Monthly Archives: April 2009

Inadequate, Inspired and Incomplete

It doesn’t take long after I begin to feel comfortable with my schoolwork, clinical science, the study of medicine in general before reality reminds me of the work still to be done. I am humbled again and realize that for every question I know, there are a dozen which I have no answers too.

Shadowing – I’ve been spending more time outside of class following doctors and surgeons around, partly to get more of a clinical exposure and partly to see what specialties I would be interested in. If you are a medical student shadowing someone, it is the preceptor’s responsibility to PIMP you. (PIMP being an acronym for Put In My Place, a process where the doctors ask increasingly difficult questions until you feel inadequate and are motivated to do your homework)

Being asked questions is a good way to learn and put your classroom teachings in context. For example, a physician may point to different parts of an X-ray and ask you about anatomy and physiology. You feel confident when you know the answers. When harder questions are asked such as the pathology and symptoms of certain diseases come around, you become less certain. Soon enough, there will be questions where you will be completely lost on. It is always nice to be reminded of the gaps in your knowledge and it always motivates me to do better.

Experts -  Shadowing any doctor (or any other highly accomplished professional for the matter) is always inspiring. As I observe them talking with patients and going over cases, I can see the clarity of their mental processes and how much care they put in. Watching a surgeon perform an operation smoothly and precisely is awe-inspiring.

I wonder if I will be like my mentors? Will I have their bed-side manners and clinical judgment? Will I miss something important and cause harm? It’s even harder to imagine that in three short years, I will “officially” be a doctor (albeit one in training) and that people will trust me with their lives and secrets.

A Work in Progress - Which brings me to my final point, I am still incomplete. I have just started on this long journey, and if you ask any physician, they will tell you that the learning never stops. All doctors are life-long students of medicine.

Rome was not built in one day. Likewise the surgeons, internists, specialists and family docs who right now seem to have such innate ability to interact, diagnose and treat patients did it gradually through many stages. That’s why, each morning I make it my goal to be a better person than I was yesterday. Although my daily challenges and successes may seem insignificantly small, through an accumulation of baby steps, one day I hope I can be a good doctor.

Playing the Waiting Game

For applicants this cycle, the wait is almost over. You have finished or are just completing your last set of exams. Some of you may be taking your last undergraduate class ever. And all that is left is the dreaded countdown till decisions day.

There is few I can say that will make the wait easier. You can pour over the statistics as much as you want, how many people are interviewed and out of that number how many acceptances are sent out, and you can talk to as many people about what your “chances” are, but in the end you will still have to wait.

I remember when I was waiting, I would feel great one day and the next I would be a wreck. The worry and anxiousness drove my crazy, until I realized that worrying had no benefit at all. There was no reason to figure out the admissions game worked if I knew I had given it my all. I did not bother other people to see how they thought they did on the interview. Even when the big day came, I didn’t make such a big deal out of it. I didn’t have any celebrations / grieving parties planned, it was just like any other day.

I did lose a little sleep the night before, but at that point, I knew it was already out of my hand and had already been decided. As long as you were satisfied with your efforts and you gave it your best, there’s no need to “try” anymore.

Our main business is not to see what lies dimly at a distance, but to do what lies clearly at the hand. – Dale Carnegie

Waiting for admissions decision is no different than waiting for your exam marks, course grades, MCAT scores. The stakes may seem higher and the implications of not making it in seem more dire but not making it into medical school is not the worst thing that can happen to you.

So to all those waiting, hang in there. Patience is an important virtue to learn. Hope everything works out.

Featured on Grand Rounds 5.30

Grand Rounds

Grand Rounds: Photo Credit NY Times

I am happy to say this is my second time featured on Grand Rounds, the best of medical writing on the web. This time’s rounds are hosted by pharmamotion so be sure to check out all the other neat posts by doctors, patients and students around the world.

Handling Criticism

There are days where I miss the anonymity of being an undergrad science student. Where professors didn’t know you, attendance was not taken and there were no real responsibilities other than looking out for yourself. In medical school with smaller class sizes, PBL learning groups and clinical sessions, feedback, self-evaluation and criticism is unavoidable. You know everyone and everyone knows you. And if you make a mistake or do something wrong, someone will not hesitate in telling you.

I have learned that taking criticism and constructive feedback appropriately is an important skill to have, not just for school but in life. You’ll have to be able to differentiate when critical comments are justified and when they are unwarranted. Furthermore, it’s important to be able to understand and learn from them and see when there are real issues to be addressed.

Accept self-criticism properly- The first type of criticism you will receive will be from yourself. As an undergrad you’re used to being a smart student, a top student. And even though I was fully aware that statistically half the class would always be below average, I found it very hard to accept after my first exam that I belonged to this bottom group. It has taken my entire first year, a new way of studying and a doubling of my efforts to finally become “average.” It’s a long learning process and learning to handle criticism and setbacks is just one of the many lessons.

As I got to know my classmates more, my past achievements and experiences in comparison seemed to be insignificant. There was always someone who would be smarter, more talented, more sociable, harder working, athletic, or better than me at certain activities. This can do terrible things to your self-esteem. You can become quite harsh on yourself, finding all your character faults or counting the times you have failed.

Instead of just focusing on the negatives, you must take time to appreciate all your own accomplishments, even if they seem insignificant to others. Compare yourself to yourself. If everyday, you can wake up and be a better person than you were yesterday, you have already made progress.

Look for the Truth in Evaluations – Getting feedback and advice from preceptors and supervisors can be a scary experience. No one likes to know that their best efforts were full of mistakes and errors. Though it might sting, often times there are valuable lessons to be found.

