Immersion Phase Update: Emergency Medicine (8/3 – 8/28)

The month of August was a whirlwind.

I completed my required Emergency Medicine rotation this month, which was an experience unlike anything I’d had before.  At Vanderbilt, this rotation consists of daily morning lectures, case conferences with residents, several shifts in affiliated emergency departments, and a couple of exams.  In essence, it’s a miniature version of a third year clerkship with a dash of first year didactic learning–lots to know, lots to do, lots to be evaluated on.  There were less than 20 of us on the rotation, including several visiting students hoping to match into emergency medicine.

To be honest, I was interested to see what sitting in class for roughly 4 hours each morning would be like after so long.  I wondered if I’d take better notes, if I would feel more confident about speaking up in class…whether my attention span had gotten better or worse since December 2013.  I took slightly better notes (having an iPad with a dedicated note-taking app helps), but neither my shyness nor my attention span had improved much.  Our lecturers expected class participation, and the class was small, so often I was called on directly to read an example EKG or to answer a question; otherwise, I kept pretty quiet.

For the most part, the lectures themselves were excellent.  Most were 50-minute overviews of various topics that we would encounter on emergency medicine–everything from pediatric emergencies to toxicology to environmental exposures (frostbite, snake bites, and everything in between).  The majority of the lecturers had their own quirks or teaching styles that made them quite engaging.  One of our main lecturers frequently quizzed us on buzz words for particular conditions–ventricular fibrillation = “shock,” hyperkalemia = “EKG,” hyponatremia = “be careful [when correcting the abnormality],” and so on.  He also made countless Seinfeld and “classic” movie references and expressed his disappointment when we didn’t know where they came from (coincidentally, I had just started binge-watching Seinfeld at the beginning of the rotation, so I was pretty happy about some of the quotes he pulled out).

In addition to traditional lectures, we also had a few simulation and procedure labs.  The first lab was an overview of how to suture, how to do a spinal tap, and how to intubate (I was pretty terrible at all of these).  We also had a lab on how to apply splints to fractured limbs, during which we covered each others’ arms and legs in plaster and ACE bandages.  The most rewarding labs were done in the simulation center, where we interacted with simulation robots that can be made to blink, talk, and even sweat.  We were divided into groups, given a patient’s age and chief complaint, and asked to manage each case, asking for vitals, ordering labs, starting medications, and calling for consults based on what we were told and what we saw on the monitors.  Afterward, we had debriefing sessions during which we learned what the key teaching points and optimal management strategies were.  I wish we were able to use the simulation center more throughout medical school; it’s a great way to learn how to diagnose and treat in real time.

Of course, in addition to lectures and labs, there was also “on the job” training in the form of our shifts.  Each of us had a total of ten shifts scattered throughout the month and at different times of day: five at the Vanderbilt Hospital adult ED (one in the triage area, two in the high acuity “A Pod,” and two in the lower acuity “B Pod”), two at the Children’s Hospital ED, two at the VA’s ED, and one at the Sumner Regional Medical Center in Gallatin, Tennessee.  Each type of shift required a different level of responsibility from medical students.

  • The triage shift was a time for us to work with EMTs, going to Rapid Response calls in the hospital and learning to start IVs on patients who came in from the waiting room.  Unfortunately, my shift was pretty quiet, so I didn’t get much practice, although one of the EMTs offered to let me stick a needle in his arm (I declined, although I’m not sure whether he was joking).
  • On the A Pod, where trauma cases as well as seriously ill patients are seen, our role was mainly to see patients with the residents, go to the trauma bay when patients were brought in, and assist where we could with procedures, updates, and other tasks.
  • On the B Pod, we served as the main “resident” seeing some of the patients, presenting to the attending physicians, writing notes, and signing out to other providers at the end of our shifts, provided that it wasn’t too busy in that part of the ED; otherwise, we functioned much like we did on A Pod.  One of my shifts–my first–was a typical B Pod shift, which was so fast-paced that I could barely get used to it.  On my second B Pod shift, both the waiting room and the ED were full, so residents and attendings saw all of the patients themselves while I acted as a “sponge” and learned as much from them as I could.
  • Peds was similar to B Pod–seeing patients solo, presenting to attendings, writing notes, keeping family and staff informed–with the added opportunity to see pediatric trauma cases.  One of my Peds shifts happened to be my one “overnight” shift (10pm – 4am).  Surprisingly, I was pretty functional during those 6 hours.
  • At the VA, medical students did not have computer access.  Instead, when a patient came in, the attending or resident might tell us about them, hand us a short information sheet about why they’d come in, and have us see the patient first.  For other patients, I simply shadowed the resident.
  • The Sumner Regional Medical Center shift gave us a chance to see what care is like outside of the Vanderbilt system.  It’s a smaller ED that is a bit slower-paced than Vanderbilt even though it is still fairly busy.  Patients are sometimes “transferred out” to different facilities for a higher level of care, a process that we do not encounter at Vanderbilt since it is typically on the receiving end of such transfers.  On my Sumner shift, I did not see any patients who needed to be transferred, so it was reminiscent of a VA shift.

