Tales From the Call Room – Medaholic’s Hierarchy of Needs on Call

If you’re familiar with Maslow’s Hierarchy of Needs, there is a pyramid structure of man’s needs. The most fundamental necessities are at the bottom with the need for self-actualization at the top.

I want to propose a similar model – Medaholic’s Hierarchy of Needs on Call

HierarchyLevel 1 – At the most basic level – you have to do your job on call. Look after patients, return your pages and get the work done. On busy nights, you’re happy with just the bottom rung.

Level 2 – On better nights, you might have the chance to eat a meal and maybe even get some sleep. A 30 minute nap, not bad. 2 hours of sleep, now we are getting somewhere. 4 hours – your post-call day is starting to look productive. 6 hours without interruptions – you might as well just have slept at home!

Level 3 – Being on call is all about presentation. Normal bladder and bowel movements, fresh breath and getting along with your colleagues. Call’s not so bad.

Level 4 – Now we’re getting somewhere. You feel great looking after your patients  and you get a lot of satisfaction out of it. You’re doing a good job and you’re happy you can provide quality patient care.

Level 5 – This is now getting to the realm of self-actualization. You’re learning, you’re teaching, you’re finding time to look up the evidence behind the treatments we prescribe. What a great educational experience, an hour on call is worth several hours studying. Finally you are learning some real medicine.

Level 6 – You get to take a shower. You feel refreshed. It’s a total game-changer.

Tonight’s call has been pretty good. I’m hovering somewhere in levels 4 and 5. I even wrote a blog post! Might even attempt level 6 and hope there are no codes.

On Having Medical Students

The last few months of residency have been a blur. Second year has been as busy as ever and on top of looking after patients, I have medical students to look after now! After being the senior resident with junior residents and medical students, I’ve gained a new perspective on medical education.

It has been interesting supervising medical students. What a big difference a few years can make, as I compare myself to these new clerkship students. I was in their shoes not too long ago, in fact it was only three years ago! For the most part, I enjoy having medical students on the CTU team, even though they aren’t always that helpful. There’s also such a diversity in terms of knowledge, skills and communication skills amongst them. So I thought I would share some thoughts now that I’m finally on the “other side.”

Medical Students will Take up your Time

In general, medical students slow you down. Most of the time, they don’t know what’s going on and because of that they will ask a lot of questions. If it normally takes 15 minutes to see a patient, it will take new med students twice as long. At their stage everything is new. From taking good histories to performing physical exams you have to factor in their inexperience. Even final year elective students will require your guidance (or at least your signature). The sooner you factor this in, the better you can plan your days.

Medical Students Need Supervision

I probably didn’t receiving enough supervision as a medical student. I could have learned a lot more if someone had looked over more what I did clerkship. I could have saved myself a lot of time spent figuring things out on my own. At the same time, I try not to micromanage or do too many things for my medical students. Although I know it’s much faster for me to do their work, the whole point of clerkship is for them to learn. Currently, I let my medical students see patients and write notes on their own. Afterwards, I review with them their findings, proofread their notes and then we go back to see the patient together. I usually try to go over physical exam manuevres at this time and then I give them a chance to explain the medical plan to the patient. I think this way gives them a sense of patient ownership.

Medical Students have Different Strengths and Weaknesses

Despite having been in the same classes during preclinical, there is such a variability in knowledge, communication styles and work ethics amongst clerkship students. Some are very book smart and the majority have forgotten all their medical knowledge.It doesn’t take long to figure out who are the excellent students and who are the ones that need help. Similarly, it’s easy to spot the hardworking and lazy ones. Some you can trust and others you will have to supervise more closely.

Medical Students want to Learn

Above all, clerkship students are excited to learn. They’ve been waiting four years of undergrad and another two years of medical student for this moment. They are here to see and look after patients! Give them opportunites to learn at an appropriately level.I personally find their enthusiasm contagious. I enjoy having new learners on the team as it helps me look at topics I know in a new light. Teaching them medical knowledge makes each topic and concept clearer for me too, as I try to explain to them in the most basic terms. I also try to teach them non-medical things during the day such as tips and tricks for getting things done in the hospital or how to communicate with families and other disciplines. So far I have gotten a good response to my teaching.

As a senior resident, I think one of the most important things we can do is give specific and timely feedback our learners. Even though medical students will pick up most things by “doing” it, they need to know what they are doing is right or wrong. There is so much inconsistency in their teaching that they often don’t know what they are doing is wrong.If they have a medical concept wrong – the best time to correct them is as soon as possible. If they make a mistake or error in judgement (which they will do, double/triple check everything they do), correct them in private and remind them that you are there to help.

Medical Students Need Feedback

I’m sure my views of medical students will change as I work with more students at different stages of their training. I find students at the start of clerkship are more keen but lack knowledge. End of year students have knowledge and experience but can often be burnt out. Ways medical students can fight these effects is to read more during the beginning of the year and learn to find balance near the end.

Overall, I found teaching and supervising medical students an enjoyable experience. Perhaps there’s still some academia in me left despite my leaning towards community practice.

Lessons Learned from Premed Research

When I started my pre-med coursework, I asked myself a universal question premed students ask: “Do I really need research experience?”

Which, let’s be honest, is not a question that has an easy answer. After all, plenty of students are admitted to medical school each year with little or no research experience. From what I can tell though, those stories are becoming more scarce, suggesting research is becoming an unspoken requirement. Because  I subscribe to the don’t-knock-it-‘til-you-try-it philosophy of life, I made the choice to pursue a research project in order to get some experience.

Now, it would be nice if I went to an enormous, well-funded university hosting a variety of research projects that have direct applications to the field of medicine, but was not the case. Instead, I found myself working on a project examining the effects of population density on mortality and bone ossification in African clawed frogs. Yeah, I know, my paper is never going to be cited in NEJM. What matters was  I could get a research experience, build connections, and figure out whether I wanted to do research work.

