medical school

c-l, ive heard from both med and fellow pharm students that ethics class tends to suck, which is bumming me out cuz I was looking forward to it next semester

anyway 4 finals to go

Yeah at least for me, there are lots of well-meaning educational attempts throughout med school that are just so poorly done that they become incredibly frustrating, and Ethics was the most grossly inept of all. It was esp frustrating since I had the good luck in grad school to see the social sciences and medicine work well together, mostly driven by med anthro dudes who were big about resolving their fieldwork research with the day-to-day of medical practice. And then I got to med school ethics and it was just all absurd hypotheticals and vague platitudes with no takeaway for real life.

I cannot be the only person who wants to spend time during Standardized Patient exams trying to break the 4th wall, right? It is just so tempting to be like "It cannot be very fun to do this all day long for three straight days, can it? I hope they are paying you good." We kinda got to do this with the standardized genital exam patients last month though, which was cool. Apparently once you get over the whole finger-in-butt thing, a prostate exam just feels like someone touching any other part of your body.

In related news, I appear to be very susceptible to dropping the rest of a thorough H&P once I see an opening for potential diagnosis. Especially with standardized exams, where all answers will either be essentially "You have asked a correct question" or "You have asked for information I was not given". Basically once I get on a thread of correct questions it is like a shiny set of keys being jingled in front of me and I forget to be like "So do you have any family history of this issue" or whatever.

oh man I was pretty fast and loose with the fourth wall, esp when it came to doing mental inventories. I would just blatantly sidebar to run thru my checklist for the PE

also just did some major scheduling judo.

med 1
board studying/vacay
anatomy TA
ortho
surg1
peds
peds surg
spring break!!!
EM
fam med
~three weeks of mystery~
OB
away rotation
infectious DZ
med/peds
ultrasound!!
neuro
psych
med 2
intl rotation
...
profit!!

It loses a little something when you take out the giant "I <3 Hot Nurses" profile photo, but I am like 95% sure from the date of this openbook selection that this dude ran into my classmates after we had finished with Shelf exams:
http://i49.tinypic.com/mvt0zm.png

Step 1 studying is the f'ing worst, btw.

To address his claims: A fairly decent number, Yes, Some of them, Sort of.

so here we are, INTERNAL MEDICINE

first night of call tomorrow yaaaaaaaaaay

Dang you guys are already in 3rd year? Congrats!

T minus 8 hours to my Royal College exam. Written tomorrow, OSCE Thursday. Last hurdle after 9 years of medical training.

I'm optimistic.

you are fake

Fake what? It's real optimism. And it better be a real exam, the registration fees were ridiculous.

cool

hey do any of you guys know about the Bohr effect? I've been practicing Buteyko breathing lately and I don't know if it's the placebo effect or what but I feel my energy levels have been upped a bit by not breathing so much. also I went swimming yesterday and got fatigued less easily when I breathed after every third stroke instead of after every stroke.

I know of it, but tbh only as far as it takes to knock out the Hemoglobin curve questions on an exam (acidity and higher temperature and increased DPG concentrations shift the curve right, decreasing hemoglobin's affinity for oxygen! Increased pH and reduced temperature and decreased DPG shift the curve left, increased hemoglobin affinity for oxygen!)

Since increasing pCO2 reduces pH (with a 10 mmHg increase in pCO2 roughly correlating to a 0.08 drop in the pH, until metabolic compensation can retain enough extra bicarbonate to turn the drop into about 0.04ish), and reducing pH increases the dissociation of oxygen from hemoglobin, it makes sense that you'd be distributing oxygen more efficiently, but exactly how much of a difference this makes in a practical sense, I do not know.

(Note, everything in parentheses in this post was primarily written to reinforce knowledge that I should have going into Boards. Using ILX to study is fun!)

similarly, this is why free divers hyperventilate before attempting long dives: blowing off co2 induces a mild alkalosis. your body actually polls the co2 levels in your blood, not the o2 levels, so lowering them by breathing heavily will give you more time before the drive the breath becomes overwhelming. the trade off is that if you blow off TOO much it's possible that you'll pass out from hypoxia underwater before yr brane says "surface now!"

also congrats to plasmon! tho I thought you were in the states?

similarly, this is why free divers hyperventilate before attempting long dives: blowing off co2 induces a mild alkalosis. your body actually polls the co2 levels in your blood, not the o2 levels, so lowering them by breathing heavily will give you more time before the drive the breath becomes overwhelming. the trade off is that if you blow off TOO much it's possible that you'll pass out from hypoxia underwater before yr brane says "surface now!"

― gbx, Wednesday, May 26, 2010 2:01 PM (2 hours ago)

yep i've had similar examples given in class about runners, too

so much better at using my freetime now

or at least appreciating it. drinkin a beer post-call after a v satisfactory mid-course eval seems like a decent way to wind down the day imo

Thumbs up, gbx.

