medical school

well it's just the practice one! it was definitely reassuring though to have it affirmed that my foundation is pretty strong, studying for the next 6 months or so can only help. and the kaplan lady said not many people break 30 on their first legit in-person practice one. supposedly they're pretty valid predictors of the actual test, but who knows, of course kaplan would say that. most people i've talked to seem to agree though

felt like i did awful on physical sciences (i...haven't taken basic chemistry since i was 17), but my scores were even, 10/10/10

Strong work, good prognostic indicator.

I taught physics, verbal reasoning and writing for Kaplan. Main thing is to be able to get double digits on verbal reasoning on your own accord. The rest of it is teachable but I had no luck bringing my students' VR scores up more than a point or two.

thanks!

the verbal was by far the easiest, yeah, i actually "didn't answer" two of the questions by mistake (by some brain fart i clicked on the answers themselves instead of the bubble next to them, which placed a strikethrough line through the answer instead of actually selecting the answer. both of them would have been right). no reason verbal should be less than a 12.

physical chem is going to be the place i need to improve the most -- i was able to deduce my way through some things but all of this anode/cathode half-cell whatever stuff is buried somewhere in the back of my brain along with whatever dumb stuff was thinking about in high school

yeah that's a great baseline, kev

my verbal reasoning score did most of the heavy lifting on my MCAT, bigtime. when i took practice tests i'd finish that section super early, and get like 11 on it. once i actually slowed down, and didn't make silly mistakes, i was able to get 13-14s

This discussion made me thing "oh thank god I never have to do standardized tests anymore" and then "oh wait I have two levels of borads to pass for LICSW and more for geriatric cert oh fuck"

however I do not believe I will have to remember any pchem for them

I totally thought I was going to lean heavily on my VR score but noticed that the more practicing I did, the lower my score on the practice tests would run (from like 12-13 down to 10 at one point), which I interpreted as a sign of overthinking (when I start obsessing about the test I tend to think it is all an elaborate trap, whereas sticking to my gut would normally be OK). I backed off a little but ended up doing a little worse than I had hoped. However, I got pretty lucky on the Biology part (which had been my highest-variance section, ranging anywhere from 10 to 13) on the actual MCAT, and that balanced me out.

http://www.medscape.com/viewarticle/815241_1

didn't know where else to post this but man alive is this guy the coolest person in the world or what

med nerd lolz...

https://www.youtube.com/watch?v=aEi_4Cyx4Uw

^^ A+ Medical Variety Night number

OK this is not a medical school question, but this seems to be where the physicians and physicians-to-be of ILX hang out (would like to hear from other health care professionals, but I don't know where the ILX nurses, therapists, etc. hang out).

With any luck I will be doing my first social work internship in the ICU at a hospital of a university named for the USofA's first pres. What is the ICU like? What will I be doing there? How should I prepare (for my interview and also for the internship if I get it)? Other thoughts?

Thanking u.

Oh this is a mixed med/surg ICU if that makes a difference.

will you have to round? pray that the answer is "no," because there is a special circle of hell that is just ICU rounds

The ICU I worked in was a mix of people just passing through immediately after major surgery (heart, organ transplant) and the super-sick/actively dying. I would brush up on end-of-life stuff.

End-of-life stuff and geriatrics will likely be my professional focus, so sounds like ICU is the right place for me to be for training. Thanks, Kate! Would love to hear more about your experiences.

Gbx, my guess is that I will round at least a little for the experience, if not as regular practice for ICU social workers. Don't really know, though. Please tell me about this special circle of hell, which I assume means more than just having to wake up at an ungodly hour. Also, are medical staff assholes to SWers as general practice or not really?

Gonna have some lols the first time a 23 year old med student talks down to me :)

ICU rounds are only hellish because they take. for. ever. like, non-stop rounding from 7am into the early afternoon. and, you know, ICU pts are complex and attention to detail is crucial, my god they are interminable.

