Category: Medical School

Life as a Medical Student

Dating in Medical School

Dating in Medical School

Medical school is a lot to handle. It can be so difficult to simply take care of yourself, let alone another human being. Therefore, dating in medical school can feel like an almost impossible task. How do you give somebody else energy and time when you barely have time and energy for yourself? Whether you go into medical school in a relationship or you start dating during medical school, it is definitely a transition. I went into medical school with my boyfriend (now fiance!) from undergrad who is not in the medical field at all, and here are some tips and tricks that I feel are valuable in making a relationship work during such a busy and stressful time.

Tip #1: Schedule time together

It might seem obvious, but just like studying requires some scheduling, so do your relationships. In order to have a successful relationship, you have to make sure that you are giving it the time and attention it requires. That said, it’s a fine balance ensuring that you’re able to keep up with school as well as give the person the attention they deserve (and you deserve)!

That’s why personally I schedule some time every night before I sleep to call my fiance! I cut myself off from studying around 930 every night so that I have 30 mins to an hour of uninterrupted time to give to him. This helps both of us immensely knowing that we have a free period of time in the day that is guilt-free where we can simply talk, and that if we are consumed by our days we always have that period to have ourselves heard. I also try to schedule a weekly date so that we both have something to look forward to, and it lets me plan my studying around it. By scheduling in the time to spend together you can guarantee that your school work gets done and that your relationship is not left neglected. 

Tip #2: Communication is key

Keep the communication line open! There isn’t time during medical school to be playing guessing games with your partner. If you enter medical school already dating somebody, make it clear that it’s going to be a huge investment and adjustment for both of you in so many different ways, including mentally, financially, and timewise. Share your schedule so that they know when you’re in class, the hospital, etc. Discuss your time constraints clearly so that there are no surprises.

If I have an exam coming up and need to spend more time studying, that is on me to make it clear to my partner. Communication is key in any relationship but completely integral to keeping your relationship healthy during medical school. Be realistic about your time, and have the means to explain to your partner what you want and need. If you only have a certain amount of time in a day or a week to talk or spend together, make sure that you are using it productively. Good communication prevents a lot of headaches later. 

Tip #3: Have honest conversations

Medical school is so selfish. You pack up your bags and go wherever it is you are accepted for medical school and residency. And that can mean leaving a lot of things behind that you may not want to, including a significant other. It’s a long road and long-distance will inevitably take a strain on a relationship. Be honest about this with your partner so that they’re aware of it from the get-go. If you think that you may have to move somewhere, let your partner know so that they can make an informed decision as to what they may do. 

Be honest about all your problems. No matter how small or big the issue, talk it out early. Medical school is stressful, and I always say that medical school is so stressful and that the only way a relationship can thrive in it is if you have a real understanding partner. But remember that any relationship is a two-way street and requires you to be understanding and honest about how you will make it work. 

Be honest about the future. When I entered medical school, my fiance and I were both honest that we likely wanted to get married after I finished medical school, and that helped the both of us have a clearer timeline and know that we were both in it for the same reasons. This helped us both pour energy into making our relationship thrive because we had the motivation and there was a point to which it would progress.  

Tip #4: Have healthy coping mechanisms

There are times you’re going to burn out in medical school. And regardless of whether your partner is in medical school or not, they will have their own things happening in their lives that affect them. Make sure that you have healthy coping mechanisms when it comes to dealing with school and that you both are able to deal with the constant daily struggles without letting it affect your relationship. 

One thing that I strongly believe in is having an external support system. I love keeping my medical school friends involved in my life because there’s nothing quite like going through things with your peers. Although my fiance hears many of my medical school complaints, I can’t expect him to have all the answers for me, as he is not going through it with me. Having that external support system keeps me sane and keeps me from putting the burden of all my complaints on my fiance. 

Tip #5: Make priorities

The studying quite literally never stops. You could study forever if you let yourself. Know when to stop yourself and when to give your attention to your partner. You have to be able to draw that line and create those priorities for that person or it will never work, and vice versa! If your relationship is a priority in your life it deserves its own time. 

For me, this comes back to scheduling time for my priorities. I treat my relationship like other facets of my life. I schedule in time every day to work out, eat healthy, and talk to my partner (guilt-free)! Life never stops, it’s up to you to carve out time for the things that matter to you. If one day you end up having to stay at the hospital longer than you anticipated, or are studying longer than you thought you’d have to, make that time up later to show your partner that they do matter to you. Show your partner that you value your relationship. 

Tip #6: Stay connected 

There will be times you may have to be away from your partner due to extensive studying, clinical rotations, residency, etc., and that means it’s more important than ever to find a way to stay connected amidst that! There likely will be some long-distance incurred at some point. It’s important to find ways to create common ground no matter your circumstances. Watch the same movies together, make a playlist for them, work out together, etc. Find those things to keep you connected. 

Tip #7: Remember that your partner is human too 

Sometimes when we’re so immersed in our lives we forget that our partners have lives too. 

Be open and honest with your partner with your expectations, needs, and the reality of your medical career. Don’t expect them to come in already knowing everything.

Remember that they have things going on and that their lives are just as important, with their daily ups and downs and their problems. Make sure that you are there for them too. Talk about their problems, their interests, their day. Medical school can be so consuming, sometimes I don’t realize how long has gone by before I’ve talked to a certain friend or family member. Give undivided time to your partner and show them that they are a priority in your life too. 

Dating in medical school can be difficult to navigate, but it’s by no means impossible. If you follow these tips and show your partner that you value the relationship and keep the communication open, there is no reason why you can’t have a thriving relationship in medical school!

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Active vs. Passive Learning

Active vs. Passive Learning

Everyone has different learning strategies. In undergrad, I was more of a passive learner. But upon entering medical school, I had to incorporate a lot more active learning to my schedule. What is active and passive learning and how do you optimize both to your advantage?

Topics

  • What is Passive Learning?
  • Pros and Cons of Passive Learning
  • Strategies to Optimize Passive Learning
  • What is Active Learning?
  • Pros and Cons of Active Learning
  • Ask Questions
  • Repeat, Repeat, Repeat
  • Practice Questions
  • Teach

What is Passive Learning?

Passive learning is, as the name says, passive. There is not more thought put into it and it is relatively simple to do. It is when the listener receives information, but doesn’t receive any feedback, like watching a documentary, listening to a lecture, or reading nonfiction.

Pros and Cons of Passive Learning

Passive learning has its advantages. First off, it’s easy. Whether you are listening in class or to a video/audio recording, your presence is all you need.

Unfortunately, passive learning is not efficient in the long run, since you will not know whether you are ready to apply the information or even if you really remember it. A few gifted students may be able to read a passage and remember it by heart, but most need more active strategies to achieve the same goal. 

Strategies to Optimize Passive Learning

Even though passive learning may not be the most efficient, there are ways to use it to your advantage. You can listen to audio lectures during the day  while driving, cooking, walking to class, or when you are on the treadmill

During my first semester, usually by the end of the day I was tired and couldn’t actively study. To make good use of my time, I actually rewatched my histology lectures just before going to sleep. Listening to the lectures was a good way to prime my brain into absorbing for the next day.

Another way is pre-reading or pre-watching the night before lecture. For example, for pathology, I watched the Pathoma videos on the topic for the next day. This strategy gave me an overview of the information, so that when I was listening to a lecture I was not lost. 

What is Active Learning?

Active Learning is when a student is involved and cognitively engaged in the learning process. This type of learning takes more effort and interaction, but is a much more durable method 

 

Pros and Cons of Active Learning

There aren’t many cons to active learning, but active learning is not easy. It takes a lot of practice and discipline since it requires a lot more thinking. 

That being said, the pros outweigh the cons. Active Learning is the most beneficial way of learning. Research shows that when students are engaged, the retention is better, providing long term support. Also, you can further develop collaboration, foster problem solving skills, and improve critical thinking. Types of active learning include asking questions, repetition, doing practice questions, and teaching others.  I will go through each of these below:.

Ask Questions

Application is key. A simple example of application is knowing why the action potential of a muscle is done and why it is different from cardiac cells.  When you understand a concept, the less you have to memorize. One way to do that is to ask questions. 

Everything happens for a reason, and if you don’t know, then look it up or ask someone. Remember, when you understand the concept, the less you have to memorize. Also, answering questions becomes a lot easier through application.

