medschool

You’re Graduating Medical School…But Are You Prepared for Residency?

This morning as I was brushing up on my medical news I came across an article in The New York Times’ Well blog entitled, “Are Med School Grads Prepared to Practice Medicine?” As an entering medical student of the Class of 2018 I was immediately drawn to the piece. Is it possible that I will spend the next 4 years of my life buried in books, engrossed by education, surrounded by patients and established physicians and still not be ready for residency? Oh god… The author of the article, Pauline Chen, M.D., recalls a specific occurrence that took place during her intern year. A fellow intern, who attended a school apparently uninterested in teaching phlebotomy, had spent nearly an hour poking and prodding a patient, attempting to find a vein. The patient, as one can imagine, was not thrilled, yelling, “I’ll hit you if you come near me again!” Another intern was able to help and perform the phlebotomy flawlessly, but admitted to being unprepared to prep a patient for surgery. The problem, thus, is the differential focus of medical schools in educating their students. While one school flawlessly prepares their students on oral presentation of a patient, another emphasizes careful reading of images. The discrepancies are unforgivable and highlight an even more important issue than lack of surgical skill: lack of communication. Instead of working as parts of a seamless and...

The 5 F’s for Almost Docs and New Interns

A little ways back, a tweet caught my attention from @JasonYoungMD who stated “My Five Foundations of Feeling Fine: Food, Fitness, Friends & Family, Falling Asleep, Fulfillment.” This seemed like the best advice I had heard for the newbie interns taking teaching hospitals by storm as well as the rising third year medical students who are about to be unleashed on the wards (if they haven’t already). It also is a great starting point for program directors who are wondering how to ensure that their residents are “Fit for duty” according to the ACGME rules. 1. Food – While this is basic part of sustenance, finding food sometimes in the hospital can be challenging, especially at odd hours. Fortunately, this has gotten better, but the choices may not be healthier. In my own hospital, I’ve seen the front lobby transform from a small coffee kiosk (Java Coast which was celebrated when it arrived) to a full fledged Au Bon Pain (ABP as we affectionately refer to it). While ABP was a welcome addition, it is easy to consume a lot of empty calories eating muffins or breakfast sandwiches! To make matters worse, research from one of our very own sleep research gurus has shown that the more sleep deprived you are, the worse food choices you make! Therefore, the thing you will reach for after a night shift is...

Nothing Prepares You To Watch Someone Die in the ER

As I arduously sorted through the endless stack of green papers with lab and exam results scribbled about them, the eerie buzz of the medic radio went off overhead.  “Hospital base, Medic 21, Code 3 notification, CPR in progress, short ETA.”  Only having a few minutes to prepare for an incoming ambulance is stressful enough, but when the patient is under CPR, it adds an additional shot of urgency and adrenaline.  Undoing all my work for the last ten minutes, I shuffled all the papers back together and set the heaping green bundle aside; prolonging the agony for another time. Hastily making my way back towards the resuscitation room, I went through a mental checklist of what I was going to need to do.  Turning into the room I was greeted by an empty gurney, a clean floor, a blank monitor with its numerous cords neatly coiled on their hooks and if it were not for the shrill of the fluorescent tubes illuminating the room from above, there was not a sound to be heard.  In  another two minutes this would all change. Reaching for a box marked “XL,” I grabbed two wrinkled, bright blue gloves, and threw them onto the counter.  After squeezing my hand into the first glove, the unmistakable chattering of an ambulance stretcher rolling over dirty laminated tile crept down the hall.  Moments later it...

ZDoggMD Drops Some Knowledge on the Pros and Cons of Medical Specialties

Featuring pediatrician Dr. Harry. Internal medicine, emergency medicine, surgery, pediatrics, and Justin Beiber…all in there,...

15 Steps to Rocking the USMLE I (And Celebrating Afterwards)

It’s a wonderful time of year. Birds are chirping, flowers are beginning to bloom, the weather outside is just perfect for bike rides and patio brunches, but you, my friend, are stuck inside making color-coded flashcards and learning the TCA cycle in preparation for step I. Relax, young medical Padawan. Fear not this beast of an exam and take some time to frolic amongst the daffodils. Here’s some advice from myself and other senior medical students on how to rock the heck out of this exam: Before the test: 1. Buy First Aid early. We’re talking first year, folks. While this may be too late if you’re currently signed up to take the exam, if you are just starting medical school, pick up a copy of First Aid. I’m not saying to all-out gun and read the entire thing within the first weekend of having it, but use it in conjunction with your block textbooks. It’s a good outline that won’t teach you concepts necessarily, but gives you a good idea of the topics you should really understand.  You should know this book inside and out. Also, don’t forget about the errata that is published online since the book does contain mistakes interspersed throughout. Just because it was written by a bunch of really smart people, doesn’t mean that they’re infallible humans! 2. Tailor when you begin studying according to...

5 Tips on How To Be A Gunner

Gunners get a lot of hate in the medical school community. It’s something I have never been able to completely understand, despite my obvious genius; however I have formulated a few theories as to why in the mean time. First, people are stupid. Second, the world is full of haters. Third, and most importantly, I’m the best. Regardless, the point is, being a gunner is amazing. You get to constantly feel better than everybody. Everybody likes you, despite rarely, if ever, showing it. And most importantly, you will probably get the best residency. So, how does one get to be a gunner? Well Gunnees and Gunnettes, I got a list that will help you be as awesome as me. 1. Raise your hand… a lot of the time. Did the professor just say something you know? Perfect. This is your opportunity to ask the perfect question. The perfect question allows you to take the material one step further, but most likely in a direction that doesn’t matter at all, and simply to show how smart you are. For instance, did they just talk about cardiac hypertrophy? Well, you should ask a hypothetical question about cardiac hypotrophy. Bam. Sure it is completely irrelevant. But, just say the opposite of whatever the guy said, use big words, insert pauses where you scratch your chin and furrow your brow to make it...

5 Endocrinology Pearls for the Internal Medicine Shelf and ABIM Board Exam

Endocrinology is an essential part of the Internal Medicine Medical Clerkship and ABIM Board exam. According to the ABIM exam blueprint, questions testing endocrinology topics comprise ~8% of the exam. Approximately ~5-10% of the NBME Clerkship exam is composed of endocrinology questions.   1. Don’t let thyroid nodules intimidate you. Check out the following post ABIM Exam Prep: How to Work Up a Thyroid Nodule This systematic approach will help you workup a thyroid nodule.   2. Workup of hirsutism is not as difficult as it seems. Follow this approach and you will be able to diagnose the cause of hirsutism. – Hirsutism is caused by either excessive testosterone or excessive 17-OH steroids (DHEA-S) production. – Excessive Testosterone production is seen in ovarian cancer or polycystic ovarian syndrome (PCOS)Ovarian cancer: worked up with trans-vaginal ultrasound to look for adnexal mass. In addition, CA-125 marker is usually elevated in ovarian cancer. – PCOS: Amenorrhea, insulin resistance, and LH:FSH ratio of greater than equal to 3:1 – Excessive DHEA-S production is seen in congenital adrenal hyperplasia (CAH), Cushing’s disease, or adrenal carcinoma – CAH: Usual cause is 21 beta hydroxylase deficiency, which is used to convert 17-OH progesterone to cortisol. Since this enzyme is deficient, 17-OH progesterone levels remain elevated. Decreased cortisol levels will cause an elevated ACTH level through a negative feedback mechanism. With increased ACTH, hyperpigmentation will also occur. – Cushing’s...