Monthly Archives: March 2012

Your Attention is More Important Than Your Time

May I have your attention please!

In a world abundant of information and distractions, time is no longer your most precious resource, your attention is.

How we manage our time and attention is something I have put a lot of thought into. As students, we have a finite amount of time for our school work. As a resident, there will be many clinical responsibilities fighting for my attention. There will always be more tasks to do than there is time, so how we manage our attention becomes increasingly important.

Back in December, I made a choice to live a more minimalist life, to cut back on the clutter and distractions, and focus on what matters. More recently, I’ve read a few books that really solidified the point that your attention-management is more important than time-management.

Tim Ferris states in his book The 4-Hour Week“Time without attention is worthless, so value attention over time.” He goes on to state that “Attention is necessary for not only productivity but appreciation.”

“in an information-rich world, the wealth of information means a dearth of something else: a scarcity of whatever it is that information consumes. What information consumes is rather obvious: it consumes the attention of its recipients. Hence a wealth of information creates a poverty of attention and a need to allocate that attention efficiently among the overabundance of information sources that might consume it.”Herbert Simon, Nobel Prize in Economics 1978

There are many things in life that are renewable such as money. Resources like time are scarcer though because once you use it, you can never get it back. But there’s something even more limited than time. It’s your attention. Attention is a subset of time, therefore it’s more limited. How you spend your attention is more important than how you spend your time. (source)

If we measure the quantity of our time in minutes, hours and days, undoubtedly the quality of our time is measured in attention.

Without attention, it is hard to focus on the priorities we know we should do. It determines what will appear in our consciousness, how we will process it and what decisions are to be made. Attention gives value to our time – it is a multiplier of each minute we spend. Many students spend hours and hours “studying” but achieve minimal results. Instead, if you approached your studies with full concentration, a hour of focused studying will be worth much more.

I went to the woods because I wished to live deliberately, to front only the essential facts of life, and see if I could not learn what it had to teach, and not, when I came to die, discover that I had not lived. I did not wish to live what was not life, living is so dear; nor did I wish to practise resignation, unless it was quite necessary. I wanted to live deep and suck out all the marrow of life, to live so sturdily and Spartan-like as to put to rout all that was not life, to cut a broad swath and shave close, to drive life into a corner, and reduce it to its lowest terms.”
Henry David Thoreau, Walden: Or, Life in the Woods

So now nearing the end of my four years of medical school, I resolve to have more focus in the career ahead of me. With exams coming up, I hope I can have full attention and concentration in acquiring this knowledge, so that come July, I can do what’s best for my patients. It is my aim to live each day deliberately and not be unwise to misspend a minute.

Further Readings

Success on the Wards – Book Review

Success on the Wards – 250 Rules for Clerkship Success (Amazon) is easily the best book I have read on how to succeed in clerkship. It is comprehensive, thorough and jam-packed with valuable information. Dr. Desair and Dr. Katta provide an all encompassing look into what clerkship is really like.

A lot of the 250 rules that Dr. Desai and Dr. Katta discuss may seem like common sense to you: Rule #13 – First, Do No Harm. But hidden away are also finer aspects of clerkship that often are missed: Rule #157 – When presenting the patient, provide an assessment and plan. However, it also not a book without its faults. At times the book can appear disorganized and certain chapters can be overly verbose and repetitive.

While reviewing this book, I appreciated the efforts of the authors to make the book as “evidence-based” as possible, citing primary literature and quoting relevant people. There were some sections that were so important that I thought every clerkship medical student should have read it. Then there were sections I thought could have been omitted altogether. Read on to see why I think this book deserves such mixed reviews.

Breakdown of the Book

The book is starts with an introduction of what clerkship is like and what are the expectations. The next six chapters cover the core rotations and the specific details of each of them. Afterwards, the book goes over clerkship situations such as admitting patients, being on call, oral case presentations, write ups and receiving evaluations.

Sitting at 400 pages long, the book requires multiple readings to get through and at times can seem drawn out. I would even say the book could probably have 100-150 pages omitted if a newer edition ever came out.

Each “Rule” is followed up with an explanation ranging from a few paragraphs to several pages. There are tips interspersed in between the pages and “Did you know…” boxes of facts and tidbits. What this book does not cover is any medical knowledge.