I passed my exam. Just goes to show that if you work hard, hold on to your dreams, and bribe all the necessary officials, you can accomplish anything.

Now I'm officially a neurologist. In the words of someone Roger Ebert recently on his blog, I'm trying to figure out what I can do with that. So far the answer seems to be: I can fill out paperwork and pay outrageous licensing and membership fees. I'm sure that horizon will eventually stretch a little further.

First day of the rest of my life, etc.

congrats plasmon!

yeah way to go!

Congratualtions, could you come and rewire my brain so that I am not repulsed by bananas?

USMLE Step 1: really almost a pleasant kind of thing to actually take, after many many terrible weeks of prepping for it with Kaplan yelling at you like "Oh man the USMLE is gonna GET YOU, you don't even KNOW." It is also extremely pleasant to be done with it. Hopefully my score is OK.

Postscript: My score was OK.

Three quick notes on OB/Gyn:

1) There is nothing more awkward than observing a pelvic exam. Doing a pelvic exam is actually pretty OK, once you get past the "I can use this speculum correctly without causing severe unnecessary pain to this lady" phase. But observing a pelvic exam, where it is you peering over the shoulder of the attending looking at the patient's cervix and being all "Oh yeah that is an acetowhite lesion right there", while you can also see the patient's nervous/uncomfortable face looking back at you? It is seriously like a transcendent kind of awkward.

2) Urogynecology: secretly this is awesome.

3) Whoever designed the OB/Gyn Shelf exam the NBME distributes so everyone can take it at the end of the clerkship should be fired, or possibly shot. That was an exam where like 30% of the questions related to things you can actually learn in the course of a clerkship, and then like 70% were some crazy off-the-wall BS. Poor evaluations of actual acquired knowledge drive me up the f'ing wall.

what's up gbx, how was that big exam? we've missed you around here for real

i coulda used a month off too, fuck these recent immuno and psych exams

i mean not that ilx had been interfering with school (i havent posted much besides whining in politcs threads and voting in rap polls) but still

sup the rest of my future heath care pros, C-L, gbx, plasmon etc

yo so the other day i was interning at h@rtford h0spital with their ED pharmacist - besides other crazy shit like MSF & shit thiis the kind of shit in which i'd be particularly interested - the personal interxns w/ patients was better than i'd seen before and i liked the fast-paced style where she'd bouce around from procedure to procedure in the ED, doing pharmacy shit like helping MDs with med selecion & dosing, explaining shit to the patients, etc. totally cool field. i'm drunxx so i'm prob explaining it shitty but def my favorite intern/etc experience yet

yo also so i'm thinking about going hard and getting a dual MPH/PharmD - my best friend wants to get an MBA/PharmD (like the MPH dual program it's only an extra year) so i might be in school for an extra year

do it!

Hi dudes. I am on surgery, it turns out that I think surgery is really uninteresting to watch, so basically it is 70-80 hr weeks of Not What I Want to Do, which is not a really awesome thing.

On the plus side, the "am I medicine people or surgery people" question got answered pretty definitively.

dude really? thought you were all about ortho

I was and then I actually found out what it was like to spend all day in an OR. I am doing a couple weeks of ortho in November, still, and hopefully it will be a little more interesting than watching abdominal stuff.

But yeah whatever like "oh man I am touching a dude's insides this is SO AWESOME" feelngs one might have during an operation is just not there. It's not gross or disturbing, either, just like, uninteresting.

huh.

i'm doing an ortho roto a week from monday---curious to see if it grabs my interest. then surgery....at a brand-new this year rotation that has GET THIS weekends OFF and NO OVERNIGHT CALL

irrationally excited about ortho tomorrow---went thru the ortho sections in First Aid and Surgical Recall. ask me about salter-harris fractures, go on, do it.

also, q for the four ppl that read this thread (...of missing plasmon): what are yr thoughts on a kindle/iPad for textbooks? i'm noticing that a LOT more textbooks are available digitally and it seems like being able to have thousands of pages worth of reference in a tiny digital device would be super handy for down time during call.

a kindle is cheaper, more portable, and ~seems~ more durable (in that it's meant to be a reader only) but it cant do color illustrations. the ipad is radder and can get all the books for a kindle, but i don't know if the kindle app for ipad does color or not (i'd guess not). plus its bigger and more likely to be stolen. plus a kindle could fit in my white coat (!!!)

but an ipad does other sweet stuff that i want

gbx when do you a) become a dr b) visit englande

a) years, bro (1.5-3)
b) springtyme

awesome, welI hope you kill it tomorrow and survive the winter

ipad dude ipad

if you don't like it the kindle's probably gonna drop to $100 soon anyway so

Med school was too long ago for me to have had the option of textbooks on a handheld. I bought lots of books, enjoyed reading way more than studying. Hardly ever made notes.