It was often difficult for me to figure out how I best could function on my shifts, but once I got the hang of things, I enjoyed the clinical experience and was able to learn more about the medical knowledge and thought process required of an ED physician.  In the ED, a huge part of the work is determining the patient’s disposition, deciding whether the patient should be admitted to the hospital or whether s/he can go home.  This decision often requires the provider to rely on an understanding of the patient’s past history, lab and imaging results, and sometimes his/her instincts about “how sick” the patient was upon arriving to the ED.

Surprisingly (to me at least), my experience also dispelled a quiet myth that there isn’t any continuity in emergency medicine.  While it is true that ED physicians usually don’t see the same patients over and over again, I worked with several attendings who followed up on patients after their shifts were over, seeking to learn about their working diagnoses or their hospital course.  One attending I worked with on my second Peds shift made sure to tell me about the results of one patient’s lab work the next day after class.

As I mentioned, this rotation had a few exams.  One was for Advanced Cardiac Life Support certification.  We spent a considerable number of our lectures learning how to manage various situations, such as encountering a patient in cardiac arrest or someone who has an abnormal heart rhythm on a monitor.  They stressed how much we would need to study to pass the certification test, telling us to make flashcards and quiz each other.  I came into the ACLS certification extremely nervous, but it ended up not being too bad.  So I’m officially ACLS certified to do CPR and run codes…although I hope I never actually have to use that knowledge.

Yesterday, I took the exam for emergency medicine.  This was my first computerized NBME shelf exam; I’m on the fence about whether I prefer that method to Scantrons.  In any case, the exam was pretty difficult, and I wasn’t the only person who thought so.  It felt like a combination of all of my other shelf exams, with the addition of weird things that an ED physician would be the first person to see, like animal bites, acute wound care, and fractures.  I came into it thinking that I hadn’t studied nearly enough, and I left feeling like studying more wouldn’t have helped.   Speaking of studying, for anyone who’s wondering, I only used PreTest.  I don’t even think I got halfway through the book, but I’m still proud of the amount that I was able to do in about a week and a half at the end of the rotation.  I’d planned to also read through First Aid for Emergency Medicine, but that didn’t happen either.  In any case, the test is over, and hopefully I passed.

Somehow I still managed to do “other stuff” this month.  I was able to arrange my schedule such that I only missed church on one Sunday morning and one Wednesday night.  I attended a gathering for members involved in the worship ministry and am still hoping to get more involved myself.  The Psychiatry Interest Group had their first event, a barbecue hosted by one of the current psychiatry residents, and SNMA had their introductory meeting as well.

All told, this month was exhausting.  I’m not going to say everything went well or that I didn’t feel overwhelmed some (read: most) of the time.  If I could do this month all over again, I’d definitely do things differently.  But now that the rotation is behind me, I can’t deny the fact that this was one of the most educational months that I’ve had since starting the Immersion Phase back in January.

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Immersion Phase Update: Physical Medicine & Rehabilitation Elective (7/5/15 – 7/31/15)

As I alluded to in my last post, this past month I took an elective that offered an introduction to physical medicine and rehabilitation (PM&R).  This specialty looks at restoring or maintaining activities of daily living, mobility, functional capabilities, etc, in patients with permanent or temporary disabilities.   It’s a broad field, dealing with everything from chronic musculoskeletal pain to cerebral palsy to traumatic brain injuries.  Physicians in the field–known as physiatrists–work closely with physical, occupational, and speech therapists in both inpatient and outpatient settings.  The department and the residency program are quite new to Vanderbilt, but they welcomed me with open arms for the month and taught me so much about the specialty.  I initially chose this elective because I’d had absolutely no exposure to PM&R, and I was pleasantly surprised by how much I enjoyed it–in fact, I’ve been recommending it to just about every medical student I’ve talked to.

