Archive for category Thoughts
Risk Averse
Posted by medaholic in Medical School, Thoughts on February 26, 2010
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Inspired by a post on Risk Taking and Failure written by a friend.
One of the most important skills everyone should learn is how to take risks. I’m not talking about foolish or rash decision making but of calculated and beneficial risks. For the most part, I credit a lot of my success to my willingness to take action in the face of uncertainty. Winning scholarships, getting job positions, finding opportunities, getting into medical school are all things I have benefited from taking good risks.
In many careers, calculated risk taking has many benefits. Business opportunities if coupled with entrepreneurial spirit and hard work can result in large financial gain. New artistic direction can be what separates you from the crowd. Having the courage to start a conversation with someone you don’t know may blossom into an important relationship. However, medicine often discourages risk taking, often to the point that erring on the side of caution is preferred.
Any risk will always have a chance of failure. You should only take risks if the odds are in your favor or if the reward far outweighs the cost. And that is exactly the problem in taking risks when it comes to medicine – the cost of failure is high.
A wrong mistake can lead to crippling disability. An erroneous slip can lead to a malpractice lawsuit or a license suspension. One lab test missed or improper history can mean life or death. For example, even if the benefits of immediate treatment means a speedy recover, if a diagnosis is made and treatment started without confirming the diagnosis, the results may be disastrous.
That is why we are taught to be thorough in our history taking and physical examinations. That is why checking up on patients is so important, so that no alarm signs slip go unmissed. That is why a differential diagnosis should be long and comprehensive, even if some items are highly unlikely. That is why extensive lab tests, imaging and consults are required. Don’t jump to conclusions. Be thorough even if it is going to cost you time and money. As a generalized rule, doctors err on the side of caution.
I think that is something I quite miss from my life before medical school. The chance to take risks and face the outcomes and consequences. I could aimed for all sorts of goals because I knew had the ability to rebound from my failures. I could push myself to my limits, be committed in several activities and try new endeavors. But now, I have a duty and a privilege to my future patients. To do well in my studies and become a good doctor. Instead of pursuing other interests, I have a job that I should do to the best of my abilities.
Perhaps I am over-exaggerating my situation to prove a point. It’s a bit like growing up. In yours twenties, you don’t have much to lose. If someone offered you one chance to win a million dollars on a 10:1 coin flip, would you take it? If you win, you get $1,000,000 but if you lose, you have to shell up $100,000. Mathematically, agreeing to the bet would be a no brainer. Now add twenty years to the same scenario, a house, a mortgage to pay, a car, a spouse, kids and bills that you are just scraping by with, your decision to take that bet drastically changes. If you win, a million dollars that could result in retirement but if you lose that money, how are you going to pay next month’s rent? Provide for your family? Would you still take that risk?
[I realize that the possibility of going into $100,000 of debt in your twenties is a great setback. You could even argue that when you're 40 and you have a stable job, you are more in a position to lose $100,000 than when you are just starting your career, but these numbers are just an arbitrary scenario and I hope you got the main point I was trying to make]
Possibility is traded away in return for stability. Predictable outcomes are favored when what you risk losing is greater than the gain. When you become responsible for other people, especially in a job like medicine where a doctor-patient relationship is so important, I would feel really bad if I made a risky decision that negatively affected someone else.
So although risk-taking is a valuable trait to have, I often think being risk averse is also an equally important trait to have especially in medicine. Being paranoid and nit-picky, which is excessive at times, may one day save a life. Someone’s obsessive need for perfection or his insecure fear of failure can make a positive difference.
What are your thoughts on risk taking and risk aversion?
Never Bored
Posted by medaholic in Medical School, Thoughts on February 4, 2010
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Although I was busy during my undergraduate studies, I can still remember days or weeks where I would be bored with school. If I was particularly on top of my school work, I would often take the weekend off and do absolutely nothing productive and instead something fun. I would slack for weeks at a time and know that I could catch up. I remember studying for chemistry intensely until I knew the periodic table and each element’s properties down cold. There were tests where I could recite dozens of physic formulas without the need for a cheat sheet. I remember having to find extra work to do to challenge myself, get involved in clubs, and push myself to go beyond class expectations.
On the contrary, nowadays it seems like work always has a way finding me. It’s rare to have a spare moment just to read leisurely or contemplate about life’s big mysteries. There’s always more diseases to study, new terms to look up, clinical opportunities to be involved with. And I know as soon as clerkship starts and residency, it’s only going to get busier.
Medicine is challenging. Compounded with my initial dislike for rote memorization – though it has improved a lot – I often find learning everything overwhelming. When I peruse the titles on the library shelves, there seems to be a textbook for every imaginable disease possible, irregardless of how obscure they may be. There’s such a variety of subjects to learn, ranging from anatomy to epidemiology to each specific specialty. For a curious person like myself who likes to know everything about anything, I find it hard to have the same confidence of knowledge as I did in undergrad. Even for common conditions such as hypertension or diabetes, there is a wealth of knowledge out there that keeps changing.
