The third year of medical school goes by very quickly. I started on Internal Medicine, which is three months long. We took our shelf exam (the national test taken at the end of each rotation) about two weeks ago. After we finished, one of my classmates asked if I realized that we were 1/4th the way through third year. I hadn’t realized that.
Third year is when we get to learn from doctors in the hospitals and clinics rather than in the lecture halls. We also learn from patients, who I have found to be the best teachers so far. But I think that the most difficult aspect of third year has not been intellectual, but emotional. As medical students, we have a lot of time to talk to our patients, much more time than the residents or attendings. We get close to our patients and then we leave and go onto the next rotation. Also we sometimes see patients get worse instead of better. And once again, we move onto the next rotation and are no longer able to care for the person who was “my patient” for several weeks.
The emotional aspect of medicine is changing rapidly. Medicine is both more personalized and less personalized today. There are designer drugs for specific genetic mutations, but there are also numerous specialists with whom a patient works. At the same time, doctors are being encouraged to be more empathetic and in touch with their patient’s emotions. I’m all for that, but I feel like the increasingly specialized nature of medicine is at odds with developing true empathy.
I feel a similar struggle within myself during third year. At Michigan, I see many of the top physicians in the world performing unbelievable procedures and providing cutting edge care. Of course, the researcher in me gets excited and thinks that this super-specialized lifestyle would provide amazing academic opportunities. On the other hand, I see primary care physicians develop decades-long relationships with their patients and intervene in just as important and much more nuanced ways. I also respect and want to emulate these physicians.
It is difficult to know now where we’ll all end up. We’re all trying to just figure out where we need to be and how to sound smart (or at least not dumb). Nevertheless, the possibilities are both exciting and intimidating.
This week was the last week of M2 year. I took my last final of the preclinical years yesterday and am not tying up some loose ends before beginning to study for step 1. I was talking with a friend who is getting her PhD in Environmental Science this morning. She asked me how med school was going and I told her that it was not as bad as I thought it would be. She said that it seemed like I must be a natural fit for it, but I explained that Michigan made it very easy to feel at home even when I was struggling to memorize biochemical pathways or trying to make it through all the reading for M2 neurology. Medical school is hard no matter what, and it should be hard. But I’ve made amazing friends over my first two years of medical school and I’ve learned a surprising amount. I am nervous about the boards and the five weeks of studying that I have ahead of me. Nevertheless, I’m also so excited about the clinical years. All of my third and fourth year friends say that the clinical years are by far the most fun and interesting of medical school. As a non-traditional student, going back to lecture was difficult for me. I’m looking forward to using different skills when I’m on the wards. I’m also so proud of our class for pushing through the first half of medical school together.
The fourth year medical students matched on Friday. Two years form now, my classmates and I will know where we are going to do our residencies. We are all curious to see what the next two years will be like, and I am optimistic that we will all continue to work hard together to learn how to take care of people.
The M2’s are currently in the middle of our Clinical Foundations of Medicine block. We have two weeks of small groups and lectures about health care. We also have been given time to prepare for the M2 CCA. The CCA is an evaluation of our physical exam, history taking, and oral presentation abilities. We will be doing cardiac, pulmonary, abdominal, neuro, and musculoskeletal exams on standardized patients.We’ll also be taking a few histories and presenting our findings to physicians. The purpose is to make sure that we’re ready to learn in the hospital starting in May 2013 (for serious?)
There is some anxiety about the CCA. It is definitely scary to think about an experienced physician watching you do a physical exam. I do no however, feel overwhelmed. We’ve been learning the physical exam for the past year-and-a-half. I feel that every time that I do another physical exam, I get a little more confident and a little faster. I know that doing a physical exam is going to be very different when we are working with real patients. It is however, encouraging that we’ve all progressed a lot over the past several months.
I am not a basic science person. I love public health and clinical research, but I hate memorizing biochemical pathways. Getting protected time to work on my physical exam and history taking skills is something that I’ve truly enjoyed about M2 year. Last year, we were so overwhelmed learning new physical exam skills that we couldn’t work on our timing and technique. This year, I feel more like a middle schooler and less like a kindergardener when I’m practicing. I still make mistakes, but I can check myself instead of being blissfully unaware of what’s happening.
I take my CCA this Friday. Then my a bunch of my friends and I are leaving straight from school and driving to Nashville to attend the Society of Student Run Free Clinics Annual Conference. We were all on the Leadership Team of the UM Student Run Free Clinic (we’ve now passed on our responsibilities to M1’s.) We submitted three abstracts to the conference about our clinic’s organizational system and now six of my friends and I get to enjoy a great weekend in Nashville. We’re excited to talk about our experience and learn from other clinics. We’re also hoping to go to some concerts. I’m personally excited about BBQ and Tennessee sour mash.
Enjoy the rest of the weekend!
This is Thanksgiving Break. I’m finally home after taking Cardiology, Respiratory, Renal, Clinical Foundations of Medicine, Psychiatry and Neurology. It has been a very busy and intense year so far. I finished our Neurology final Sunday night and Monday afternoon I flew into Newark airport. Home is extremely relaxing with the exception of my dogs barking.
As part of Neurology, we learned about the “special senses,” which are hearing and vision. Then today, I saw this really unique idea:
A computer science and engineering graduate student at University of Washington created a program that can help visually impaired participants perform yoga. The technology uses Microsoft Kinect to determine how you are moving and gives you feedback as to how you should reposition yourself. The goal is to open up yoga and other forms of exercise to people who have not previously been able to see instructors in classes and videos.
Michigan emphasizes the patient experience as we are learning about diseases. We often have presentations from patients who have been living with a diagnosis that has recently been covered in lecture. Nevertheless, I had never considered how visual impairment would prevent a person from participating in physical activity. It is extremely exciting to see that computer science and engineering to expand exercise to a population that has not been able to access traditional forms of exercise instruction.
This morning, I read an extremely well-written article in the New York Times about women in science. Here is the article for anyone who is interested in reading it. The article was a shock to me for several reasons. First, I did not excel in science and math as a high school student or in college. As a non-traditional student, I studied South Asian History. I took creative writing classes, acted in plays, and played the drums. The arts and humanities had no shortage of strong, female role models and peers. I did not realize that I had any interest in or aptitude for science until I worked as a clinical research coordinator. After college, I worked in Reproductive Endocrinology and Infertility, a subspecialty of Obstetrics and Gynecology that is filled with accomplished, ambitious women.
Now at the University of Michigan, I feel that there is no shortage of female doctors who want to give me career and life advice. My only complaint is that I am too frequently advised on how to balance a career with family. I was born when my mother was a fourth year medical student and my father was completing his MD-PhD. I was raised to believe that having a job and a family is not a balancing act, it is life. I also find it frustrating that my male friends are not offered the same advice. It is assumed that they’re not interested in family life or that they will not be expected to nurture children and a career simultaneously.
Regardless of my positive experiences in medicine, this article reminds me of the prejudice that my mother faced as a Chemistry major and a medical student. She isn’t bitter about her experiences, she is just happy that I have not faced the same obstacles. I never had any idea that my female peers might have had to overcome the same narrow minded thinking that challenged my mother’s ambitions. I can only assume that the female physicians who offer me leadership and professional advice have also faced these barriers. Just as importantly, I know that there are similar disparities in science among minorities. After reading this article, I don’t wonder whether bias still exists. I wonder why aren’t we talking about it.