Throughout the month, I rotated through a number of outpatient settings that gave me a better idea of the breadth of PM&R.  I saw more typical clinics that served pediatric and adult patients presenting with mainly orthopedic or neurologic chief complaints.  I got to observe several procedures, such as botox injections (for limb spasticity, not for cosmetic reasons), spinal injections, and joint injections.  I even helped out with a few of these; for the most part, I simply helped the physician draw up medications into syringes or held the ultrasound probe, but one morning the attending let me inject steroid into a patient’s hip.  I was so excited to do this, even though the attending was holding my hands the whole time.

I was also placed at fairly unique clinical sites that medical students usually do not get the chance to experience.  In “wheelchair clinic” at the pediatric rehabilitation suite at 100 Oaks, I observed a physical therapist and equipment vendors as they fit children for colorful wheelchairs and car seats.  When I shadowed the physical and occupational therapists at the VA, I learned about everything from paraffin baths for arthritis to dry needling techniques for painful trigger points; I even got to go inside a balance assessment machine, which uses various tests to determine the level of function of certain neurologic components of balance.  I also observed a physical therapist in what is called lymphedema clinic; this site typically serves patients who have swelling due to lymphatic issues or muscle tightness after surgery, and the therapists there recommend equipment and perform maneuvers to help decrease patient discomfort.  On two mornings of the elective, I went to the Dayani Wellness Center, a fitness center geared toward patients with heart diseases, lung diseases, and other similar diagnoses; nurses, exercise physiologists, and other personnel create workouts, hold fitness classes, and use health coaching strategies in order to help patients meet their exercise and nutrition goals.

Additionally, I spent a week with an inpatient attending at Stallworth Rehabilitation Hospital.  Before that particular week, Stallworth was simply the place where patients often got sent when someone felt they needed “inpatient rehab” after a stroke or some other debilitating injury.  I didn’t really know anything else about it, but I learned quickly.  Typically, patients spend about 2 weeks at Stallworth, receiving some combination of physical/occupational/speech therapy daily depending on their needs and goals.  If the patient was admitted for a spinal cord injury, they usually stay a few weeks longer and receive the same services during that time.  Physicians make rounds every weekday, talking to and examining their patients, assessing for new medical concerns, writing prescriptions, and other typical tasks.  Meanwhile, case managers work on discharge planning, figuring out where the patients will go–home or to a skilled nursing facility, to name a few options–and what type of follow up they will need with therapists or physicians after they leave Stallworth.  In addition, the patient’s team of nurses, therapists, physicians, and case managers meet together during the week to discuss medical, social, and other barriers that might lengthen his or her stay.  I found that Stallworth is an environment built upon interprofessional care, with the idea that many medical professionals can and should work as a team to effectively meet their patient’s needs.  This came in handy, because I was taking a concurrent class on interprofessional education that required me to shadow two care providers who were not physicians (I chose to observe a case manager and a speech and language pathologist).  In addition to learning about the system and general routine of Stallworth, I talked at length with the PM&R attending on various topics; it turns out that he is quite interested in the intersection between his field and neuropsychiatry, so we ended up having lots to discuss!

When I wasn’t doing work for the rotation, I spent quite a bit of time working on my residency application.  This past month, I met with the Dean for Student Affairs to discuss the medical student performance evaluation (MSPE) that will accompany the application.  At this point, I am up to my neck in editing my personal statement and curriculum vitae.  At the time of my last writing, I hadn’t started writing either of them; however, I was able to put together working first drafts of both while I was away in Detroit a couple of weeks before starting the PM&R rotation.  I’ve since sent them to several friends and faculty members and have received great feedback on both.  I am also working on finalizing the list of programs I’ll apply to, as well as collecting letters of recommendation.  In the midst of all this, I found out that I passed Step 2 CK, so I’m almost done with the exams whose scores I’ll need to include with my application.