I knew what I was signing up for when I decided to go to medical school. Long hours, grunt work and a whole lot to learn. It can get draining, mentally, emotionally and physically. There will be days where going to the washroom and taking a nice hot shower will become a luxury. Sleepless nights, angry patients, grieving families. Life long learning until the day you stop practicing.
Medicine can be pretty tough, but boring? There’s rarely a dull moment. There’s always something to do, something to learn, something to challenge you. It’s a trade-off I can live with.
The Taste of Failure
Posted by medaholic in Medical School, Thoughts on January 7, 2010
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Failing is a bitter medicine to swallow but like medicine, it is ultimately good for you. And even though I’ve accumulated my share of mistakes over the years and I am not really affected too much by it these days, there are still incidents and failed attempts that bruise my ego and leave me questioning my abilities.
I was recently reminded of these feelings of frustration and self doubt when I received a series of rejection letters from a few jobs and scholarships. It has been a while since I last ran into such “bad luck.” Sometimes the competition is just too fierce and sometimes it’s just the luck of the draw.
I can still remember being denied admissions to my top choices for university programs, all seven of them. And I still remember the countless hours I spent filling out applications for scholarships I never did win or jobs that never got back to me. I vividly remember getting rejected from medical school the first time I applied; I was devastated. Or being rejected the second time the next year, it wasn’t any easier.
Failing is a part of life. It’s easy to forget that sometimes, especially when you compare yourself to people around you. As humans, we often choose to see only what we want to see. While we often praise the success of others, we rarely focus on our own strengths and tend to focus on our own shortcomings. We tend to ignore the importance of making mistakes and how our successes often arises from tough situations.
It’s good to be reminded once in a while what failure tastes like. It’s like a strong smelling ginger that awakens your sense of complacency. And although not everything will always go my way, I remain optimistic. Because looking back now, my current achievements and success was built on overcoming my own failures. I became a more responsible student after my rejection letters. I became a more patient person as I waited to enter the medical profession. I will be a better person because of my failures.
As a wise personality from my childhood once said, “Take chances, make mistakes, get messy!”
Learning to Learn in Med School
Posted by medaholic in Medical School, Pre-med, Studying, Thoughts on December 31, 2009
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Learning in medical school is quite different from learning in a undergraduate setting. The concepts of medicine themselves aren’t that hard to grasp or different from the biochemistry, physiology and general biology in a typical premed course.
Simply put, each individual concept in medicine is easy to understand; connecting all the ideas and knowledge together is the more challenging part and is what makes a doctor. The increased volume of knowledge, need for long term retention and integration with clinical skills is what makes learning in medical school different, but not necessarily more difficult. Although, I have only studied medicine for a short time, I have begun to notice what works for me and what doesn’t and would like to share my own lessons on learning medicine.
1. Be an Active Learner, not a Passive Student
Learning is fun! As a medical student in preclinical and clinical years, your main responsibility is to learn, doing so in a respectful and enjoyable manner. No one is as responsible for your education than yourself. It’s your job to make sure you acquire the knowledge and clinical skills needed to become a competent doctor, not your school, not the licensing board, but YOU!
Do you still remember your transition from high school to university and how nobody was there to hold your hand anymore when it came to learning? Same goes in medical school. Luckily, there is no shortage of things to learn and do in medicine. Don’t feel obliged to just stick to just whatever the professor or lecturer says in the classroom, medicine is a far broader field than most know. Shadow, get clinical exposure, talk to physicians and learn outside of the classroom. Don’t spend all your time just focusing on material that you will be tested on, take time to learn what is important and essential to the practice of medicine! You would be surprised how poorly what is tested and what is important correlate, just ask a practicing doctor.
Remember that you are not in medical school to get good grades so you can get into the residency of your choice. That may have been true in your undergraduate studies, but it shouldn’t be in medical school. You are studying to become a doctor and you should ensure that you take the necessary steps to become a good one. Never let school get in the way of your education.
2. Nobody Remembers Everything their First Time Around
There is a lot of memorization in medicine, there is no avoiding it. But even the brightest students don’t remember everything their first time through. Spaced and constant exposure to the material is needed for any long term memory to be created.
Cramming may work to pass an exam but I highly doubt you will learn anything in the end. That is why I have found frequent reading and continual exposure critical to acquiring and retaining large amounts of knowledge. You may not remember all your antibiotics and bugs the first time through, but the more you repeat it, the better it sticks.