Pros

The best part of the book is it analyzes every aspect of clerkship. Whether it’s taking caring of patients or presenting a topic, Success on the Wards outlines some of the best practices. The latter half of the book is where it shines best. The section on Oral Case Presentations and Evaluations is eye opening experience to how preceptors evaluate students. It teaches you to focus on high yield activities. Rule #115 – Avoid a verbatim reading of the patient’s write-up is a classic mistake many clerks make. Similarly, not having confident answers and not preparing and practicing your presentations are correctable problems.

Furthermore, a lot of the tips (there are about 80 of them) are as valuable as the rules themselves. Tip #63 – Displaying enthusiasm regularly can have a “halo effect” on your work. Team members may tend to view all aspects of your work in a more positive light.

Cons:

Despite all the good things I have to say about this book, there are a number of aspects that make this book less than ideal to read. The first is the book tends to be repetitive. Especially the first seven chapters where they review the different rotations. Most of them repeat what the last chapter said, some sections are copied and pasted from the previous chapter. The fact that the first ten rules are pretty much identical “If you’re considering a career in X specialty, recognize advance planning can strengthen your application” takes away from strength of the book.

Furthermore, the differentiation between tips and rules can be confusing, considering the tips are often times just as valuable as the rules. Combined with the fact that there isn’t a summary list of all the rules, the organization of the book is one aspect that can be improved on.

Considering that the last 100 pages contains over 100 rules, the last half of book is a much better read than the first part. There is also a random section on an approach to hyponatremia that I thought was out of place.

One of the unique aspects of the book is the amount of primary evidence and literature it uses. Each chapter has dozens of references that lend the book credibility. However at times the “evidence-based advice” can be disruptive to the flow and overly wordy.

I believe a lot of the formatting problems arise from how the book was written. Prior to this publication, a lot of the advice given was written for another book and a lot of the new material was written independently of this. When the book was put together, the way things were worded was not always helpful to flow of the book. Perhaps later editions will resolve this issue.

Conclusion

Overall, Success on the Wards is a great resource to have and the information provided will be invaluable to any clerkship medical student. A lot of the rules and tips are common sense but in a book this thick there will bound to be something for everyone. I can easily recommend this book to medical students as a good starting point for preparing for clerkship.

Compared to similar reads like How to be a Truly Excellent Junior Medical Student and First Aid for the Wards, this book is more comprehensive in breadth and depth. The other books also lack the section on getting feedback and evaluations will also help you understand how your clerkship performance is evaluated.

I would recommend this book to any pre-clerkship student who has questions about clerkship and who want to get started with the right step. This book would be best read before clerkship but current clerks and even residents may find it helpful. The only thing is that it can be quite long so buy it early and read through relevant chapters as necessary.

Disclosure

This book review was made possible by md2b who provided medaholic with a copy of the book to review. There are no other financial incentives.

More Than Just an MCAT Score

This is a guest post from Elsevier Health

If you are thinking about applying to medical school, then you know the hard work and dedication it takes to fulfill that goal.  Endless hours of studying and lab studies, writing term papers, and succeeding in all areas of your studies are hurdles to overcome to gain acceptance into the medical school.  Everyone knows the importance of MCAT scores and undergraduate GPA, but is that all it is about?  Do you need anything else to get in?

I do think there is an area that is not tapped into by the majority of applicants.  Activities beyond the scope of the classroom are a great way to gain knowledge and hands on experience. These experiences a volunteer gains from their selfless actions is something that cannot be taught in the classroom.  Although some people may choose volunteerism to bolster a resume and to look good on an application, the feelings of satisfaction felt from volunteering are major motivators for participants to continue to volunteer. Below are some topics that, aside from undergrad grades and MCAT scores, give medical students a competitive edge when getting into medical school

Volunteerism

Volunteerism encompasses many areas of life both on campus and off campus. From cleaning up communities, serving meals to the poor, spending time with seniors, to tutoring disadvantaged students there are so many people and organizations in need.  Any type of volunteerism is going to make you a better person and eventually a better doctor. For example, volunteering at a local blood drive can help you familiarize yourself with the blood donation process. As a volunteer, you can calm people down who may be afraid of needles, monitor a donor’s vital signs or even help distribute cookies and juice after the donation. Although you do not have to focus on the medical aspects of volunteering, the experience you will gain in that area will help you in the field. Blood donation services such as, United Bloog Services, help you to see the positive work that is being done to help people in need of blood donations.

