed us up to talk.
As an example of a question I asked, I asked the general table of pediatricians what part of their job they enjoy most--seeing sick or healthy patients. One of the doctors responded that it was a fair and actually a very good question, and he commented that I was probably getting at whether or not being a pediatrician would be challenging enough to be interesting. I thought he was pretty astute, because that is actually a large concern of mine. As I have gone to my pediatric preceptor this year, sometimes the healthy patients drive me bonkers with boredom. He said that developing relationships will the families of patients over time and seeing them when they are healthy is very fun, but it's actually very challenging because you have to always be on your toes for when someone actually is sick. He said he usually sees at least one case a day that presents a challenge, and it's not boring at all for him.
I probably asked 5 or 6 different questions to different doctors, and all of these questions are things I have been wondering about for a while. I am only a first year medical student, but I already feel the pressure to start formulating an idea of what I want to do. I ultimately think that I will really have no idea what I really enjoy until I start my clinical rotations, and it's probably OK to be in the dark like I am now. However, I think every medical student is afraid of not being able to choose what they want to do until it's too late and it's time for match applications. I can only imagine how stressful that might be. In fact, I heard advice from many different doctors that night that the earlier you can figure out what you really want to do, the better. Some doctors even finished an entire residency before they realized they wanted to go into a different field and thus did 2 residencies. That sounds awful.
I got the following email from the New England Journal of Medicine on Tuesday:
This is my interpretation of the NEJM rejection email
If you want to know the timeline for submitting a manuscript to the NEJM, my experience might be helpful. Submission on Thursday, rejection email received on Tuesday. Or, you might ask, how long does the manuscript review process take at JAMA? I then submitted my essay to JAMA on the same Tuesday and received a similar rejection email on Wedneday. Now that's impressive.
When you get rejected from 2 journals with super short turnaround times, you can't help but start to realize you suck. Thus, I figured today that my essay probably needed some revising. So, I spent another hour and a half editing, adding, and changing some things around. I think it's significantly better, and I submitted it to the Annals of Family Medicine. By the way, it's no simple task to prepare an essay for submission to various journals. Each journal has their own requirements for format and article substance, and it's pretty tedious and time consuming to go on their online system and submit it. Anyways, I think this journal is more appropriate for the type of essay I wrote, so I think I stand a much better chance at getting it published. Hopefully!
If not, then I might be tempted to give up on the entire thing and come to the (hopefully not) inevitable conclusion that (a) I don't have anything unique or interesting to say and (b) I'm a terrible writer and (c) I've wasted close to 20 hours of my time.
Have you ever wondered how we tune out noise? Why do we eventually stop noticing the sound of the clock ticking? If you're trying to study, how can you tune out other noises like people talking or cars going by? It turns out we can literally tune out different noises at will to the point where our brain simply doesn't hear them!
This is the organ of corti in our ear. Notice the inhibitory neurons going to the outer hair cells... we can basically shut off the entire system if we want to!
The above drawing is my crude representation of the organ of corti. This part of our ear is where the actual sound waves finally get converted to a signal that can activate a nerve. The nerve is connected to the inner hair cell and it carries the signal to the brain, and it's how we actually hear noise. We have different hair cells which will respond to different types of sounds or frequencies.
The outer hair cells are one of the middle steps. They create a wave of fluid that stimulates the inner hair cell. Without the outer hair cells, we hear nothing because the inner hair cells never got stimulated. The cool part is that we can voluntarily turn off the outer hair cell. The auditory dominance column in our brain sends a signal to the outer hair cells, and the outer hair cells become completely unresponsive as a result. Thus, we don't hear what we don't want to hear!
It might be somewhat of an exaggeration to say that we have voluntary control over the whole system. I think it's most active when we are focusing on something else and our brain doesn't want to distract itself so it turns off the ears. Hence, when you are day dreaming or staring into space and thinking of something else while your spouse or significant other is talking, it's not that you weren't listening. It's just that you didn't hear what they said :-)
Remarkably, however, we don't have to turn everything off. We can just turn certain noises or frequencies off. For example, if you're trying hard to listen for the violin in an orchestra, the brain seems to tune out some of the other instruments that you don't want to hear but leaves the cells necessary to hear the violin on.