Sitting through a lecture is a passive learning activity, but you can make it more active. If you don’t understand something in lecture, ask about it during or after the lecture. You can also jot down questions you have for your personal study.  If you have a tutor or the professor offers office hours, study the material and have a conversation about it. Collaborating with your colleagues about questions you have can spark an interesting discussion and promote  long term retention and a healthy learning environment.

Repeat, Repeat, Repeat

After you understand the concept, you have to memorize the rest. Repetition is key. The more you see the concept, the more you will retain it according to the chart. The key is to do it consistently everyday. You can do it through using Anki cards. Throughout a course, you can make our own Anki cards and practice them on a regular basis. Or you can use a premade Anki deck and allocate a certain amount of new cards to do everyday. 

I loved asking a friend to quiz me because it was a lot more interactive than doing flashcards on a screen. At the same time, I set aside thirty minutes to an hour of time at the end of a day to practice my Anki decks as a quick review.

Practice Questions

Practice questions are not only a good way to practice repetition and application, but also to practice test taking. Since multiple choice questions are the most common way of testing, it is important to practice in such a format. 

The first step is to figure out a strategy for how you want to tackle these practice questions and how you want to review them. For example, some people like to read the question first then the answers or read the answer choices first and then the question. Figure out which strategy works best for you.

After answering the question, regardless of whether you got it right or wrong, analyze the answer choices. Understand why you chose your answer and why the other answer choices are incorrect.

Teach

There is a common saying in medicine: “See one, Do one, Teach one.” It is true. Teaching is one of the best ways to solidify what you know because you have to know the material and explain it. 

There are different ways to approach this. For example, in one of my study groups, each of us was assigned a topic and were responsible for teaching it. This was a much more interactive way of learning, as each of us became an expert on our topic and learned from each other.

Another way to utilize this strategy of active learning is to become a tutor. During my second year I started peer tutoring and it really helped me refresh topics such as biochem and physiology. Remember, a lot of what you learn in basic sciences comes back for Step 1. It is to your advantage to revisit material you have studied in the past.

Conclusion

Overall, active learning is much more beneficial than passive. Try to optimize more active learning in your study schedule and you won’t regret it. Happy learning!

If you have any questions or want to see my life through medical school, find me on Instagram @future_artist_md

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How Bullet Journaling Saved My Sanity

How Bullet Journaling Saved My Sanity

I could never find a planner that fit. I wanted something that had monthly calendar pages, but also had pages that showed my week at-a-glance and allowed me to put in deadlines and plan my day. I wanted two-page spreads, but I also wanted enough room to write in to-do lists and notes that came up while I was sitting in conferences. The more I searched for a system, the more I realized that the system I wanted did not exist. 

After spending my first year in med school with my head barely above the water, overwhelmed and completely confused ninety-percent of the time, I knew that I needed an organizational system that would change, grow and adapt with me. And after a few weeks of Google searches, I came across this article on BuzzFeed about bullet journaling. The rest is history (and therefore, in my planner).

But what is bullet journaling?

 A system created by Ryder Carroll, much of his creation began when he realized that nothing he was looking for could be found in a store-bought book. This is also what prompted me to started looking and thankfully, I stumbled upon his website which got me to exploring his system! His premise is that bullet journaling is a purposeful productivity, it is mindfulness disguised as productivity, and while keeping us focused, also provides an outlet for our creativity.  I find that it also is a safe space that can help relieve mental exhaustion by providing one’s mind a place to rest.

 

 How did I start?

It was hard. But articles like these encouraged me to keep at it, to keep experimenting and to figure out what worked for me, even if it was a more functional setup. My planner situation at the time was a store-bought planner that didn’t have the space I needed to lay out my monthly/weekly/daily deadlines and I wanted to create a space for those things. I started with a list of what I needed (a monthly layout, a weekly overview, and a daily log), chose a blank notebook (I started with a charcoal grey Leuchtterm 1971) then let my system evolve from there!

 

What problems did it solve for me?

I was having so many issues with medical school as the year moved forward, with 15 classes a semester, we took an exam in every class every day on top of daily recitations, weekly case presentations (per class!) and then of course, regular exams and group projects (Fishbone diagrams, I’m looking at you). Like many medical students, I was overwhelmed. I knew something was going wrong, my time management was off and I was missing assignments or forgetting readings which caused me even more stress! And while setting aside time for planning didn’t seem ideal when I was so strapped for time already, in hindsight, it is really what I needed to make sure that I maintained focus and also stayed productive without losing my mind.

The first thing it fixed for me was my panic. Forcing myself to settle down at the end of every week (Sundays for me!) and flip through my syllabi and class schedules to write or adjust things in my planner became an enjoyable ritual. I would stream my favorite show, make a cup of tea and sit in my chair while I cross-checked my schedule with any announcements that spoke to changes in deadlines or in our schedules for the week. These little Sunday rituals became my source of calm and helped me ground myself before the start of each week, helping me to mentally prepare for the onslaught of work that would inevitably come.

The second thing it fixed was my haphazard brain. I am constantly worried about missing something. This system provided me a simple way to triple check myself constantly. On my monthly spreads, bright red would scream that there were exams coming up, while purple denoted short quizzes or assessments. Blue was for written assignments and lectures that would require advance preparation while black was meant to signal me to tasks and homework I needed to complete. Green was a special color, designated to fun events like sem-ender parties or the planned dinner outing with classmates. I kept my color code consistent throughout my self-created planner so that the monthly spreads could be copied directly into my weekly overviews and my weekly overviews would relate directly with my more detailed daily task lists. The daily tasks list was my favorite part of each week as on the left it detailed the daily assignments for each class and on the right I would note reminders and to-dos throughout the day like “Print out lecture slides for tomorrow” or “Professor wants a copy of our PowerPoint slides for the case” or “Check if the deadline has been changed later.”

The third thing it fixed was a need for a creative outlet. In addition to my class schedules and assignment deadlines, I took ideas from other bullet journalers like a daily memory log (a sentence a day for each day of the month), productivity charts and mood trackers and incorporated them into my monthly sections. I left pages blank in the back of each of my journals for me to write in. I scribbled about things I was grateful for on parts left blank and filled the others with decorative stickers or memorabilia. Looking through them now, I can look at an old stain and remember where I was that day or see the crinkled edges of the journal and recall when it got wet as I was running through the rain.it is clear that they’re not only a detailed record of my assignments but a curated collection of memories and fleeting moments.

 How did I make it work for me as a student and even post-graduation?

The best part about this system is that it is flexible, adaptable and it’s completely customizable. Post-graduation, I no longer needed as much detail because I didn’t have nearly as many deadlines or as many assignments, so I recalibrated, keeping the monthly and weekly overviews, but removing the daily logs and adding more creative spreads that allowed me to practice more writing, jot down random ideas and keep some more memories! Today, my bullet journal serves mostly as a guide and a really fun hobby – it helps me keep track of my Step studying and adapts to my needs as the weeks move forward and my exam date approaches.

What is my current set up?

These days, I find that preparation for the Step exams and studying takes away from the time I have to create so in the past year, I’ve gone from using blank dot-grid notebooks to pre-made planners with a lot of flexibility. The advantage to this is that I no longer have to complete every single spread for each month and week from scratch. After a lot of research, my current planner of choice is the Jibun Techo in A5 Slim which I find to be the perfect size to carry around in a purse, backpack or messenger bag. I love its layout, it’s got a monthly spread and a vertical weekly spread, which I love because it gives me an overview of my week while simultaneously letting me see what my day will look like. Not to mention that the paper is absolutely luscious.

What are my favorite tools?

 I am a self-proclaimed pen snob, so even when taking notes, I’m picky about what I use and the paper that I write on. In my bullet journal, I am currently loving the Unistyle Fit which allows me to take three colors on-the-go! I also discovered this amazing correction fluid that is off-white, which means that my mistakes no longer glare at me from inside the pages of my meticulously maintained system! And finally, for the inevitable changed plans, I love the Tombow 2558 pencil in graphite grade B because it comes with the best little on-pencil eraser that I have ever experienced in my life and writes so smoothly, it’s satisfying.

After the initial fear and anxiety and then the additional insecurities about my lack of creativity and artistic ability, I am proud to say that I have been happily bullet journaling for the last four years. There may be a little bit of a learning curve, and I would be lying if I did not tell you that it is a rabbit hole that you may never claw yourself out of; but the system that began as a way to organize my to-do lists quickly became one of my favorite hobbies.