Local assisted living facilities, nursing homes and senior care centers are always looking for young volunteers to help out with various activities.  Sometimes the light and enthusiasm that a young person brings to a lonely senior is something that can touch a patient far beyond medicine.  The intimacy of getting to know someone in such a weakened state can give you that human touch and empathy needed to connect future patients.  As a doctor, you will be working with patients that are very diverse. Developing exposure, compassion and communication skills through volunteering is an excellent opportunity to grow in one’s profession.

Charity Work on a Global Scale

There are numerous global organizations that help connect a willing participant with a medical mission of their choice.  Sites like: Missionfinder.org make it easy to see what missions are available.  If you choose a mission based on your interest, you will have more success while there and enjoy the experience.  Having the opportunity to witness firsthand the medical challenges that others in third world countries face is a reality check for many pre-med students, who may not know this pain and suffering exists in the world. For example, when medical students go to third world countries, they are responsible for disbursing medication and completing simple medical tasks, such as cleaning infected wounds. Many people have been unable to cleanse their wounds or treat themselves with simple antibiotic ointments. Your visit to their remote village can save them from developing gangrene or another flesh eating bacteria.  You will bring back experience that can be shared with fellow students and educators, as well as a new found gratitude for advancements in medicine.

Using Volunteer Experience to Develop Basic Interview Skills

We are all sums of our life experiences. When a student is preparing for a medical school interview, one should reflect upon their own experiences as a volunteer. Take the skills you learned as a volunteer: compassion, empathy, teamwork, communication, determination and perseverance and apply them to your interview. The ability to be human and relatable is also an important factor when on an interview.  Be sure to showcase your personality, teamwork and communication skills, as these are critical skills for medical professionals to have.

When in the interview, be sure to paint a complete picture of who you are as a person. Your grades and test scores are important, but having a personality is equally crucial. Be sure to check the nerves at the door; keeping in mind, the interviewer was once in your shoes! Remember to tell engaging stories and share examples of your work ethic though prior experiences, perhaps explaining a particular experience from a volunteer mission trip.

Follow Medical News and Journals

Finally, when on an interview, be sure to let the interviewer know you are staying abreast on medical news and medical reading. There is a chance the interviewer may ask you what medical books and magazines you read. It is importance you familiarize yourself with important journals such as  The Lancet and Science Daily.

Conclusion

When you are selected for an interview for medical school, your MCAT scores will speak for themselves.  Everyone knows that those who are dedicated and work hard will earn high grades and high MCAT scores.  A well rounded applicant needs to be able to relate to his or her future patients and medical staff. A calm, self assured individual are desired traits for prospective doctors. Emulate this within your interview.  Interviewers are looking not only an intelligent individual to cure and prevent illness, they are also looking for personality traits, such as a calming bedside manner, patience, compassion and empathy. Medical schools want to know that the students they are training to become future doctors will represent all of these qualities.

About the author:

Elsevier Health is a leading publisher of medical journals and textbooks such as The Harriet Lane Handbook and Goldman’s Cecil Medicine, used in universities around the world. Elsevier Health has also extended a promotional code to Medaholic readers. Please enter the code 61015 at checkout to recieve 10% off your purchases from http://www.us.elsevierhealth.com. Unlimited use. Offer expires 1/1/13.

A Smorgasbord of CaRMS Tour Advice

A smorgasbord is a type of Scandinavian meal with multiple dishes of various foods. In English, it often refers to a large heterogeneous collection of diverse items. During my CaRMS tour, I got a lot of useful advice from residents and other students. Each fact on its own would not be worthy of a post, so instead I am going to group them together for a rapid fire collection of interview tour tips.

Packing Tips

  • Pack for the right weather – if you are going to Vancouver bring an umbrella, if you will be in the prairies bring a warm winter jacket. Dress accordingly to the climate
  • Stuff socks in your dress shoes and wrap them separately in plastic bags to make packing easier
  • Have a waterproof ziploc bag for your toiletries
  • Roll your clothes to pack more efficiently and to save space
  • Your interview clothes should never leave you – bring it on the plane as carry-on
  • Bring a lint roller

Finances

  • Book flights on Tuesday/Wednesday when there are seat sales
  • Use points to book flights if possible
  • Stay with friends to eliminate accommodation costs
  • Travel with other people to split the costs of hotels/car rentals
  • Use public transportation – it’s a lot cheaper than taxis
  • Save money on breakfast and lunch by attending the free refreshments provided by residency programs

Traveling

  • Avoid backtracking during the tour, ideally you should go from West to East or vice versa, once.
  • Have a pitstop at your home school midway to re-energize, repack, relax
  • Explore every place you go to, get a feel for the place  – you may end up there
  • Walking is one of the best ways to see a city
  • Meet up with friends staying in other cities

Personal Sanity

  • Enjoy the process and mix your interviews with some sightseeing
  • Don’t have regrets – always focus on your next interview at hand
  • Spend some time with people who are not on the tour for perspective
  • Visit home if/when possible

Cal Newport Book Reviews

Since a majority of my readers are undergraduate students, today I will review two books that I think are extremely useful for anyone currently in college or university. Both books are written by Cal Newport an academic faculty who is an expert on student success. I frequently read his blog Study Hacks for his insightful posts and highly recommend it to everyone.