ime, medical staff are very appreciative of SW, simply because they magically make things happen that, like, really really need to happen in order for all that medical stuff to stick. this is particularly true (doubly, triply) in my world (the psych ward)

any attending that caught wind of a med student or resident talking down to a social worker would probably have their guts for garters, imo

ime ICU rounds have been very multidisciplinary - you should probably be prepared to round a bit. kate is right that a lot of your time will be spent dealing with end-of-life stuff, particularly if your hospital protocol calls for social work involvement in family meetings (and it should). these are situations that are tremendously interesting to read about and learn about, but can be very frustrating/difficult/emotionally draining IRL, so be prepared for some ugly. so few people have advance directives. you've probably gotten into hospital social work because you're interested in helping people through some of the most emotionally and financially stressful periods of their lives -- the thing about working in the ICU is much of the time that'll mean dealing more with families than the patients themselves, since often they're intubated or otherwise unable to communicate. but i think social work has an extremely important role in ICU care -- the clinicians understandably are under a lot of stress due to the fragile conditions of their patients, and too often there's a poor understanding of what the goals of care are/poor communication about what exactly is being done/etc. good, compassionate doctors take the time to sit down with families and have the difficult conversations, and thats the kind of doctor i want to be, but their time is not limitless. this is where you are needed. NB this is what my impression of social work is from a clinical perspective so maybe you will do totally different stuff idk

gbx what do you dislike about ICU rounding in particular?

that they take all day!

hahahaha so true. i sort of love rounds though

oh btw i did not see that xpost duh

Thanks much kk and gbx, that is helpful info!

Re: advance directives--this is a passion of mine. My folks are all set with theirs (I am their medical proxy), but I am on spouse's case to get his parents (who are in their 80s) to do planning. Of course, I have not documented my own wishes or gotten spouse to get his down on paper. . . guess that should be a New Year's resolution.

also "guts for garters" is my new favorite expression!

ICU rounds are usually multidisciplinary for clinical staff -- medical, nursing, pharmacy, RT -- but I'd be shocked if you'd be expected to sit there for hours while everyone reviews the blood gases, chest X-rays and electrolytes.

Most inpatient wards have discharge planning rounds roughly once a week, in which social work plays a big role in helping with family issues, making arrangements for placement in a care facility, etc. Discharge planning would be less important in ICU, as patients are usually transferred to the ward before plans are made for what to do at the end of the hospital stay.

I'd imagine your main role will be in helping families with end of life issues. The doctors should be the ones explaining the diagnosis, prognosis and treatment options, but the support and care from social work is very important in that situation (for one thing, as gbx says, you have more time to spend with them, and you'll probably be more caring/compassionate than most of the medical staff). You'll likely be asked to sit in in any meetings the medical staff have with families about possibly withdrawing care, etc.

Another thing that might be part of your work there is dealing with insurance insurance. Lots of patients have disability insurance to pay for time away from work, cover mortgage payments, etc. In the US, there'll also be the challenge of paying for the medical services in the first place. In Canada, social workers help families with all of those practical financial matters, and I'd expect that will come up for you even dealing with patients in ICU.

I wasn't sure if insurance issues would fall to the social work department or to other departments within the hospital (billing or what have you); I have, however, developed a knack/patience/persistence for dealing with bureaucracy (lol government contract work), so I can definitely handle that stuff.

How often are ICU pts in need of direct social work care? My limited experience with ICU pts has been with folks who are medically fragile but still able to communicate, participate in decision-making, etc. If ya'll had to put a % on it, what % of ICU pt directly engage with social work services?

Depends on the hospital. Some ICUs cover post-op, post-stroke, post-MI, sepsis and other situations where the patient won't be tubed and may be able to communicate and discuss things with you. In the hospital I work in, those patients are almost all managed in separate step down observation units, and ICU is reserved almost exclusively for intubated patients.

Generally speaking, hospital social work is mostly dealing with families, not the patients themselves. Even stable ward patients are often too sick (delirious etc) and/or neurologically impaired (stroke, dementia, etc) to get as much out of your services as their family members will.

am about 2/3 through gawande's "better" and imo this is the strongest of his 3 books. the section on physician involvement in state executions is both characteristically thoughtful and uncharacteristically forthright. would highly recommend

haaaaaaate PS

?

wait so are you a first year right now?

no, physical sciences on the MCAT lol

Hey so it is pretty much official (so long as university and hospital can see eye to eye on the paperwork) that I'll be starting a social work internship in gee doubleyou's ICU in May!

What can I do to prepare?

Strictly hypothetical q: say someone has bronchitis and has to choose between a Z-pack or cipro to treat--which should it be?

The hypothetical traveler got rxs from her doc in case of UTI or TD, but failed to discuss URIs, which was dumb of both her and doc because she ends up getting bronchitis every couple of years.