Halfway through residency I bought a MB Air on the theory that it would be light enough to lug around and I could use it to study on the go. That worked okay but I always needed the power cord, so it wasn't really very light.

On the Air I was using Mental Cases to make flashcards for studying. I inherited a database of 1700+ cards from a guy a year ahead of me in the same program, after he passed his exam. The flashcards were useful, but I bet my friend benefited more from making them than I did studying from them.

The main thing I did in residency was read and collect articles as pdfs. I had a complete library of review articles saved and organized into folders. The idea was to find articles written at the right level for my exams: not too esoteric / cutting edge, but at the same time detailed enough to cover genetics, pathophysiology, mechanisms of medications, etc. My NeuroFiles folder ran to 1400+ articles by the time I did my exam.

Very late in residency a friend pointed me to a warez site with all sorts of textbooks available for the pirating, mostly in pdf but a few in chm or other formats. I grabbed a few dozen of my favorites, but there were lots of gaps (good books they didn't have, or only had in outdated editions). Those went in a NeuroBooks folder. The problem with giant textbooks in pdfs is that they take a long time to load and search, so I would split certain books up chapter by chapter to make them more manageable.

Obviously, I had way too much to read, let alone review. But compiling all those articles turned out to be an incredibly useful resource for search. The pdfs are all internally searchable, so once you pile up a thousand of them, you can find any esoteric detail in seconds just by searching a text string. I do way better, way faster, searching my database than anything else (Google, Up to Date, Pub Med, etc).

I bought myself an iPad the day before I started work as an attending. All my files are synced across 2 laptops and a desktop and the iPad with SugarSync. I use GoodReader to read pdf's on the iPad. The main limitation, and it is a huge step down from the laptop, is that I can't search the internal text of the pdf's without opening them.

If I could do clerkship again in 2010 (oh the joys!), I'd get an iPad, download a few selected texts (mostly overview books like Harrison's), and then fill several folders with pdfs (which are free and legal for the downloading, as long as you've got a subscription through your library). For medicine-related topics, you can go to the NEJM site, select a "collection" to browse, and get dozens if not hundreds of articles including clinico-pathologic case reports, images in clinical medicine, etc. Then you want some program that will force you to make your own study notes. Mental Cases works on the iPad, but I've never made cards there, only on the laptop.

Plus you really need an iPad to fully appreciate Angry Birds.

fyi dropbox also reads pdfs, and keeps all your files synced on a central server across all your computers

my one concern about the ipad is that it's kind of heavy to carry around all day

thx plasmon, glad to see you back!

btw dudes Papers (an app) is totally killer for archiving journal articles.

"Spot diagnosis may be magnificent, but it is not sound diagnosis. It is impressive but unsafe. The deduction and induction from observed facts necessary for the formation of a definite opinion provide good mental discipline for the observer, help to imprint upon the tables of the mind perceptions and clinical pictures that can be usefully recalled in the future, and give a sense of satisfaction that is only slightly diminished if the resulting opinion should prove to be incorrect. One often, if not always, learns more by analyzing the process of and detecting the fallacy in an incorrect diagnosis than by taking unction to oneself when the diagnosis proves correct."

^^^Cope's, y'all

i've been checking out some english textbooks (well, oxford handbooks), and they are w/o question 100000x more readable/enjoyable than their knuckle-dragging american counterparts.

nb i was a lol english major, who ended up reading mostly 20th century brit lit but w/e

I was actually thinking to myself today that I should have gotten an iPad for textbooks, since I have gotten in the habit of walking into the hospital without a backpack, and so if I am looking to do some kind of productive studying upon my escape I am kind of at a loss. Today I just ate a sandwich and glanced blankly at the copy of Surgical Recall I jammed in my coat pocket and then I went home and haven't done anything since. (This is basically a running theme during surgery for me.) I am barely keeping my head above water thus far thanks basically entirely to online access to Schwartz's Principles of Surgery, and Sabiston to a lesser extent, which I should go read now.

In the preclinical years I actually went with the strategy I used during grad school, which is very brute force and needlessly time-consuming, which is to try and write/type as much material from my lecture notes out into a module-by-module giant Word Document, and then copy it again before the exam, because I feel like writing it in my own words, and then rewriting my own words over with more of an idea of the whole narrative forced me to use different parts of my brain that are more effective at retaining information than the part that reads stuff. On the plus side all of that can be pulled for a Spotlight search if I'm like "Oh man, what the hell is a Zenker's diverticulum again?"

xp I nearly got a PhD in history (of medicine, but still). I think American books are written for like "Here are science facts" people, which is awesome except I am like so infinitely far away from being one of those people.

oh man, I'm so glad I"m not the only one who uses that technique to cram!

^^^real talk. high yield stuff is only good after I've read actual sentences and/or taken good notes.
xp