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8 reasons why every non-US medical student should study for the USMLE

8 reasons why every non-US medical student should study for the USMLE

If the title wasn’t self-explanatory enough, this blog is basically an open letter to my fellow FMGs about why studying for the USMLE is a great idea, even if you don’t currently have plans to do your residency in the US. As someone who can’t fathom leaving Australia as an intern (great working conditions, guaranteed employment, higher pay) to go to the US, I still found the knowledge and additional skills I gained by studying for the US board exams to be invaluable, as they helped make my life in medical school easier. Here are some of the reasons why:

Retaining knowledge

It’s always helpful to reinforce your knowledge from multiple different learning scenarios. It’s the whole basis of spaced repetition and it explains the popularity of apps like Anki. You learn a concept, and then repeat that concept until you understand it. Studying for the USMLE is a great way to revise concepts in a slightly different light than what you may have encountered in your medical school. Tackling the same concept multiple times, in slightly different manners, is sure to really reinforce that understanding in your mind and help you retain that knowledge for longer. Also, most USMLE preparation content, such as Physeo’s, is delivered in the form of short (10-15 minutes or less), condensed lectures, which means if you ever need to revise a particular concept, you can simply pop up the relevant video and cover that content in minutes.

Opening doors

Maybe you’re not currently planning to go practice medicine in the US. But what if you decide that you’d like to in the end? Particularly if you’re already studying medicine in a foreign country, it’s always best to keep as many options available to you as possible. It’s very difficult to take the board exams (particularly Step 1) after medical school, because by that stage, you’ll have forgotten much of the basic sciences material that that exam revolves around. Chances are, you probably won’t be able to remember the mechanism of the second-line drug to treat that bizarre, super-rare metabolism defect when you haven’t touched biochemistry since your first year of medical school. So if you can afford it, taking the USMLE exams can help keep doors open further down the track.

Identifying your weaknesses

Medical students have trouble identifying their weaknesses, because there’s just so little way to know what you don’t know. Fortunately, many learning resources such as Physeo contain USMLE-style questions that can help you measure your performance. The Physeo questions also label which discipline and topic (e.g. endocrinology/pathology or cardiology/pharmacology) every question is, so you can identify exactly where your weaknesses are, and work on them. Alternatively, you can also invest in a questionbank (we particularly like Amboss and UWorld), which will do the same thing.

Making sure you’re on track

Similar to the point above, studying for the USMLE can help you not just identify your weaknesses, but also track your progress. Maybe you have an exam or quiz coming up, and want to see if you’ve improved your knowledge base after your week of revision. By checking your performance in a particular topic before and after your revision, you can see exactly how effective that week of revision was, and whether you need more revision or can move on to the next topic. More broadly, you can also track your progress over time, to see whether you’re improving your knowledge base or whether you’ve forgotten some things and need to brush up on some old concepts.

Extending yourself and learning new things

The USMLE covers more content than most medical schools cover in lectures, even in medical schools in the US. As such, board exam resources such as Physeo are likely to go into more concepts and in greater depth than your medical school lectures will as well. For example, medical schools in Australia have less of a focus on the basic sciences, particularly things like anatomy, because the assumption is if you’re going into fields that require that knowledge, you’ll learn those just before or during your specialized training, so Australians keen on surgery might do a masters in surgery or an anatomical dissection course before training to be a surgeon. This means if you’re keen on extending your knowledge beyond what is expected of you at your medical school, studying for the USMLE is a great idea. It can help you stand out in classes with your extra depth of knowledge and can make exams just that little bit easier.

Studying on your own terms

Studying on your own terms and your own schedule is incredibly liberating. If I want to cover concepts before my medical school does, I can. For more difficult concepts, such as eye physiology, I’ve often watched the relevant Physeo video a few days before my scheduled lecture. This allows me to gain a good understanding of the basics before the lecture itself, so that I can have an easier time keeping track of what’s happening in the lecture and therefore get the most out of it. Currently, I often use Physeo, Amboss or First Aid as a super quick revision of some important concepts before heading off for my rotation, which allows me to integrate basic sciences knowledge with clinical skills, and also allows me to not look like a fool when my attending asks me questions.

Exposing yourself to a different line of thinking

In most medical schools in Australia and the UK, and even in the US, we learn medicine quite differently than what gets tested in the USMLE. I can’t speak to how medical schools are run in other countries, but certainly for these three, most learning revolves around systems and case-based learning. So a typical tutorial might involve a brief discussion of symptoms and treatment plans of a few common presentations, followed by an in-depth discussion of one particular case, tracking it from the very beginning (probable history and examination findings based on the presenting symptom) right til the very end (list of 5+ differentials, followed by treatment and discharge plans). Very rarely do we ever get a rapid-fire sequence of presentations and have to identify a single detail in that patient’s singular most likely diagnosis or their management, which is quite typical of most USMLE-style questions. Being able to think quickly and focus on minutiae is also an important part of medicine, so to improve those types of skills that aren’t so commonly assessed in your medical school’s curriculum, studying for the USMLE would be a great idea.

Knowing more than your friends

This might be the most important reason of all for some, but studying for the USMLE will certainly give you an edge over your friends who haven’t studied content outside of your medical school’s curriculum. One time, a professor asked a question to the team, and once the answers started drying up, I butted in with an “orotic aciduria”, and the number of dirty looks my friends shot me gave me a level of satisfaction I literally cannot even put into word s. So if that’s your jam, start studying for the USMLE.

Dating in Medical School

Active vs. Passive Learning

How Bullet Journaling Saved My Sanity

To Fail Isn’t Failure -Five Things I Learned After Failing Step 1​

The Best Resource for Physiology​

How to Tackle Seasonal Depression

Preparing for the 2020-2021 Virtual Residency Interviews

Physician-Assisted Dying

Oh No! I Made the Baby Cry-Tips for Pediatrics

You Got a Bad Grade. What Next?

by
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To Fail Isn't Failure -Five Things I Learned After Failing Step 1​

To Fail Isn't Failure Five Things I Learned After Failing Step 1

I can honestly say that the fall to rock bottom never hurt as much as it did that morning. I held my breath as I waited for my score to load and when I saw the three big numbers, emblazoned in red and the bold FAIL right next to them, I asked myself for what seemed like the hundredth time that month, why are we doing this again? I was frustrated. And even more than frustrated, I was infuriated. I cried for what seemed like twenty-four hours and when the tears ran out, I sat there in silence because words were not enough. 

I would be lying if I said that I got right back up the next day and went full-force back into studying. The truth is, I had to take a long and hard look at the work I had done so far and do quite a bit of self-reflection both on my study techniques and test-taking methodology but also on my approach and perspective to this process as a whole. But having failed at something is not the same as being a failure, and though it took me a while to figure that out, I did learn some things along the way. 

  • Lesson #1: Self-doubt and fear will be your undoing

Remember the saying “confidence is key?” Post-failure, I understand it more and more each day. When you self-deprecate, when you think to yourself “I’m such an idiot, how could I miss that?” or “There are thousands of people that pass this test on the first try, my degree is a joke,” then you inadvertently start to doubt your abilities, which leads to doubting your knowledge, which ultimately and subtly leads to second-guessing yourself on your exams. 

I first noticed this while answering questions in a random practice block on UWorld. My inner trauma of believing myself to be a failure and unworthy of the MD began to manifest in my thought process. I would choose the correct answer, but then ask myself if I was sure because you thought you were sure last time, but obviously you weren’t, and end up getting the question wrong. Rinse. Repeat. For a month until I figured out that once again, it wasn’t my lack of knowledge or content deficits that were causing this part of the problem, but my own self-doubt and fear. Confidence is key.

  • Lesson #2: Remember your why.

Why did I put myself through this? Is an example of the wrong question to ask yourself after you’ve failed. Why do I still want to be a doctor? Is better, but still difficult to answer while experiencing the level of devastation you’re feeling after failing. Why did I start? Is the question that I chose to begin with. And my answers varied from things like: because I always wanted to be a doctor, because it’s my childhood dream, because I love helping people… and as I began to list my reasons for starting, they evolved into the reasons that I stuck with medicine to begin with: because there is nothing else that I can imagine doing, because I remember assisting in an OR where I got to see the human brain and it was amazing, because I realized in my four years of school that I can do anything as long as I want it and work for it.

When I realized how much this process helped me learn and grow and how much medicine has given me (pitfalls and all) and how it has never taken away, I remembered my why. That I was doing this because I loved it. And love means keeping at it, especially when it’s hard. 

  • Lesson #3: Let people love you.