Despite having my hands full with all of the above, I still had time for some extracurriculars.  A week after I got back from Memphis, two of my dear friends from church got married; it was wonderful to be able to celebrate with them.  A week or so later, I entered a vocalist search that EDM genius Zedd opened up to his fans; I wrote and recorded lyrics for a new instrumental track that he’d made, and although I haven’t heard back from the artist himself, I’ve gotten great feedback from friends since posting my vocal demo on SoundCloud and YouTube.  In addition to all this, I joined some of my classmates in welcoming the Class of 2019 during their orientation week; aside from making me feel really old, they seem like a pretty cool bunch of people overall.  Several of them signed up to join the a cappella group, and they eagerly showed up for our first rehearsal; despite some of them saying that they had never sung before, we were able to sight-read and sing through a song that the group had performed previously.  I was also able to go back home for a children’s and youth conference at my church there, during which I met Travis Greene, a gospel artist who sings one of my current favorites (it’s such a favorite that I did a cover of it on my YouTube channel).  And this past week, I went with a friend to Bridgestone Arena for the Nashville leg of Outcry 2015, a brand-new tour featuring Christian music greats such as Passion, Trip Lee, and Hillsong.  I was exhausted the next day, but it was totally worth it.

Thanks for reading!  Stay tuned for my next update.  On Monday, I start my month of Emergency Medicine, which will include lectures and ED shifts occurring at various times of day (and night).  Wish me well!

Immersion Phase Update: Step 2 CK (5/26/15 – 6/19/15)

Exciting news!  I just finished taking Step 2 CK (clinical knowledge), a formidable, 9-hour, multiple choice beast in the U.S. Medical Licensing Exam series*.  I designated this 4-week block as a “flex” month so that I could study (at home!) with no other obligations.

Most of my classmates who had taken CK before me said that it was better than Step 1 (back when I took the MCAT in college, I recall a then-medical student telling me pretty much the same thing).  Step 2 CK is less about hard-to-recall basic science concepts and more (but not completely, in my opinion) focused on sort-of-hard-to-recall clinical concepts.  Because the test is taken after core clinical rotations, it doesn’t take as much intense book review; it’s somewhat easier to retain information about a diagnosis when you saw it on the wards first.

As usual, I came into studying with a day to day schedule.  I’d planned to do all 2250ish questions in UWorld, with a second pass through as many possible of the ones I got wrong, and read Step 2 Secrets cover to cover +/- First Aid for Step 2 as needed.  By the end of my first day of studying, I realized that my plans were too ambitious.  By week 2, after changing things around 3 or 4 times and talking to a classmate about what her approach had been, I decided to ditch the schedule–and the review books–altogether and focus on UWorld questions alone.  It was for the best.  I didn’t get to take notes on difficult questions like I’d planned, but I was able to see every question at least once.  When I found myself struggling with particular concepts, I hit the books/old clerkship notes/the Internet in an effort to gain a deeper understanding.  Believe it or not, I even spent some time with our old friend First Aid for Step 1, as I had found some chapters particularly helpful in the past (looking at you, biostats).

Despite spending the majority of my waking hours studying, I still made time to maintain my exercise, Bible reading, and mindfulness meditation routines, as well as spend time with my family at church and around the dinner table.  They got used to me drilling questions on my iPad while eating and walking around in circles around the house in an effort to reach my daily step count.  Instead of cramming in isolation on the day before the test (read: just yesterday), I joined my mom for a brief day trip to Nashville; even though I hadn’t intended to study at all, I ended up reviewing more in the car than I probably would have if I’d stayed home.

The test itself was pretty challenging.  My ultimate goal had changed from “get a better score than I did on Step 1” to “stay awake long enough to answer every question and not run out of time.”  Armed with a couple of caffeinated energy bars (Larabar Cappuccino and Clif Peanut Toffee Buzz), a jacket, and the chorus of “Whom Shall I Fear (God of Angel Armies)” by Chris Tomlin running through my head on a loop, I felt pretty calm about the ordeal.  But I was still very tired.  I found myself zoning out often and had to pause frequently just to take a deep breath during each of the 8 hour-long blocks.  I only took 2 breaks (one after block 2 and one after block 5); a part of me is currently wondering if I should’ve taken one more to cut down on fatigue.  Hindsight is 20/20, no?