You don't want Cipro for a chest infection, poor lung penetration. Moxi is the respiratory fluoroquinolone of choice around here. Cipro's good for GI and UTI.

Zithromax all the way.

if it's really bronchitis, the person likely does not need an antibiotic. dare you to suggest that!

cipro in fact gets into the lungs just fine, it just has poor activity against strep pneumoniae, which is why it's a poor empiric choice for most lower respiratory tract infections (and not considered a "respiratory quinolone" like levo or moxi). if a sputum culture comes back sensitive to cipro, it's a fine drug to which to de-escalate, assuming it's the narrowest-spectrum choice. it's even a part of some hospitals' empiric double-pseudomonas coverage (usually along with a beta-lactam) for ICU-bound PNA patients

when i was on ID rotations, in central connecticut, the resistance of strep pneumo to azithromycin was around 20%, so doxycycline (along with ceftriaxone, if the person was going to be hospitalized) was preferred empirically for most presumed LRTIs, assuming there were no drug-resistant risk factors. for most outpatient pneumonias/bronchitis, azithromycin works as well against the virus that probably caused the complaints as any other antibiotic, though ;)

oh sorry, i didn't really catch the context of the question -- ie for travel. when i traveled to thailand/burma to work last summer, i brought zithromax. either is fine for her purposes really.

ha, just read the other thread! i agree with kate!

Azithro also has anti inflammatory qualities iirc which is why it gets prescribed for COPD exacerbations that aren't clearly bacterial

Thankfully the crap cleared up on its own, but I thank you for the advice and discussion!

Somewhat related question: what do/did ya'll do when you were stoodents and had a messy URI (active coughing/sniffling/sneezing) but were expected to be seeing patients in the hospital (including ICU)? Just drug up, wear a mask, and try not to cough at the bedside on rounds? Or are you encouraged to actually stay away in such situations (ha)?

as a student? stay home. or show up with a mask, have someone notice you're sick, and get sent home.

as an intern, i'm a little too integral to the actual operations of the medical team (ie - if i'm not there someone else has to do a lot more work), so the threshold is a lot higher. i've only taken one sick day all year, iirc, though i probably could've reasonably take one or two more.

tho i haven't done (and won't ever do) an ICU rotation as a resident, i'd imagine the thresholds are even lower for students and maybe just a tad higher for interns (due, again, to the volume of work).

ah, thanks, good to know. I was thinking it was probably NAGL to be a coughing/sneezing/sniffling bug bomb in front of patients and families, especially when the patients are in critical care. Like, even if you wear a mask and are otherwise really careful about infection control.

My roommate is kinda freaking out right now because she got bit by a cat in Myanmar but didn't get her first rabies vaccine shot until 6 days later

She also has been wrestling with a case of food poisoning that is displaying flu-like symptoms

What do I tell her to console her

go to a fucking doctor

Yeah she went yesterday

best consolation is soup ime

laphet ime

If she gets a rabies vaccine before she's symptomatic (and that's assuming the cat even has rabies), she's good.

And if not, send her to Milwaukee: http://en.wikipedia.org/wiki/Milwaukee_protocol

ianad but before i clicked that i was going to recommend putting her into a coma because i heard about that girl on some stupid npr show. before i heard that i didn't realize quite how bad rabies is!

plasmon, you taught kaplan in the past, right? i hesitate to turn this into SDN, but here it goes: what kind of consistency should i be looking for on these practice tests before i have a good idea of what my score will be? i'm doing very well on the practice exams, but the range is so wide i really have no idea what to do with my scores, or how fluky they are. i understand the concept of the bell curve and how once you're a consistent 10/11 test taker, a couple of good guesses makes it much easier to jump up a point or two relative to 7/8/9 students, but the full-length (kaplan #3) just kind of scared the shit out of me. i got a 13/14/15, which i just feel like is not where i am yet (or probably ever, given that my exam is in 3 weeks) -- my last 2 were 11/11/10 (though this was a month ago) and 12/13/10 (earlier this week). i guess it was just a harder test with a more generous curve, but that score is so ridiculously high as to be meaningless to me, bio in particular. i think i'm a solid 11/12/11 right now. i plan on taking the other two required FLs next week, but after that, are there any tests that you think are better than others? i'm not gonna have time to take all 15 other ones or however many there are