It is no secret that there is a sort of unspoken shame placed on those who have failed, like a dark (but extraordinarily heavy) cloak. We hear about “red flags” and how “that’s the worst possible thing that could happen,” but then it happens. And the world begins to feel like a sinking ship waving a red flag, too scared to send out an S.O.S. We are afraid to tell our parents. We don’t want our study buddies to know. We can’t imagine our classmates finding out. We did not plan for this, and yet here we are. 

We live in a world where the 250s, 260s, and 270s reign. We see their posts, read their advice. We pressure ourselves into trying to fit that model and yet, despite our best efforts, we end up at the other end. The best thing I did for myself in the aftermath of my failure was sitting down amongst the pieces of my broken plan and texting a mentor that I had failed and thanking him for his help. He texted me back and asked: “Can I call you tomorrow?” and in a state of disbelief mixed with gratitude, I told him yes. That single phone conversation saved me from the season of doubt I was sure to have entered. “Pau, it’s okay,” he said, and even though I replied, “but it’s not okay!” He repeated himself: “It’s okay. You took the exam, one of the hardest exams in the world. Next time, you’ll kill it.” And hearing that from a success story, from someone whose opinion I deeply valued, made the difference. So let your friends love you. Cry on the phone. Text them when you’re feeling down. Let them know you are stuck in a rut and that red flag escapes becoming the white flag of surrender and turn into your banner of triumph. 

  • Lesson #4: Stuck is not stagnant.

Having failed in the midst of a pandemic, my CS exam canceled, my CK exam date nowhere in sight, and a retake of Step 1 looming in the future, I felt that I was living my worst fears. Most people say they’re afraid of being alone? I have always said that my biggest fear was stagnancy; looking around in five, ten, twenty years and realizing that I have not grown, changed or improved. Failing Step 1 made me feel as if a year of my life had been wasted.

Being stuck, though, is different than being stagnant. Because when you’re stagnant, you have stopped all efforts. You stop moving, you stop fighting. You have given up and given in. I imagine being stuck more like a car in a mudpit, where you’re revving and revving and pushing that gas until somehow, someway, you’re vaulted out of that pit, mud splattering everywhere, dirt dripping down your front, your hard work and struggle clearly visible. And no matter how long you spent with your tires squelching, fighting against what feels like a bottomless expanse, you never stopped moving. And now, you’re on your way again! 

  • Lesson #5: Make things new.

One of the first things I thought about after failing was this can’t happen again. But how do you pass a test you already failed? The first thing I thought was, I’m going to have to take a look at how I was studying because obviously the way I was doing it the first time just did not work. 

And so back to the drawing board I went, listing out resources, ruling out methods that didn’t work for me (sorry, Anki) and discovering new methods that did (hello, Divine Intervention podcasts!). I stopped burning through UWorld just to “finish my first pass” and started approaching the questions by system, creating small notebooks of UWorld journal entries, littered with bright pink Post-It notes of concepts that still didn’t make sense to me. I asked for advice, I sought comfort, I watched videos on test-taking strategies and question approach until finally, I did it: my study methods were reborn and more effective and the results showed. 

I went into my exam that morning in March being so afraid of failure because of all the warnings I heard in the months, weeks, and days leading up to test day: anything is better than failure, you don’t want a red flag, just pay the test fee again because you don’t want that on your record. Post-failure, I spent weeks processing, being so angry with myself and at the universe, wondering why months spent preparing went to waste, berating myself for everything I should have or could have done, hating myself for the day I took off six months ago or the nights I was too tired to watch Pathoma. And for the first time in my life, I spent time entertaining Plan B, a life without and away from medicine, one that would earn me a comfortable living without having to take the USMLE Step Examinations. Tempting doesn’t even describe it.

Then, a switch flipped. I stopped tolerating my self-inflicted doom and gloom thoughts and decided to start studying again. I decided to move forward with a post-failure timeline I laid out in a moment of lucidity and began reading, doing UWorld (slowly and without the added pressure) and in the last three weeks, have seen significant improvement in both my assessment scores and more importantly, my understanding. 

So yes, maybe I don’t have to be a doctor. 

But in the marrow of my bones, I know that I need to be.

Dating in Medical School

Active vs. Passive Learning

How Bullet Journaling Saved My Sanity

8 reasons why every non-US medical student should study for the USMLE

The Best Resource for Physiology​

How to Tackle Seasonal Depression

Preparing for the 2020-2021 Virtual Residency Interviews

Physician-Assisted Dying

Oh No! I Made the Baby Cry-Tips for Pediatrics

You Got a Bad Grade. What Next?

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The Best Resource for Physiology​

The Best Resourse for Physiology

Physiology can be a challenge. Though the concepts may be simple, understanding and applying them is the key. That being said, during the basic science classes and USMLE Step 1 dedicated study period, Physeo was amazing for physiology.

Topics:

  • How to Study Physiology
  • Videos
  • Practice Questions
  • Textbook 
  • Anki
  • What Makes Physeo Different from Other Resources
  • My Daily Study Schedule for Physiology 
  • Supplemental Resources for Physiology

How to Study Physiology

Focus on understanding over memorizing. Physiology is different from studying other subjects like microbiology that require a lot of rote memorization. In physiology,just because you memorize a definition, it doesn’t mean that you can apply it. Do not make the mistake of memorizing all the concepts without understanding what each concept means. The key for physiology is asking the “why?” questions. For example, a good student would be able to explain what is happening in each step of the cardiac cycle and why it is happening the way it is. 

In addition, it is important to integrate physiology into your other subjects like pathology and pharmacology during basic sciences. Connecting all the subjects together will save you a lot of time during Step 1 dedication period. To further expand on this, a good student would be able to explain (depending on the cardiac pathology) what a change in the cardiac cycle and cardiac pressure loops would do and why.  

In general, physiology is one of the backbones to medicine. Understand physiology and you will not be lost. 

Videos

The Physeo Videos were super helpful. They are visual and give good explanations for the concepts. Plus, during the videos they ask questions which are good checkmarks to figure out if you understood the concept or not. Though a section of a video may seem long, each video is only about ten to fifteen minutes. It is super easy to listen to and follow along. In addition, I used Boards and Beyond videos to supplement the Physeo videos.

During pre-dedicated, I watched all the physiology videos before lecture as a preread. I usually like to watch them at normal speed or at 1.25 speed so that I can annotate in my First Aid without pausing the videos during my first time watching them. Although, when I would have a question about something I just watched, I would pause and write it down.. This is helpful because I was able to organize a list of questions I wanted to ask my professor either during office hours or right before or after lecture.

Practice Questions

I used the practice questions right after watching the videos to see how much I retained in a short period of time. I also used them after a lecture while I was in pre-clinicals. For example, if I learned about spirometry in physiology class, I did the practice questions after class for that specific topic. In addition, they give in-depth explanations and you can repeat the quiz as many times as you like. Also, the questions can give good insight into what you need to work on and can further solidify the concept. After reviewing the questions and answer explanations, I had a good foundation to do more practice questions on Uworld. 

During my dedicated USMLE Step 1 period, at the end of each day I would note which topics I missed and rewatch the videos for those specific topics.Over time, you will see a pattern in what types of questions and topics you need to work on. Then, I would use USMLE Rx for those specific topics. For example, if topics I needed to work on were cardiac PV loops, cardiac murmurs, and cardiac congenital defects, I can pick practice questions on those topics on Rx. This method worked really well for me because I focused on improving my weaknesses, which really reflected on my practice tests. 

Textbook 

The Physeo textbook was a good resource to read after watching the videos. They consist of thorough summaries of each section and it is great to use them as reviews. In addition to the Physeo textbook, I  annotate in my USMLE First Aid when I am reviewing practice questions. The Physeo textbook compliments the summaries in First Aid really well. My Physeo notes go in my First Aid book so that all my notes are together. As a visual person, it was a good way to organize all the information into one place.

Anki

At the end of a long study day, Physeo’s Anki deck was clutch. For each section there is a custom-made Anki deck you can download and use at your convenience. Plus, the Anki cards build on each other. As soon as you finish a new deck of cards, you revisit the old cards. These are great to practice active learning, helping you retain much better.

It is helpful to use the Anki decks as practice after watching the videos and doing the practice questions. Usually I use them at the end of the day before I go to sleep as extra practice. According to studies, it is suggested that repetitive active learning is best for retention. I also used the Yousmle physiology decks which followed the same philosophy as Physeo.

What Makes Physeo Different from Other Resources

Physeo is different because it combines all of its features and resources into one. Plus, along with physiology, it offers other subjects like biochemistry, anatomy, pathology, etc that you can connect the physiology concepts with. For Step 1, it is the all-in-one package to success. 