The three things that I got out most from my research as an undergraduate (well, post-baccalaureate) student:

1) You form close relationships with some of the best professors in the world.

Not only has she been an excellent sounding board for my hare-brained ideas, she also got to know me well enough to write me a strong letter of recommendation. Apparently, despite a few broken pieces of glassware and other minor (and sometimes major) lab mishaps, I managed to convince her that I’m actually competent. Maybe she’s not so smart after all.

2) You learn to work in team environments

Because my teammates and I all have full-time professional Look At Me I’m A Grown-Up jobs, we came up with creative ways of addressing the logistical problems of our work when meeting face-to-face was  not feasible. Just like patient handoffs, frog (well, data) handoffs are critical.

3)  You get a real sense of accomplishment

I don’t know about you, but I feel like I come from a culture that de-emphasizes personal accomplishments, which is kind of a bummer. I mean, you work hard, you overcome a challenge, and then you have to shut up about it lest someone respond dismissively. Well, after a year of spent tediously rearing our tadpoles, painstakingly collecting data, staining our specimens so we can visualize their developing skeletons, and cataloging the presence or absence of dozens of bones in hundreds of specimens, we are finally putting together an abstract for submission to a conference. And I am going to buck my culture and say yes, I am happy with what we have accomplished!

Which brings us to this past week. At our last meeting, the three research students were hunched over our laptops, alternately exclaiming “YES!” and “Wait… Noooo!” as we fiddled with our graphs in an effort to discern trends out of noise. We are not at the home stretch yet. Abstracts need to be finished, posters have to be started.

Conclusion

So, with over a year of experience, am I a convert? Does research light my fire? The answer is… I have no idea. Maybe? Probably. Who knows.

There are dozens pf things I enjoyed about my project, yes, and a decent number of them are things that are not project-specific but rather applicable to research as a whole. And there are plenty of aspects of medical research that I might love that are wholly absent from the project I have the most experience with. . All I can tell you for now is that I don’t hate research, and I am not terrible at it, and I might enjoy it a bit more if it was in a subject I found more engaging.

With this in mind, the typical advice of “It doesn’t matter what kind of research you do, just do some research,” may be bad advice for many of us. Maybe we ought to amend it to “Admissions committees don’t care what kind of research you do, but you should pick something that’s either medically relevant or personally interesting.” Too bad that’s not quite as pithy.

What do you think, readers? Did your undergraduate research experiences affirm or destroy your interest in research, or do you just feel mildly uninspired?

(PS: For those of you playing along at home, as of this writing, I’ve received eleven interview invites and three rejections. I’m flying out for the first interview at the end of August and could not be more excited. This is really happening!)

Reconnecting with my Goals

work in progress

Since I normally take classes year-round and have been taking premed prerequisite classes after my bachelor’s degree, July was my first month of no classes in six years! Though I’m still working, this was my first month of completely unstructured time.

Turns out, unstructured time is kryptonite to my productivity.

With the July coming to a close, I realized just how much time I spent parked in front of my computer, decompressing with Netflix and Reddit. And you know what? I am not going to let it get to me. Nope! I’m going to muzzle the part of my brain that wants so badly to be perfect all the time. I was due for a break, and I kept up with my secondaries, and The West Wing is fantastic, so no, I’m not going to agonize over a “wasted” month. At the same time, I need a game plan for August.

Thus, without further ado, I present to you my August resolutions:

Just say no to Netflix. Really great programming available on-demand in nearly infinite quantities – Welcome to the future, kids! Unfortunately, it’s a huge time-suck that I can’t really afford. Now that I’ve finished devouring all seven seasons of The West Wing, I’m done. Exceptions to this rule: Netflix as background noise when cleaning, exercising, or spending time with my boyfriend is fair game. (The fact that my boyfriend and I unwind in front of the television with our cell phones out is another post entirely.)

Practice Spanish. For most of July, I completely neglected my language studies. Now I’m back on the wagon, keeping up with the Pimsleur series in the car and Duolingo on my computer. The problem with language learning is that it is a slowwww process. When I get impatient, I start researching language learning tactics, and before I know it, I’ve spent hours researching instead of practicing. No es bueno. This month, I’m going to make a concerted effort to stick to the systems I already have in place (the aforementioned Pimsleur and Duolingo, plus Anki and Spanish-dubbed Simpsons) instead of wasting time chasing down new leads in an unending search for the ephemeral best language learning system. Just like the best camera is the one you have with you, the best system is the one you actually use.

Eat better. Crappy food choices short-circuited any chance I stood at losing weight during July, but at least I didn’t gain any, either. In August, I’m recommitting to tracking what I eat and staying under my calorie goal using MyFitnessPal.

Finish my secondaries, prepare for interviews. It may feel like there’s no end in sight, but the window for secondary applications is drawing to a close. By my count, I have five left to write. I have interviews scheduled for the first weeks of September already so I need to schedule some prep time with one of the more intense professors at my undergrad institution.

Shadow some physicians. While I generally think my application is solid, I have to admit clinical observing is one of my weaker aspects. Which is silly – compared to the other things I’ve done to get to this point, shadowing should be easy! Sure, nobody likes cold-calling doctors, but I’ve been putting it off for long enough. If nothing else, I really need to make some progress in this area before my schedule fills up again.

So there you have it. I do hereby swear, affirm, and pledge to adhere to the above guidelines for all 31 days of the month of August, and to check back in and report my progress (or lack thereof). Full steam ahead.

What about you – What goals have you been working towards? How will you use this month to better prepare for medical school, residency, or whatever life plans you may have planning?

Photo credit – Flickr Blumpy