However, I must caution against repeating a lecture over and over again. Many schools record their lectures for student convenience and I think it is a waste of time to attend a lecture and then to go home replay the same lecture. Not only are you spending twice the time to cover the content, you are also becoming a passive learner who is hoping to absorb all the information by osmosis. It is the same as glazing over lecture notes repetitively but never taking the time to grasp the concepts. That is why focused and active learning must always take place.
3. Build a Basic Skeleton, then Fill in the Details
With the vast amount of knowledge to be learned, it’s quite common to get caught up with memorizing minutiae. After all, most exam questions tend to be focused on specific nitpicky facts. However, if a skeleton of knowledge isn’t built for each topic before these details are learned, it becomes hard to keep track of all the information floating around.
For any disease, I try to approach it in a systematic and consistent way. I like to start with a good definition or summary sentence for each new term. Using a good medical dictionary (and acronym and abbreviation dictionary) can make a big difference. Mondofacto, MedTerms, Medline, MediLexicon, Taber’s or even a dictionary or wikipedia are good sources.
Always start with the basics if you do not know them. Normal human physiology, anatomy, biochemistry, etc should be understood first before learning about the abnormal pathophysiology and disease states.
Apart from Etiology, Epidemiology, Clinical Signs, Diagnostic Tests, Treatment, Prognosis, etc I try to summarize the main points for each disease on one page of paper. Often a review book such as Toronto Notes or First Aid can be an excellent resource to learn the key and essential facts. Once you have the main points down, feel free to fill in any additional details.
4. Learn from Multiple Perspectives – Peers included
It would be a shame if your entire medical education was based on just your class lectures and recommended readings. Sure, the material you will be tested on will be from these notes but there is also a lot of material that will be left out that is important! Furthermore, class notes are often poorly organized and sometimes even incorrect.
Better yet, once you begin learning from multiples sources (and not just wikipedia) you will be able to differentiate what is important and what is not. The key concepts and facts will be repeated in multiple books because … they are important! Even comparing your class notes with a textbook will help you organize the information better and in turn you will spend less time with irrelevant material.
This applies to more than just textbooks. Learn from different teachers, learn on the wards and learn from your peers. There are a lot of nifty learning aids and tools that you may be unaware of.
5. Make the Knowledge Your Own
Take ownership of the things you learn about. If that means rearranging lecture slides into something you can understand, do it! Mark up your textbook with multi-colored highlighters and side notes if it will help you learn. If you want to learn the difference between multiple diseases, creating a comparison table is an excellent exercise and quick visual aid you can use.
Similarly, creating your own mnemonics or finding ones you will remember can make dry material more interesting. Create songs, rhymes and dances when possible.
Every time you create your own notes, you are reorganizing the information in a way that you can understand and digest. However, I would caution against just copying out notes mindlessly. You must organize the information to suit how you learn.
6. Ask Questions
There is no quicker and effective way to find your gaps of knowledge than by asking questions. That is why tests are such a practical tools in learning and that is why pimping (pdf) by attendings can be beneficial to you.
The pursuit of knowledge begins with a good question. After going over a topic, I like to turn over my notes and ask myself some questions. What did I just learn? Why is such and such important? How does this relate to this other condition? How can I differentiate between this and that? In doing so, not only do I come to realize what I don’t know, but I also create links between different concepts which further solidify my base of knowledge.
7. See one, Do one, Teach one
The old adage of seeing one, doing one and teaching one holds true when practicing clinical skills. It combines the best of repetition, active learning, different perspectives and taking ownership to help you learn and remember.
All students will observe, proactive learners will do, few will teach. I guarantee that if you take the time to teach somebody else a topic or a technique, you will end up benefiting from the experience. Even though I am not a big fan of group studying, one type of group work I do enjoy is when every group member first does their own reading and studying and then comes together for a review session. Every member is assigned a topic to go over and teach; they are to be the expert. By teaching in front of your peers, you get to know your topic inside and out because you will need to outline and explain all the concepts clearly. Furthermore, your peers will ask questions that can identify your weaknesses and similarly, they can contribute to the discussion if details were left out.
8. Practice Makes Perfect
Finally, I’ve come to realize that the journey I am on is a long one and everything doesn’t always come easy the first time around. I often forget my anatomy or confuse two different things for each other. I mispronounce drug names and many times I just don’t know. But luckily, I am still in the early stages and there is much more to go and with dedicated practice, I will improve. It’s important to set high standards but not to be too hard on yourself. Rome wasn’t built in a day and neither were doctors in days, weeks or even a year. It takes 10,000 hours to become an expert in a field (Outliers, Gladwell) which roughly works out to be somewhere after medical school and in residency. And even though I feel as if I have learned a lot, I know that there is still much more to learn ahead of me. So I look forward with optimism and excitement because I am slowly getting better at learning and I find learning medicine fun. =)
If you have any tips on how to learn, please leave a comment. I would love to hear how other people approach their learning!