My Daily Study Schedule for Physiology

This is my schedule for how  I used Physeo and other study resources during pre-clinical and dedicated USMLE Step 1 period. 

Pre-clinical schedule:

  • 8am – 11:30am: Lecture
  • 11:30am to 12:30pm: Lunch
  • 1pm to 2pm: Discuss today’s physiology lecture with study buddy and do associated practice questions
  • 2pm to 4pm: Discuss today’s lectures with study buddy for other classes and do associated practice questions
  • 4pm to 5pm: Yoga Class or Zumba Class
  • 5pm to 7pm: More practice questions
  • 7pm to 8pm: Dinner
  • 8pm to 9:30pm: prewatch Physeo videos for tomorrow’s lecture

Dedicated USMLE Step 1 study period schedule:

  • 5:30am to 6:30am: Gym
  • 7:00am to 9:00am: Breakfast
  • 9:00am to 12:00pm: Physiology Uworld
  • 12:00pm to 1:00pm: Lunch
  • 1:00pm to 4:00 pm: USMLE Rx Physiology questions (topic specific)
  • 4:00pm to 7:00 pm: Physeo and Boards and Beyond videos and questions (topic specific)
  • 7:00pm to 8:00pm: Dinner
  • 8:00pm to 9:00pm: Physeo and Yousmle Anki Decks

Supplemental Resources for Physiology

As mentioned previously, in addition to Physeo’s resources, I used other resources for physiology. In no particular order, here is a summary of the supplemental physiology resources I used: 

  • Boards and Beyond Videos
  • Yousmle Anki Decks
  • USMLE Rx practice questions
  • Uworld practice questions
  • USMLE First Aid
  • Class Lectures

 

Conclusion

At the end of the day, physiology is one of the foundations to medicine. You have to understand it in order to integrate it well with other subjects. With Physeo, you are set up to start exactly that process.

If you have any questions or want to see my life through medical school, find me on Instagram @future_artist_md

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Preparing for the 2020-2021 Virtual Residency Interviews

Preparing for the 2020-2021 Virtual Residency Interviews

Residency interviewing season is finally here, and it is time to prepare so that you can be confident and show off your best self to programs. You have come so far after jumping through hoops to get into medical school, studying your hardest during dedicated step exam periods, and persevering through tough days in the hospital during clerkships. Now, you get to tie all your personal, academic, and non-academic experiences together into a story to persuade residencies to choose you.

Residency interviews were already nerve-wracking, and now due to the COVID-19 pandemic, many students are feeling stressed about navigating interviews virtually during this 2020-2021 application season. However, do not let your fears distract you into a downward spiral because “obstacles are those frightful things you see when you take your eyes off your goal,” as Henry Ford once said. This article covers important tips to prepare your technology and interview space for an ideal virtual interview experience.  

 

Part 1: Interview Logistics

Interview formats

Virtual interviews this year are divided into two formats –live virtual interviews and asynchronous virtual interviews (on-demand interviews). The live virtual interviews use an online video conference program to simulate the in-person experience with an actual interviewer speaking to and seeing you in real time. While the live virtual interview is more typical, some programs will be using an on-demand interview format where you will actually video record yourself asking questions and answering interview questions, and then having your video reviewed by interviewers at a later time.

 As interview invite emails are sent out, be sure to look out for which format the residency program will be using. In either scenario, you will still need to prepare for both the interview questions themselves and optimizing your technologic set-up to ensure a smooth experience. Other important things to know about the interview besides the format are what online video conference program you will be using, how many interviews will be conducted, how long the interviews are, and what the rest of the interview day schedule looks like. 

Setting up your virtual interview location and equipment

Start off by choosing a spot where you will be sitting down for your interview day—which includes the group presentations, resident question and answer sessions, and the interview itself. While some students are planning to interview at home, others are booking rooms on their medical school campuses to interview. If you are hesitant about the reliability of your electronics, try reaching out to your school’s IT department to see if they have rentals for video equipment, headphones, microphones, and laptops.

Space:

  • Choose a location that is quiet and private. This is not the time for cameo appearances by your cat or your roommate who forgot their charger on the wall. 
  • Ensure a bland background without any visual or audible distractions.
  • Avoid communal spaces like café’s, libraries, shared living rooms, etc.

Webcam and Lighting:

  • Assess the lighting in the room and whether you will need additional lights such as a lamp or even a ring light, which you could find on Amazon.
  • Assess the quality of the webcam on your computer and decide whether you will need to purchase a separate webcam from the built-in one on your device.
  • Analyze the height and distance of the webcam and its field of view. Try putting your laptop on top of books or a box so that the webcam is at eye-level, as looking down at the camera can be unflattering. Ideally the camera should be centered with your full head and upper half of your torso in view. This is especially important if you like to use hand gestures while speaking.

Sound:

  • Consider using headphones or earbuds if your computer audio is not loud enough for you.
  • Identify sources of distracting noises that might be heard during the interview and address those.

Distractions:

  • Silence any phones, watches, or electronics. 
  • Move any pets into another room. 
  • Inform any friends and family ahead of time not to knock or call you during your interview.

Comfort:

  • Find a comfortable chair and a table with a nearby outlet.
  • Have a desktop or laptop ready with a cell phone on hand as backup just in case you have issues with your computer.

Ensuring Reliability:

  • Charge all devices the day before and test them a few days in advance to ensure functionality.
  • Ensure a reliable, working internet source.
  • Try using a sticky note on the edge of your screen with any written questions you need to remember to ask

Practice with your set-up

After you have set your interview space and devices, give it a test run. Have a friend or roommate give you a video call and practice speaking into the camera. If you do not have someone to practice with, you can record yourself as if you are answering interview questions and watch yourself. It might seem a little painful to watch yourself, but it will give you a sense of how you come across on the screen and can help you decide on any technical adjustments like adjusting lighting or trying a different microphone.

Part 2. Preparing for the interview itself

The preparation required for the virtual residency interviews are the same as what you would do for a regular interview in the pre-COVID era. A common place to start is reflecting on your application and thinking of what the salient points of your application you are hoping to get across to the interviewer. Think about your personal statement and be prepared to expand anything you wrote. Review your entire application and anticipate any questions that the interviewers may ask you. While it’s important not to sound like a robot who has memorized answers to interview questions, it can help to think about your responses to common questions so that you appear polished and thoughtful.

Take a minute and look at the list of questions below. Do you think you could confidently answer some of these common residency interview questions?

  • Tell me about yourself?
  • Why did you choose this specialty?
  • Where do you see yourself in five years?
  • What are your ultimate career plans?
  • Why do you want to come to this program?
  • What are your strengths and weaknesses?
  • Why do you want to be a physician?
  • What will you do if you do not match?
  • Describe an interesting case you saw in the hospital.

Sometimes, interviewers might ask questions that may seem non-traditional and somewhat difficult. While it can be hard to predict which questions you’ll be asked, it’s in your best interest to answer them calmly and thoughtfully. If a question seems odd, you might try saying something along the lines of, “That is an interesting question. Let me think about that for a moment,” to buy you some time to come up with an answer. Answer the question briefly and use facts to support your response rather than emotion. Remember that if you do not understand an interviewer’s question, you can politely ask them to repeat or clarify the question. Typically, interviewers are not looking for a right or wrong answer. Rather, they are assessing your reasoning and approach to the answer. The way that you answer a question reflects on your values and helps residency programs get to know you and whether you will be a good fit for their program.

Here are some examples of “non-traditional” interview questions.

  • If your house was on fire and you had to save only 3 items, what would they be?
  • Teach me something non-medical.
  • Describe the worst incident you have experienced during your third-year clerkships.
  • Tell me about a weakness in your application?

You can start practicing your interviewing skills and answering questions clearly and confidently by recruiting the help of a medical school advisor, mentor, friend, or roommate. Hand them a list of interview questions and ask them to practice with you periodically. Seek and incorporate feedback on the content and delivery of your answers. Below are additional websites where you can find more practice interview questions.

Final Thoughts

With a plan in place to set up your interview workspace and plenty of practice thoughtfully answering questions, you will be well on your way for a successful (and fun) virtual interview season. Good luck!

Additional Resources

Here are more articles on preparing for virtual interviews from various professional organizations and residency programs.