The first book titled How To Become a Straight A Student is a must read for anyone starting their post-secondary degree. I remember how my student habits dramatically improved after reading this book in first year. The second How to Win at College is a short but compact collection of advice and pearls that is useful for any student.

How To Become a Straight A Student

Where this book excels is at how realistic it portrays university life. It focuses on strategies that work and building a system of success. One of the key skills I developed up during my first year was having a systematic approach to my schoolwork. I was not a top student in high school, I was at best above average. However, in university I began forming new habits that eventually lead me to place first in many of my classes.

How to Become a Straight A Student is divided into three parts: the first focuses on Study Basics, the second on Test Taking and the last on Essay Writing. If you find yourself struggling to keep up with your schoolwork or finish assignments on time, part 1 is for you. Cal Newport clearly states a simple time management strategy that I still use everyday. He emphasizes ways to minimize procrastination and teaches you how to prioritize your work. Part two follows up with ways to optimize your learning and exam performance. Part 3 focuses on writing skills, that didn’t pertain to me as much due to my heavy math/science load.

A lot of the advice in this book is not complicated. They are simple and implementable – study in isolation and use the quiz-and-recall method to study efficiently. The book gives you the highest yield strategies and nothing else.

The most important piece of knowledge I received before starting university was that university is a clean slate. No matter how well or poorly you did in high school, it no longer matters.  Everyone is given a new chance and it’s up to you to make the best of it. Reading a book like this is an excellent idea before starting university.

How to Win at College

How to Win at College : Surprising Secrets from the Country’s Top Students is a lighter read. It consists of 75 chapters that each focus on a quick word of advice. The chapters range from 2-5 pages, and it’s easy to breeze through this book  in a sitting.

This book won’t give you the same depth as his other book but instead supplements his previous material and enriches it.

There are some hidden gems that I wish I did more of when I was in undergrad. #8 Befriend a Professor and #39 Meet Often with Your Adviser (an excellent way to get a reference letter).

Other chapters focus on more common and implementable strategies #22 Study in Fifty-Minute Chunks, #31 Don’t Study in Your Room, #69 Find a Secret Study-Space. Some are more humorous but no less important like #5 Make Your Bed and #14 Laugh Every Day.

There are some points I disagree with #12 Avoid Daily To-Do Lists and #51 Use High-Quality Notebooks. But overall this collection of advice is valuable to any student.

Conclusion

If you are a high school student or just starting university, I would recommend How To Become a Straight A Student for its realistic depiction of university life and its approach to find academic success. If you’re already a university student who does quite well, How to Win at College may give you some new ideas to better yourself.

Another similar book you may also wish to look into is What Smart Students Know by Adam Robinson, which focuses more specifically on how to study for tests and exams, and methods and techniques on improving your performance.

Let me know what you think of these books! Are there any other books you would recommend?

Match Day

This is it! Today is Match Day. Perhaps the most nerve wracking day of medical school. The day I find out where I will be for the next few years and which residency program has accepted me (or not).

Surprisingly, I’m not that nervous. Considering there was nothing I could have done differently in the last three weeks. Anyways, wish my luck!

I will try to update this post as soon as I get a chance to. It might not be until late tonight, as there will be a lot of celebrating (or crying) to be had.

UPDATE !!! – Matched into Internal Medicine at my first choice school! I am ecstatic!!! =)

The Number One Question I Got Asked at Every Interview

When I was on the CaRMS interview tour there was one question that every program, regardless of specialty or geography, would always ask me.

It was a simple question. One that revealed a lot about your personality and character and I believe how you answered this question would could determine whether you would be a good fit for a residency.

Was it why you wanted to do their specialty? What do you see yourself doing in the future? An ethical situation?

Surprisingly, the question was “How do you handle stress?

