Knowing Something

Matt Might made a illustrated guide to a Ph.D that I saw a couple months back. It very much applies to medicine too. If you’re interested in science, and you haven’t decided between grad school or medical school, go check out his blog. There’s lots of good reads that will make you think. Here it is reproduced, with credit given.

An Illustrated Guide to a Ph.D

Imagine a circle that contains all of human knowledge:

By the time you finish elementary school, you know a little:

By the time you finish high school, you know a bit more:

With a bachelor’s degree, you gain a specialty:

A master’s degree deepens that specialty:

Reading research papers takes you to the edge of human knowledge:

Once you’re at the boundary, you focus:

You push at the boundary for a few years:

Until one day, the boundary gives way:

And, that dent you’ve made is called a Ph.D.:

Of course, the world looks different to you now:

So, don’t forget the bigger picture:

Keep pushing.

Toronto Notes – Text Review

Over the family day long weekend, I got a little break from the day in day out stresses of clerkship. Anyways, I just want to put out a big plug for one of my favorite resources of all-time.

TORONTO NOTES

(www.torontonotes.ca)

I heard of this volumous text even in my pre-med days. It’s basically THE encyclolpedia Bible of medical knowledge for medical students. I might be exaggerating a bit but I’ve passed a many exams and clerkship rotations with this good book.

A quick summary from their website

Toronto Notes originated as an informal compilation of notes, developed by the University of Toronto graduating medical school class to help each other study for the MCCQE I. Twenty-six years later, it has evolved into a 1400-page textbook, a clinical handbook, and multiple online resources ranging from an online version of the text to PDA software to interactive learning tools. Toronto Notes is now sold throughout the world, and almost all Canadian medical students use Toronto Notes throughout their training.

I could go on and on about why I love this resource, from it’s high yield and EBM tidbits to it’s friendly formatting and awesome mnemonics. This is THE student’s notebook to medicine. Here’s the quick summary.

Pros:

Breadth and depth, covers over 25+ specialties including all the most high yield knowledge
Evidence based with good tidbits on papers, trials, etc on the margins
Friendly formatting
Awesome for summarizing large amounts of information
The info on the margins is GOLD! You’ll learn all the best mnemonics and questions staff always pimp you on

Cons:

Everything is in bullet form, therefore it’s hard to learn from it as a primary resource
Can be tedious to lug around (1000+ pages) though you can rip out each section and just put it in a folder that is convenient to carry
Occasional errors here and there, but relatively few for a volume this big

Conclusion:

If you are a medical student in Canada, do yourself a favor and pick up the latest copy of Toronto Notes. It’s only around $150 something if you buy it through your school, and it can easily last you all 4 years in medical school.
I will probably pick up a new version at the end of med school. They constantly update it and you can access all the information online too.

Good Page Bad Page

Good page: Mrs A. needs a coumadin order. Easy fix. Look at her INR, look at what she’s been getting the last few days, prescribe a dosage and you’re done.

Bad page: Mrs A’s heart rate is 130 bpm and we don’t know why… Her last INR was 5.0

Good page: Can you write a tylenol prn order for Mr. B’s pain?

Bad page: Mr. B isn’t responding, he’s been getting a lot of hydromorphone today…

Good page: Ms. C has some crackles in her lungs but her vitals are normal, can you come and assess?

Bad page: Ms. C is crashing, come here quick!

I don’t mind being paged about minor things such as medication re-orders, filling out paper-work, talking to a family member, etc. Because even though the pages can be minor nuisances, every page that is not a bad page is automaticallya good one.

Tricks for Waking Up #7

You can never trust yourself when you’re half asleep.

Tip #7: Leave a reminder for yourself

A simple note reminding you of the chores you have to do before you leave the house, or important things happening that day will motivate you to get out of bed.

If I have an important test that morning or a meeting I can’t miss, I will put a physical reminder right beside my alarm so when I turn it off, I know that I MUST get up. Any item that will trigger your sleeping mind will do the trick. It just needs to be different from the routine, so that you know it’s something important.

It can even be as simple as changing your alarm sound or moving the location of your alarm.

Tricks for Waking Up #6

Your perception of time is unreliable when you’re half awake.