From the Association of American Medical Colleges (AAMC):

https://www.aamc.org/what-we-do/mission-areas/medical-education/conducting-interviews-during-coronavirus-pandemic

From the American College of Physicians (ACP):

https://www.acponline.org/membership/medical-students/residency/preparing-for-residency-interviews/key-things-to-remember-about-residency-interviews

From the American Academy of Family Physicians (AAFP):

https://www.aafp.org/students-residents/medical-students/become-a-resident/applying-to-residency/prepare-for-residency-interviews.html

From the New England Journal of Medicine (NEJM):

https://blogs.jwatch.org/general-medicine/index.php/2020/05/virtual-residency-recruitment-in-the-time-of-covid/

From the Boston University School of Medicine:

https://www.bumc.bu.edu/busm/student-affairs/career-planning/virtual-residency-interview-preparation-video/

 

 

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Physician-Assisted Dying

Physician-Assisted Dying

“There is a difference between a person who is dying and a person who is suicidal. I do not want to die. I am dying.” – Brittany Maynard.

To understand physician-assisted dying, you’ll need to understand the following; it deals with a patient suffering from an incurable terminal disease or extreme chronic pain.

Physician-assisted death is different from active euthanasia. In physician-assisted dying, the lethal substance, usually a barbiturate, is either ingested or injected intravenously by the patient himself. Whereas, the doctor administers the lethal dose in active euthanasia.

It comes as no surprise that doctors often find physician-assisted death more palatable when compared to euthanasia. It is much easier to write a prescription according to your patient’s wishes than to inject them with something fatal.

If you have primarily based your views on this subject after reading the book, Me Before You, I will have to request you to kindly forget it’s existence. I have very few nice things to say about that book. It offers a maddeningly narrow view on a much deeper and complex subject.

Terminology:

I prefer to use value-neutral language to not be hurtful or offensive to the patients. Furthermore, it encourages you to make your own views on the topic without unconscious bias and judgment. I request you to consider doing the same in your daily life by using: death with dignity, assisted dying, assisted death, physician-assisted death, physician-assisted dying, aid in dying, physician aid in dying, or medical aid in dying.

Legality of Physician-Assisted Dying:

Physician-assisted dying is currently legal in Switzerland, Germany, Netherlands, the Australian state of Victoria, and in the U.S. states of Washington, Oregon, Colorado, Hawaii, Vermont, Maine, New Jersey, California, and in the District of Columbia.

Switzerland: First country to legalize physician-assisted dying in 1942. This law applies to non-residents also. Commonly offered by non-governmental organizations (NGOs) like Exit, Dignitas, Ex International, and Lifecircle. There is extensive paperwork involved to safeguard all parties. The process takes up to 3 months. Moreover, a police inquiry is started following the declaration. Active Euthanasia is currently illegal. 

Germany: Assisted dying was legalized in Feb 2020, following a five-year ban. The legalization came after extensive criticism of the previous ban that affected palliative care. This is a particularly sensitive issue as Germany has a history of involuntary euthanasia during WWII when 300,000 people with mental and physical disabilities died under a Nazi campaign.

Netherlands: The ‘Termination of Life on Request and Assisted Suicide (Review Procedures) Act’ of 2001 legalizes both physician-assisted death and euthanasia in the Netherlands. The proceeding took root following a 1973 case, where Dr. Truus Postma following repeated requests from her mother injected her with morphine. It is commonly referred to as the ‘first euthanasia’ case in the country. It was very controversial. She was found guilty but received no/minimal punishment (two different reports). The ‘Postma case; is most commonly cited in the Netherlands when euthanasia is the topic of conversation. The ‘Groningen Protocol’ was created in September 2004 outlining the criteria under which physicians can perform “active ending of life on infants”.

Australia: ‘Voluntary Assisted Dying Bill 2017’ came into effect in the Australian state of Victoria in June 2019. Western Australia passed a similar bill in 2019 which is expected to come into effect in 2021. For a brief period between 1996 and 1997, euthanasia was legal in the Northern Territory. Currently, active euthanasia is illegal in all of Australia. Two Australian courts in 2009 and 2011 have sentenced people for providing means of death on account of the patient’s mental incompetency.

United States of America: Oregon was the first American state to pass the ‘Death with Dignity Act’ in Nov 1994. Following this, multiple states introduced similar bills but most failed. In 2014, Brittany Maynard, a public advocate for assisted death, chose to die by physician-assisted death in Oregon, thus renewing the debate nationwide. She is largely credited for the introduction of multiple bills in different states. Currently, 10 American territories including Montana have legalized assisted death.

Religious Views on Physician-Assisted Dying:

When it comes to religious views, the difference between euthanasia and physician-assisted dying is often not made. It is said that euthanasia was a common practice during the time of Hippocrates. Later, with increased proselytism to Abrahamic religions (Christianity and Islam) and their belief in absolutism, the discussion has become more complicated. Different subtypes of Christianity, different churches, and different Popes’ have issued vague but critical statements over the years. Similarly, Islam has often been critical of active euthanasia but also doesn’t believe in prolonging life using life-support machines. With a history of crusades, Protestant-Catholic conflicts, Shia-Shunni conflicts, and rise of the Islamic State, all views on this matter have always been accompanied by controversies.

One can imagine how extensive the discussion is when it comes to Hinduism, the world’s longest surviving religion which is constantly evolving with time. Hinduism is largely based on the consequences of one’s actions, known as ‘karma’ rather than the action itself. The Vedic texts and Bhagavad Gita don’t explicitly mention the acts of physician-assisted dying or euthanasia. Like Hindus, Jains also practice non-violence or ‘ahimsa’ which is again open to individual interpretation. Buddhism has opposing views since it’s foremost principle is human compassion. Indic religions give more importance to the intention behind one’s action rather than the action itself. Additionally, some religions have acceptable forms of ‘suicide’.

No religion in the world, over the period of hundreds of years, has come to a common agreement on this topic. It may be impossible to do so. Religious views on this subject are very vast. It comes down to this: Physician-assisted dying is opposed by those who believe in the sanctity of life and is supported by those who believe in compassion and respecting individual liberty.

Points Against Physician-Assisted Dying:

  • Sanctity of life: This argument has strong religious and secular beliefs against taking human life. Assisted suicide is considered to be morally wrong because it contradicts these beliefs.
  • Passive vs. active distinction: There is an important difference between passively “letting die” and actively “killing.” Refusal or withholding of treatment equates to letting die (passive) and is justifiable, whereas physician-assisted dying equates to killing (active) and is not justifiable.
  • Potential for abuse: Certain groups of people who are financially unstable or/and cannot support a person of special needs may push the patient into assisted death. This is a grey area as these patients are also often victims of domestic abuse. So, the patient’s motives for choosing physician-assisted dying can be hard to determine.
  • Professional integrity: Medical ethics strongly oppose this practice. Moreover, professional bodies like AMA stand against it. Additionally, there is concern that this could harm the public image of doctors.
  • Fallibility of the profession: This pertains to the physicians’ margin of error. The diagnosis and/or prognosis may be uncertain, which, in turn, affects the treatment. Thus the government has an obligation to protect lives from these inevitable mistakes.
  • Emergence of palliative care: As it focuses on making the patient comfortable towards the end of his life, the need for physician-assisted dying is largely reduced.

Ethical Safeguards:

  • Patient has the power: Physician-assisted dying ultimately depends on the patient’s choice. The patient can choose to opt for or against the procedure. The patient is free to administer the dose at a time of his choosing. It also allows the patient to change his mind, even at the very last moment.
  • Preferred to active euthanasia: It is emotionally easier for the physician than euthanasia as he or she does not have to directly cause the death; he or she merely supplies the means for the patient’s personal use.
  • Consent: Taking written informed consent explaining the patient all the options available, and that he is free to change his mind at any point in time, reduces the risk of unwanted death of the patient. It further helps the patient consider all his options before making a decision. This procedure of obtaining consent can be recorded by the hospital to adequately protect both the doctors and the institution.
  • Age: Like all medical procedures you must be of legal age (18+) for your opinion to be counted.
  • Psychiatric screening: The patient’s competency to make a decision and a mandatory mental health screening to rule out any psychiatric disorders that may impact a patient’s competency must be assessed prior to the procedure. Furthermore, two different doctors must sign off on the procedure to reduce the chance of its abuse.
  • Physician free to refuse: It is in the best interest of everyone involved to give the physician the freedom to refuse to participate in the procedure. It should be their personal choice. Instead they can refer to the patient to a different physician.