At first, I found it surprising that every interview I did, whether it was an MMI or a panel interview, open or closed file, would ask this simple question. Classmates who had applied to different specialties too confirmed the ubiquity of this question.

The question was even more common than standards questions of why this specialty, what are your strengths and weaknesses, etc.

How do you Handle Stress?

The more I think about it, the more I realize how good this question really is. With just one question, the interviewer can assess your inter and intrapersonal skills. They can determine what types of adversities you have overcome and whether you have a healthy response to stress that is conducive to residency. They can see if you’re a well rounded person who has appropriate stress outlets or whether you’re a person who knows how to seek help when needed.

Furthermore, it was a question where each person would have a unique take. Everyone responds to stress differently and there is no one right way of doing it.

Residency programs want happy and productive residents. Unfortunately, being a resident is often stressful and tiring. By identifying people who can cope well to the rigors of residency, program directors will hopefully deal with less burnouts and leave of absences.

How to Answer the Question

In order to answer this question successfully, you should understand what stress is and that there are appropriate and inappropriate responses to stress. Furthermore, there is such thing as good and bad stress. Just like a musician with some butterflies, often times a little pressure in our work makes us perform best.

Acknowledge that residency will be a stressful time with a lot of pressure from your staff, patients and families. You want to convince your interviewer that you will survive and thrive during residency.

The best way is to have an example of a time when you were stressed and how you managed the situation. It’s important to have a personalized and memorable story on hand that can make a lasting impression. Good examples could be the first time you called or code or being in a situation that was above your comfort level. Be descriptive.

Next, tell them how you handled the stressful situation. You should be sincere in your answer and realize that everyone handles stress differently. Take the example further and talk about how you release some of the pressures of work in your personal life. Some people find outlets in their friends and families. Some prefer to have some time by themselves. Others like to get it out of their system with physical activity or artistic endeavors. Whatever your method(s), you should tie them back your example.

My Response

“I believe I am a person who handles stress appropriately and thrives when I’m in a situation with a lot of pressure. I know residency can be difficult and stressful but I believe I have the right mindset and social supports outside to be an excellent resident. One of the most stressful situations I have been in was being on call as a new clerk and assessing a patient who was actively crashing on the ward. It was a terrifying experience but I was able to maintain my composure and approach the situation rationally. I was able to fall back to my basic training of assessing ABC’s and vital signs. Furthermore, I realized my own limitations quickly and immediately asked for more help. With extra support, we were able to stabilize the patient and transfer him to the ICU. I learned a lot from that experience about being level-headed and taking a step back to look at the whole picture.

Similarly, I have a lot of outlets outside of work. I like to run, play basketball and journal. My family and friends keep me down to earth and are always there for me. They help recharge my energy. I have also been very lucky to have found some mentors who I can share my experiences with and receive feedback from. Overall, I am a person who does well under pressures of treating sick patients and I know how important it is to have a balanced life outside of medicine.

That’s my basic approach to this question. Would you approach this question differently? How would you respond to stress?

3 Interview Questions You Must Prepare For

On top of knowing your residency application in and out, there are three questions that you must prepare for before all your residency interviews. These three questions require some thought and time. You need to do your research and if you answer too vaguely, you will harm your chances.

The three questions of course are

  1. Why do you want to come to this school / program?
  2. Why do you want to come to this city / location?
  3. Do you have any questions for us?

In many ways, how you answer these three questions is a strong indicator of your interest in a program. If your answers are vague or ambivalent, interviewers and program directors will see that you have not done your homework. This can negatively influence your interview.

I remember the night before each of my interviews, I would try to brainstorm a few responses for each of those questions. I would go through the school’s website and brochure to think of unique aspects that appealed to me. If I had friends in town, I would ask them to tell me why they enjoyed living there.

In the case that you did an elective there, I would be sure to mention how much you enjoyed the experience. Be sure to include some specifics of why you liked it there, whether it was the collegial environment or excellent teachers. Residents are another great resource to hear about the ins and outs of each program.

Similarly for coming up with questions, I would aim to brainstorm for a minimum of three questions to ask. You should not ask questions that can find yourself on the internet. Instead, probe deeper and ask questions that have opinionated or provocative answers. An example of a generic question would be “What intended changes do you see in the next five years?” A better question, could go like “I see that resident work hours have been reduced this year, what actions are in place to ensure adequate educational opportunities?”

By preparing for these three questions before each interview, you will look keen and interested at each interview. After all, the mentality you should have before each interview is that this school is now my top ranked school, even if only for a day.