Links
Work has been busy. I’ve been doing all sorts of stuff related with Swine Flu. I haven’t had time to write anything, so instead here are some links to articles I have read recently (big reader of NYTimes anyone?) and also some links to useful study websites. Hopefully this will be stimulating and help with your school work. Sorry for the lack of posts. I’ve working on another project for now that’s taking most of my time.
One thing I’ve found is the more I learn about medicine, the more I have to know than just the science, pathology and clinical skills. Medicine is truly an art – a combination of communication skills, leadership, management, negotiation tactics and patient compassion. There’s also many fields that you must be aware of like public health, political advocacy, career-lifestyle challenges and health economics, even if they are not your areas of expertise. It’s challenging but also rewarding.
Health Care
A Doctor by Choice, a Businessman by Necessity
Does More Sleep Make for Better Doctors?
Tweeting From the Operating Room
When Doctors Make Mistakes
Links
Unsustainable
Posted by medaholic in Admissions, Thoughts on June 11, 2009
First: I would like to thank everyone for their comments / emails / support. I greatly appreciate them all.
I have been running this site for almost a year now. During that time, I have had several popular posts, I made a fairly complete flow chart outlining the whole medical school admissions process and I have had several thousand readers. However, I believe this site is not sustainable without some changes and further personal incentive.
I’m not trying to be greedy. There is a cost to run this site, it’s approximately $80 a year for the server, domain name, etc. Additionally, the time needed to run this site, maintain it, and create more content can be quite a burden. For all the time (and time is precious) I put in, I don’t get any money out of it. And lately, less and less satisfaction. If only this site could be more sustainable…
I believe if there was a reward system (Either personal satisfaction or monetary) in place, I would be more inclined to create content. I know this is the internet, information should be for free! But considering my knowledge and experience, I think I could go out and easily charge $50 / hour doing medical school admission consulting. I don’t want to charge money for this site. For my qualifications: I got into medical school early, I did well in my undergrad studies, and I believe I did fairly well on my interview. Furthermore, I have helped out with the admissions process, reviewed essays and references, been an interviewer and have successfully helped more than 10 people I know successful get admitted.
So I’m asking readers, What should I do? Should I switch to advertising, a subscription, sponsorship or a donation model to keep this site running. Each will have its own pros and benefits. It sucks that I have to even consider this, but I have to consider my own needs too and as a medical student with doing well in my studies as a priority and growing debt, I don’t want to have to worry about this site.
Any help would be appreciated. Thanks for posting comments, I appreciate all of them. Some of them are very helpful, encouraging and thought provoking.
EDIT: The main purpose of running this site is NOT for the money. A commenter posted out that there are a lot of free services out there I could use to. After reading that, I think what I actually want is a connection between the effort and work I put into this site and a reward or personal satisfaction. (I posted in the comments about this). I am not planning to shut down my site, just perhaps find some motivation and reevaluate my reasons for running this site.
It feels like I’m writing to an empty audience sometimes, a monoquily if you will. The main purpose of this blog is not to journal my day, write about my feelings and thoughts (although I do that now and then). It want to help people understand the medical admissions process, help them become better students and make them more informed about health issues.
Perhaps it’s a writer’s block or burnout, but there are days when I log-on and I just don’t want to do anything. Somewhere along the way, I lost a bit of the joy I had in the beginning. It’s partly due to doing the same thing over and over again – helping people with their “What are my Chances” questions or the should I take Organic Chemistry in the summer? – but another aspect is it’s hard to get satisfaction out of helping an anonymous person you have never met and who’s only purpose in contacting you is to get something out of it.
I help out people all the time in person, giving them strategy and tips on how to do better in school, what medical school is like, etc. And although that’s the same thing, I get some personal satisfaction. I can see my results. I will hear back from them if they get into medical school and that makes it worth it. There is a connection between my efforts and a final reward, whether that is personal satisfaction or gratitude.
Mind Your Manners
Despite helping the sick and needy, it still surprises me as to how rude some doctors can be to their staff, students and patients.
A simple please or thank you. Facing your patient when talking to them. Not yelling at people to follow instructions. Being punctual with your appointments, apologizing for the long waits.
Perhaps they have been in a position of power too long or that patients are willing to do anything they say, but doctors should not look down on their staff and patients.
People say bedside manner does not matter as long as your doctor is smart, finds the right diagnosis and gets the job done. I disagree.
The process is just as important as the end result. Compassion is as important as hard work and precision to details. It’s not that one is greater than another, it’s that both are needed!
“Nobody cares how much you know, until they know how much you care”
And patients who have doctors who care are much more compliant with their treatment and much more likely to follow instructions. Manners do matter.
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.
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!