Medaholic Turns Five

Source - Flickr

Last week, this blog turned five years old. Apart from the 48 hours of downtime I had while migrating servers, there was not much fanfare – no celebration, no new theme, not even a post. Now on my first free Sunday in a month, I have a chance to reflect about it.

In many ways, this blog has been a reflection of what I have done in the last half decade. This blog and its readers have been with me through premed, medical school, clerkship rotations and residency. Through my posts, I’ve tried to share my thoughts on what being a doctor is like. I’ve written before about death, sickness and health. When I have busy rotations, I tend to post less. When I have free time, I try to grow the site. Along the way, I met many who are also on the same journey as me.

It’s been an unexpected and humbling experience. Unexpected because I didn’t think I would make it this far and do so well. Humbling because of all the support and encouragement I’ve received from readers.

For those who aren’t aware, this blog was initially called Open Source MD. The site is still up if you want to check it out. Reading through my old posts, I could tell I was naive and overly ambitious when I first started this blog. I was a new medical student trying to make my mark on the internet and change how patient care was delivered, without having ever cared for a patient yet. There is a paragraph I want to quote though because I think it still holds true.

“I hope that I can look back four years from now at these posts and still realize that I have my optimism and ideals that lead me to this profession. Through recording my memories down and reflecting on my personal growth, perhaps I will gain a better understanding of medicine.”

I can say confidently, that I do have a better understanding of medicine now. I have helped patients overcome their illnesses and I have harmed patients. I have broken bad news countless times. I have laughed with with patients, I have cried with them. What a privilege it is to care for patients.

Moving Forward

Looking back, Medaholic has gone through several phases. Initially, I wrote articles on how to get into medical school – which included posts about the MCAT, application process and interviews. As I went through medical school, I talked about medical education, note-taking, surviving clerkship and preparing yourself for residency. And currently, as I am completing residency, I am focused on work-life balance and career development.

Obviously, medaholic addresses a wide audience from high school students to residents – that’s why this year I asked Lizz to join the team. She is where I was exactly five years ago and about to embark on her own journey – I’m sure she has lots of potential and a wealth of information to share. So instead of focusing past topics – MCAT, Admissions, Interviews, Medical School – I will let Lizz take up the flame and run with it.

As for me, I’m still around and I know it’s time I start writing for myself again. I am going to write about things I’m interested in and not on topics that I’ve outgrown. I want to look back again in five years time and see how much more further I’ve gone. There are still things I will still be doing because I enjoy it such as reviewing apps, books and resources. But I also want to challenge myself with new things. I don’t want to be the blogger who writes little substance for the sake of writing. I have some projects and topics I want to write about soon.

So here’s to the next five years at medaholic, I’m looking forward to it. I hope you will too.

Writing Well Counts

Please excuse my lack of writing. I have been studying for my upcoming MCCQE Part II exam – the second part for our Canadian general medical license.

However, this time each year, I still take some time out to help friends and acquaintances with medical school applications. Although I no longer know the cutoffs and marking criteria for each medical school, I still help out by proofreading essays for clarity and content.

From the applications this year, and years past, the biggest problem I find is style. It seems that four years of science courses can make a person forget how to write sentences. What I read is often overly complicated and cluttered with cliches. It’s unfortunate because most of the content is better than the form.

Three short pointers to anyone applying this cycle (or in the future)

  1. Read your sentences out loud
  2. Edit ruthlessly
  3. Get someone else to look over your writing

Two books that I highly recommend and refer to frequently

 writingwell

Sorry for coming off as an advertising board – I just edited some horrendous essays.

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.