More so, if several evaluators repeat the same weaknesses, this should be an area you need to focus and improve on. Don’t always handle criticism with a hostility. A enthusiastic and humble attitude makes the difference between a frustrating comment and an opportunity to grow.

Separating the Critic from the Criticism – No one loves a messenger of bad news, so please don’t shoot the messenger! For the most part, your preceptors and professors are on your side. Every teacher wants to see their students mature, develop and succeed and sometimes in order to do that, they have to pass you through the fire for refinement. It may be uncomfortable but if you see it for what it’s worth, you can emerge as a changed person.

Ignore the ignorant – There will be critics that will give completely untrue comments. First see if there is any grain of truth to what they are saying. If their tone or choice of words is a hostile one, put on a tough skin and ignore the critics. Handling criticism is as much about listening attentively to criticism and picking out useful information as it is selectively listening.

Take the Internet with a Grain of Salt – Finally, a wise advice for anyone, anything that anyone says on the internet should be taken with a grain of salt. You should take what you read carefully and always evaluate it on your own. Not everything you read is true or correct. Even my posts should be evaluated critically.

My personal experiences with forum members and running this blog have taught me a lot about responding to what others say. The majority of readers have interesting points to share, some even thank me. But there are also people that are outright malicious. I try to moderate appropriately when this does occur but ultimately, you learn to ignore naysayers. Not everyone will agree with you. You will not always be correct. There will always be arguments and pointing of fingers. It’s fine to agree to disagree and if you do so appropriately, both parties can walk away on good terms.

Thanks for reading. If you have a tip, experience or story to share about handling criticism, feel free to leave a comment!

The Shortlist – Year One

I was talking to a graduating medical student and asked him how he figured out which specialty / residency he wanted to do. His reply was “there are two ways to go about it.”

The first way is to start listing what interests and what criteria you would like (lifestyle, procedural, continuity of care, shift work). You then rule in specialties that fit these guidelines. The other way is to start with a list of all the medical specialties and begin ruling out programs you would NOT do or have no interest in.

He asked me then to list my top 5 prospects and bottom 5, and told me to keep track of my thoughts on them. Hopefully, by the end of third year before applying for programs, I should have an understanding of what I would like to do. So without further delay, my shortlist as an M1.

Top 5

  1. Internal Medicine
  2. Radiology
  3. Ophthalmology
  4. Orthopedics
  5. Family Medicine

Bottom 5

  1. OBS / GYN
  2. Pathology
  3. Dermatology
  4. Anesthesiology
  5. Psychiatry

It will be interesting to see what I will have as my top prospects this time next year. I’m sure as I shadow more doctors and gain more exposure to the different specialties, this list is bound to change. For now, I think I like working with my hands and the reward of curing a patient appeals to me. Also, continuity of care and patient interaction is fairly big on my list, although my choice of radiology does seem contradicting.

What are your top prospects for specialties? And for people who have graduated already, how did you come to decide on your specialty and what drew you to it? What turned you off from other ones?

Indecisive About Medical School

Credit garry61A friend recently brought up an interesting point of view. He is just about to finish his undergraduate degree in life sciences, he’s done well so far and his GPA shows it. He wrote his MCAT and applied to multiple medical schools this year and received and attended several interviews. And the strange thing is that after completing all these individual steps, he’s still not sure if Medicine is what he wants to do.

He may very well end up with an acceptance in hand and decline it. And that’s perfectly reasonable.

It must be strange to think that with so many applicants out there wanting to pursue a career of medicine so bad that there are a few applicants each year that receive an acceptance and have no clue with what to do. I spoke to a graduating medical student the other day who retold his story of how he was accidentally accepted into medical school. His original intentions were to go into public health and he only applied to medical school as a backup, so he wouldn’t regret it in the future. Strange how things work out.

There are other applicants who defer their acceptance for a year to complete their master’s or even work abroad. The fact is getting into medical school is not the only thing that matters in life. There are many goals and pursuits that are just as worthwhile and meaningful to pursue.

Furthermore, medical school and the process of becoming a doctor is a large commitment. Apart from the debt of tens of thousands, by the time you practice you would have sacrificed your youth in school, studying, memorizing, learning.

This isn’t a decision that should be taken lightly. Ultimately, it should be you who should make the decision. Not your parents, your peers, expectations of others. If you think there’s something you love doing way more, I would urge you to consider that.

For instance, if you’re a varsity athlete who has a chance of making the Olympics but also has medicine in the back of your mind, pursue what you would LOVE doing more. This goes beyond just athletics. If you want to do research, work abroad, teach, or whatever more than go to medical school, you should seriously consider it.

The worst case scenario is you realize you don’t like what you’re doing and you apply to medical school. It’s much much harder to do it the other way. By the time you graduate from medical school, your accumulated debt and sacrificed time will compel you to go into practice right away. It will be hard to start another career at that time.

Medicine is a flexible field.  – For most people, it’s big enough in scope and depth that everyone finds something they like doing. Whether that’s working with their hands in surgery or satisfying their curiosity with research, medicine has something for everyone. Even the math and physics types may be surprised at how many sub-specialties  have a use for their knowledge.

So if you are one of those people who are indecisive about whether medical school or medicine is for you, give it some long and serious thinking. Medicine has a lot of rewards and unique opportunities but it’s not for everyone. But it would be reckless to enter this profession without knowing what being a doctor is really like, what kind of a person you are and what you would like to do.