Tip #6: Have a visible clock

You can never trust your sense of time when your’e just waking up. How often do you say to yourself, I’ll sleep just five more minutes before you end up sleeping for 30 more minutes. If you don’t have a constant reliable measurement of time, you should get one ASAP!

Ideally you want a clock that’s easily visualized. I prefer a lighted clock that can display the time even in the dark. Large analog clocks are useful too, though I have found from experience they can often be misread (Minute and hour hands mixed up, misreading by an hour. Similarly, cell phones have the same problem. You have to pick them up and press a button before you can see the time. Also because of it’s small size, you really have to focus to see the time.

With a big clock, awareness of time is not a problem.

If you only hear the alarm clock and don’t register what time it is and how much time you have left before you have to leave, you are in less of a rush to wake up. I have been saved from being late several times just because I have a large visible clock right beside my bed. Sometimes an unintended quick glance makes me aware of how late I am and my brain suddenly kicks in to wake up to minimize the delay in getting out of bed.

The Essential Pocketbook for Medicine

Anyone who has ever been on a medicine rotation in a hospital book must have surely noticed the little Red Pocket Medicine Book, which in its newest version is actually now a Green Book, published by the Massachusetts General Hospital and Lippincott Williams & Wilkins.

This concise, pocket size (perfect fit for a white coat) is a lifesaver for anyone in internal medicine. It’s thorough, evidence based and has saved my butt many times on the ward. It’s one of the best references for medical students, residents and even attending staff use it.

Check out the free sample pages on Amazon and just read the reviews!

Pros: If you are able to cover and master the material in this small book, you’ll easily be at a resident level, maybe even a senior resident. The downside is the book is compact. It’s hard to learn the basics from it if you’ve never covered the contents before. If you’re lost at how to approach a problem, this book will tell you the essentials needed for the best standard of care in just a couple of pages.

Cons: It’s dense. Definitely need to have a more thorough teaching resource if you haven’t covered the diseases / approaches before. It also uses American trade names and units. The text can be small and packed together sometimes.

Conclusion: This book is an excellent reference and quick guide to all the major systems and disease processes in internal medicine. It is evidence based, compact and complete with its depth of knowledge. The downside if you’re for Canada is that it uses American units for lab values/dosages.

I highly recommend anyone considering internal medicine to buy this right away and start learning proven and evidence based medicine! If you’re school subsidizes the purchase, there’s no reason why you shouldn’t have one. A genuine lifesaver (saves patients and saves you from making mistakes) on the wards. It’s the one book I make sure I carry with me whenever I am on call.

Best Things About Being on Call

http://www.flickr.com/photos/picturepurrfect685/5311356536/

Call can be pretty brutal sometimes. Some nights you don’t get to sleep at all and you end up staying awake close to 30 hours by the time you hit the sack. Despite the many downsides, there are some pros about being on call.

You get to do more - less people means you need to step up your game. You get to see more patients and figure out what needs to be done. And as new learners, increased clinical exposure is the best thing you can get.
You learn more when you are the one making the decisions and committing to them. You take ownership of your patients and learn to become more confident with your decisions.
You are a critical part of the team - you are covering for other people when you are on call. Because of you, others are able to go home and feel at ease that patient care is continued. They will return the favor too.
You can catch up on work – When the nights aren’t busy, you can use that down-time that you might normally waste at home to finish any remaining work. Whether it’s a dictation to be done or a note to be written, you have a lot more time to get all your work done.
You lose weight - you’ll burns hundreds of extra calories for every additional hour you stay awake
Beautiful sunrises in the morning that signal the shift is coming to an end. Post-call mornings always seem refreshing, as if a weight has been lifted off your shoulder.
Save yourself a day of work – Think of it as doing a back to back work day so you can skip the next day. A break in the middle of the week can often make a big difference in your stress levels.
Post-call day naps. Best slumber of your life.
Time off during work hours – For anyone who works full time during the week, it can be pretty hard to get some errands done after work hours. Whether that’s going to the bank, getting your car fixed and so on, there are many things that can only get done during the day. Post call days are perfect for catching up on those loose ends.
Sense of accomplishment – whether you saved a life during your call shift, diagnosed and managed a new admission or contributed to patient care, at the end of call you get satisfaction that you made a difference.

I won’t make a list of the downsides of being on call, that’s a whole other issue, but if you have any pros/cons or personal experiences with being on call, feel free to leave a comment.