Points In Favor of Physician-Assisted Dying:

  • Autonomy: Patient autonomy is one of the most fundamental ethical lessons we are taught in medical school. The patient has the right to make decisions about his body and health. A competent person suffering from an incurable disease in extreme pain must be given a choice to die with dignity.
  • Compassion: Patients suffer. They suffer physically, mentally, emotionally, and not to mention financially. It is not always possible to relieve suffering. This helps by reducing the amount of time a patient suffers.
  • Individual liberty vs. state interest: Though society has a strong interest in preserving life, that interest decreases when a person is terminally ill and has a strong desire to end his life. A complete prohibition on assisted death excessively limits personal liberty which should take precedence in such cases.
  • Reduces abuse of opioid analgesics: With the legalization of physician-assisted dying, stronger measures can be taken to reduce the use of opioid analgesics in healthcare. This has a direct impact on reducing it’s addiction rates and abuse.
  • Lack of palliative care: Not all countries in the world have the same laws when it comes to palliative care and not all countries pay for palliative care of its citizens. For example, in India, despite recent relaxations, most doctors never prescribe morphine in their lifetime, and fentanyl is highly regulated and is mostly used by anesthesiologists or in cases of extensive polytrauma. Even tramadol is rarely prescribed out of the ER. Patients living in similar countries suffer for years from chronic pain or are bed-ridden for the majority of their lives because they can’t afford lifelong treatment.
  • Encourages a conversation: Some would argue that assisted death already occurs, although slowly and in secret. Legalization of physician-assisted dying would promote transparency and open discussion between the patients and doctors.

Every discussion has both points in support and points against it. When it comes to ‘Physician-Assisted Dying’, I firmly stand in favor of it. By that, I’m not saying every terminally ill patient should opt for physician-assisted dying. Absolutely not. 

When I say I am pro-physician-assisted dying, I mean, the patient has the right to choose. I believe a person has the right to live and the right to die on his/her own terms. They know themselves best. It is their body, their life, and it should be their decision and voice that matters.

If a patient believes in the sanctity of life, he gets to make the choice to opt-out of physician-assisted dying. If a patient believes in dying with dignity, he gets to make the choice to opt into physician-assisted dying.

We are a planet of almost 8 billion people. People who follow many different religions. People with broad and conflicting views. People with strong personal reasons to support their sentiments. This article fails to mention interpersonal relationships, the most important driving force behind most human decisions. One decision cannot apply to everyone. One decision will not make everyone happy. And it rightfully shouldn’t. Our differences are what make us human. That is why I believe having a choice is important. People should be able to decide what is best suitable for them.

Points to consider:

Please understand that this article covers a small portion of an enormous subject. There is so much more literature to read about the same. Here are some thought-provoking questions to consider as you formulate your own opinion:

  • Should next-of-kin be able to consent to physician-assisted dying?
  • Should physician-assisted-dying be ethically and/or legally applicable for patients suffering from chronic psychiatric conditions?
  • For older patients suffering from neurodegenerative diseases?
  • For infants/children born with birth defects?
  • Physician-assisted death is currently illegal in all Asian countries. Why?
  • Should active non-voluntary euthanasia ever be legalized? Are there circumstances in which it could be considered?
  • Active Euthanasia is legal in the Netherlands, Belgium, Colombia, Luxembourg, and Canada. Out of which, only the Netherlands legalized assisted death also.  Should countries that have already legalized active euthanasia also legalize physician-assisted death?

Glossary

Physician-Assisted Dying: Physician makes the means of death available to the patient to be used by the patient himself at a time of his choosing.

Euthanasia or Mercy Killing: Act or practice of painlessly putting to death persons suffering from a painful and incurable disease or incapacitating physical disorder or allowing them to die by withholding treatment or withdrawing artificial life-support measures. (Broad definition)

Active Euthanasia: When a patient’s death is bought upon by an active intervention by the doctor. The doctor administers the lethal dose.

Passive Euthanasia: When a patient’s death is brought upon by omission. The doctor stops treatment leading to the patient’s death. DNI/DNR is a form of passive euthanasia.

Voluntary Euthanasia: When the decision of dying is made by a competent patient himself. With the patient’s consent, a doctor administers the lethal dose or stops treatment.

Involuntary Euthanasia: When the decision of dying is made for a competent patient without his consent. Patients may be unwilling to make the decision. The doctor administers the lethal dose or stops treatment. (Illegal in all countries)

Non-voluntary Euthanasia: When the decision of dying is made for an incompetent patient (brain dead/vegetative state) by the family. The next-to-kin gives consent. The doctor administers the lethal dose or stops treatment.

Palliative Care: A medical approach that improves the quality of life of patients and their families facing problems associated with a life-threatening illness, through prevention and relief of suffering. The goal is to relieve pain and suffering. The treatment may or may not be in tandem with curing the patient. Applicable to all age groups.

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Oh No! I Made the Baby Cry-Tips for Pediatrics

Oh No! I Made the Baby Cry - Tips for Pediatrics

As an older brother of 7 siblings of a variety of ages, I enjoy seeing my siblings grow up and always tried being the model brother, although I was not good-looking. I kid! However, in all seriousness, this responsibility did lead me to enjoy being around children.

As a medical student, I feared becoming a pediatrician, because what if I made a baby cry or a child does not let me perform a physical exam? Or what if I make a parent upset because they do not feel I’m taking adequate care of their child?

Luckily, I had met some awesome residents during my medical school career. As a currently aspiring pediatrician, I would like to share with you their advice on what you can do to be a great pediatrician! 

Even if you do make a couple of babies cry…

Principle #1: Addressing the children

Principle #2: Be creative

Principle #3: Include the family 

Principle #4: The dreaded physical exam

Principle #5: Ask for help, stay curious, and learn from your patient

Principle #1: Addressing the children

On your pediatric rotation, you will definitely encounter all sorts of children. Some children may be so shy that they may not even dare look you in the eye, while other children may be so fast and active that you may think they are a reincarnation of Barry Allen.  

In either scenario, you have two options. You can either A) give up and focus your interview solely with the child’s parent or B) attempt to communicate with the child as your patient. I hope you chose option B! 

As a possible future pediatrician, it is good practice to be able to adapt to any patient as there are many personalities encountered in pediatrics! Practicing introducing yourself to the patient and trying to communicate with them shows that you are interested. It not only makes the patient feel more comfortable with you, but also makes their parents feel more comfortable with you.  

Even if your attempt to make the patient feel comfortable fails, whether your shy patient remains silent or your Flash patient runs off to the horizon never to be seen again, this practice of addressing your patients allows you to have the potential to grow your social intelligence as well as learn how to address different personalities in the future. 

Principle #2: Be creative

Sometimes in order to reach a child and gain their trust you must go above and beyond to show that you are someone that they can trust! Being creative may not be easy for some and for this principle, it may be a good idea to hit the “Phone a friend” button in your head and contact some of your right-brain friends for help. 

I’ve found personally that script-reading could be very helpful for your shier patients. For example, I personally had one patient who would never speak to the pediatric team in the hospital. So after rounds, I would print scripts from the Lion King or Coraline, which was her favorite movie, and we would act the scene with her mom! It was then I would hear her voice and laugh. Nothing in the hospital sounds sweeter than a child’s laughter. 

Now, you do not have to be the most creative person to be a great pediatrician, however, minimally it is essential to be able to adapt to your patient and show enthusiasm. This is the time to carry stickers or little toys in your white coat. Maybe remember a few corny jokes to tell, as many children enjoy jokes! If you dare, maybe you can prepare little magic tricks such as a magical vase that makes a red ball disappear or a coloring book that does not have any images inside unless supplied with magic? Weird…

No matter what you do, just be creative as this skill will not only allow your patient to open up to you but also allow them to trust you. 

What is a good name for a hotdog? …Frank!

Not my best joke, but you get the point. 

Principle #3: Include the family

Now that we know that we should address our patients and how to do it, let’s also try to remember to keep the parents involved in the care. I know this may seem hypocritical as principles #1 and #2 are based on focusing on the patient, but I will explain.

One of the most exciting parts about pediatrics is that not only do you have the opportunity to educate children about their health, but you will also have the opportunity to educate parents. 

You will find that most parents are eager to understand why their child may not be feeling the best, and the importance of involving them cannot be stressed enough. This principle is crucial when your patient’s parents are first-time or younger parents. 

So now it is time to become a teacher. It is important to find ways to make important topics simple and easy to understand. It is always rewarding knowing that you relieve a parent of the stress of having a sick child.

“We are not just teachers, we are manager’s of the world’s greatest resource: Children!” 

  • Robert John Meehan

Principle #4: The dreaded physical exam

Now that you know how to skillfully address your patient AND to also address the patient’s parents like a teacher, you can move on to the physical exam. This may seem procedural as you are a seasoned medical student, but wait…now the patient can evade your physical exam!

One of the most uncomfortable parts of the routine physical exam that many children do not like is the HEENT exam, especially when you examine their ears. Having an otoscope inserted into their ears or nose will make any patient cranky. 

Some tips that I was advised are to save this particular exam towards the end of routine physical examination as a whole. For example, perform a heart, lung, and gastrointestinal exam first, then proceed to the HEENT exam. Once you get to the HEENT exam, that’s when you can perform your expert tactics to make the exam as easy as possible. 

First, if your patient is small enough, you can suggest that their parents can hold them while you are performing the exam. This allows your patient to feel as comfortable as possible and if the exam makes them uncomfortable then their parents can assist you by holding your patient steady while you perform your exam. This tactic also reduces the risk of any kind of injury that may happen if the patient is not steady. 

Secondly, remember principle #2. Be creative! Some students like to improvise during their physical exam by “finding” comical things inside children’s ears or nose. Examples can include finding mickey/minnie mouse, Elsa from the movie Frozen, or even tacos, which is the personal key to my heart, but I digress. In addition, you can also allow your patients to become familiar with your physical exam equipment such as letting them touch the lighted tip of your otoscope. The familiarity can help your patients relax during the physical exam. 

Finally, remember that no matter what, your physical exam is crucial to the patient’s care. It sometimes can be tricky, as children are resilient and may not be able to voice their concern or are unaware what is abnormal. So be meticulous! Assume every child is guilty of illness until proven healthy! 

Principle #5: Ask for help, stay curious, and learn from your patient

Principles 1- 4 will guide you through any clinical encounter in your pediatrics clerkship. This principle is useful with the aftermath. Did you ask the right questions during your interview? Did your physical exam help you determine your diagnosis? This is where most of your learning as a future pediatrician comes in. 

With everything, never be afraid to ask questions. If after an encounter you are unsure, ask! Believe it or not, even at the residency level you will constantly question yourself and think about things that you may have missed. This is a common feeling that I have found out and it is a feeling that I personally feel makes you a better pediatrician. 

I was advised to ask and to be curious, because this is how every clinician learns throughout their careers. This is how you can maximize your learning from each and every patient that you may encounter. 

If you are an aspiring pediatrician like myself and you remember these five principles during your pediatric clerkship then I believe you are on the road to being the best pediatrician you can be. So when you hold that baby and he or she starts to cry, just remember that every great pediatrician probably held a crying baby in their arms as well. 

“Good, better, best. Never let it rest. Until your good is better and your better is best. “

  • Tim Duncan
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You Got a Bad Grade. What Next?

You Got A Bad Grade. What Next?

Let’s face it, bad grades suck. It happens. Sometimes we make mistakes or there are events that are out of control. How do you overcome and learn from it? 

Topics

  • First, Breathe
  • Figure Out What Went Wrong
  • Change Study Strategies
  • Take Tips From your Upperclassmen
  • Find a Tutor
  • Go to the Professor’s Office Hours
  • Take Care of Your Mental Health

First, Breathe

When you first get the news, it can be a bit of a shock.  Especially if you worked very hard and expected good results.  Check-in with yourself. Whatever you are feeling, first notice it. If it is a negative thought, consciously choose again. Each person reacts differently, so don’t judge your feelings. 

Failures are not truly failures, but lessons. Ask yourself, what is this experience trying to teach me? Also, don’t beat yourself over what happened. Forgive yourself and move on to figuring out the core of the issue.

Figure Out What Went Wrong

The real questions to ask are what went wrong and why. Blaming external factors will get you so far. Truly introspect and understand what you need to change.

Is it a faulty study strategy? There are different study strategies and the ones you choose depends on what type of learner you are. Consider asking yourself: are you a visual, auditory, or a dexterity learner? A lot of times a combination of the three are present, but usually there is one learning style that is dominant compared to the rest. For me, I am a visual learner. I need to see and map things out on a white board or use visual pictures like in Sketchy Medical and Physeo to grasp the concepts.

Other questions you can ask is whether it is a content issue, a test-taking issue, or both. Though I wasn’t naturally the best test taker, memorizing content was my strength. Despite knowing the content, I needed to understand and integrate the concepts. This was my struggle for biochemistry. I knew all the pathways by heart, but at the time I needed to take extra effort to connect all the pathways together. 

Change Study Strategies

Once you have figured out what you need to work on, find a strategy that will work for you. I kept some strategies that I had before such as hand-writing notes, but I added on different methods. For me, I needed to take on a lot more active learning, such as doing practice questions and asking certain types of questions to help me understand the concepts.  In addition to the changes I made, I found a study buddy. Having a good study partner was valuable as we would bounce off ideas while going over lecture and doing practice questions together.

During COVID times, learning has become online. Although I haven’t taken online classes during this pandemic, I learned that I focus on the lecture better in person than in the recording and made it a habit to attend class in person. I took notes on as many important things I could pick up in class and filled in the rest of my notes after class. For online classes, I suggest watching live lectures instead of recordings. And if you have to watch a recorded lecture, treat it like a live one. 

Take Tips from your Upperclassmen

Asking for help is not a sign of weakness, but strength. Upperclassmen can give you valuable insights on a course they have taken in the past. Here are some questions you can ask to get a better idea of how to succeed in the course:

  • What did you think about the course?
  • What did you think about the professor’s teaching style?
  • How did you do in the course? This question is important because you want to know if with how they studied they aced the course or barely passed.  Additionally, if they did poorly, it can be helpful to know that you are not the only one that struggled.
  • What do you recommend doing and not doing?
  • How did you study for the course? You can also tell them your study strategy and ask what they think you can add or delete.

Find a Tutor

Along with asking upperclassmen, you can be tutored by one too. My school offered large group, small group and peer tutoring. It is helpful to consult people who have taken the course so that you can get some insight into what will be emphasized on test day.

If you are an auditory learner, a lot of my colleagues found large group tutoring beneficial. The tutors created tutoring slides which were summaries of the lectures and taught for certain time periods throughout the week. 

Some upper semesters also offered small group tutoring. This was a little more cozy with only about ten to twenty people in a room. I did this for biochem and our tutor used to explain the pathways and write it on the whiteboard. It was a good review of the week’s material.

Peer tutoring was available with one-on-one interaction. I used this the most to ask questions and to be quizzed. I actually tried a couple tutors at first, and then stuck to my favorites. For any type of tutor, if you messaged them a question, they were happy to get back to you.

Go to the Professor’s Office Hours

Office hours can be a blessing. If your professor offers it, use it. This time is a good way to learn and build rapport with them. 

During basic sciences, I went to office hours regularly. While most expected you to come prepared with questions, some took the extra mile when explaining concepts. One professor I had was willing to spend as much time needed to summarize the important points of a lecture. 

Regardless of the professor, make sure you study the material and come prepared. That way, you will get the most out of the meeting. In addition, you can also ask him or her about your exam and how best to study. If allowed, you and your teacher can go over the exam together and figure out what is the best way to move forward.

Take Care of Your Mental Health

When you experience a setback, it’s easy to feel down or struggle to bounce back.  Taking care of your mental health will keep you on course and help your motivation.  There are different ways to take care of mental health: exercise, meditation, and social support are all examples. Exercising regularly was a big help for me. My school offered gym classes, and I loved going to yoga and Zumba classes. An hour of exercise a day was good to recharge my brain and get back to studying.

Meditation is a good way to practice self-awareness and stay grounded. Even 10 minutes a day is helpful. There are many meditations you can try out on youtube and spotify. Try to find which ones work for you and incorporate it into your practice.

Talk to someone that has gone through what you are going through. It can really give yourself some perspective and inspiration to move forward. Whether that someone gives advice or a pep talk, it makes it all worth it. 

Also, ignore the naysayers. Sometimes your colleagues and advisors may encourage you to quit or give up. Though it is important to be realistic, I believe you should always put your best foot forward and see what happens. Remember, people are capable of seeing others only to the capacity they see themselves.

A lot of times when people are going through their own challenges, they do not share their experience for fear of being judged.  From the people I have talked to, I don’t know anyone that hasn’t gotten a “bad” grade in their life. No one has the perfect life. You are not alone.

Conclusion

Overall, bad grades are just setbacks, not your destiny. You can learn a lot from it, and I am confident that for the next test you will be much more prepared. All the best!

If you have any questions or want to see my life through medical school, find me on Instagram @future_artist_md

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