For the most part, I’m just relieved that it’s over.  And I’m relieved that I have about 2 weeks off before my next block, the Physical Medicine and Rehabilitation elective that’s offered at Vanderbilt.  Next week, my family is heading to Detroit with my home church for the National Baptist Congress of Christian Education, and the week after that should be fairly relaxing at home.  I’ll also (finally!) carve out some time to work on some important tasks that I’ve been neglecting due to busyness (practicing driving, working on residency stuff…)

*because I’m writing this a few hours post-test, I fully expect it to be somewhat incoherent.  Apologies.

Immersion Phase Update: Pediatric Genetics (4/27/15 – 5/22/15)

I spent another month at the Children’s Hospital, but this time I was on the outpatient side of things, in pediatric genetics clinic.  This elective is not one that most people decide to take, especially if they’re not going into peds.  But I’d come into medical school thinking that a career in pediatrics–maybe genetics–was a strong possibility (before med school, I’d even toyed with the idea of becoming a genetic counselor).  I shadowed a geneticist one morning as a first year and saw a handful of interesting patients and diagnoses.  By the end of that half-day, I wasn’t sure whether it was the career path for me, but I was glad to learn more about the process (3-year pediatrics residency plus a 2-year genetics fellowship).  Anyway, I digress.

Fast forward to last fall, when we registered for Immersion Phase courses.  At this point, I was still pretty clearly divided between psych and peds.  But I knew that no matter when or what I decided, I would take the peds genetics elective.

On this elective, I saw patients with genetics counselors and attending physicians during their normal clinic days and times.  Most of the time I shadowed the providers and interacted with our patients and their siblings, but sometimes they had me take the lead on getting the patient’s history, performing the physical exam, or even drawing out a pedigree to glean more information about family history (we learned some of the basics of pedigrees in school, but they are a lot harder to draw than they look). When I first started taking on roles in clinic, I spent lengthy amounts of time with the patients and probably slowed things down quite a bit, but I think I started to get faster in the last few days.

The best thing about this month was the fact that I got to meet patients with diseases I’d previously only read about.  One such disease is Lesch-Nyhan Syndrome, whose features–abnormal muscle tone, self-injurious behavior such as biting the hands, sometimes even gout and arthritis–are due to a defective protein  that causes the body to not be able to recycle the building blocks of DNA.  The hand-biting can get so bad that most people with this disease have to get their teeth extracted to prevent permanent damage.  The patient we saw in clinic with Lesch Nyhan Syndrome was at the point where tooth extraction was part of the discussion.  I was asked to do a 30 minute presentation during the month, and I chose to talk about this particular patient both because I remembered this disease from my Step 1 studying days and because it sort of relates to psychiatry.  I can send any of you my presentation slides if you’re interested, but I’ll warn you that it might be better as a cure for insomnia than as an educational tool.

Learning about the tests available to facilitate diagnosis was also quite exciting. The field has made many advances, even in the past few years.  Some patients we saw were return patients from a couple of years ago, who had been told at that time to come back when a new test might be available to help them.  We were able to then offer those new tests in an effort to find a genetic cause of their symptoms and come up with a more concrete plan for long-term management.  Some insurance plans, such as TennCare, are also expanding their coverage for some tests.  I hope to be able to follow some of the patients that I saw, just to see if their test results reveal any answers a few months down the road.

In addition, there are a number of research opportunities for individuals with diseases that are likely genetic but poorly understood at this time.  One such opportunity that was recently introduced to Vanderbilt is the Undiagnosed Disease Network (UDN). The providers I worked with often recommended patients to this program when all of the genetic testing that had been done for them to date was not able to give a definitive diagnostic answer.  The idea at that point is that there may be new genes that have some as yet unknown role in known genetic disorders, or that patients may be presenting with genetic disorders that the scientific community has not discovered or studied yet.  UDN’s job is to help fill in some of the knowledge gaps that currently exist.  I hope that I am able to keep up with UDN proceedings somehow, because it is an exciting opportunity for Vanderbilt and the patients the institution serves.

In addition to the genetics elective, I also took a section on medical error and coping with making mistakes, something that I will invariably have to deal with when I am a physician despite having thought only a very small amount about it now.  And I took an “advanced communications” course, in which we learned how to provide care that seeks to meet patients where they are in terms of cultural background, level of education, degree of comfort with the clinical environment, and other factors.  We completed several assignments for this course, which included giving patients a “math test” of sorts to determine health literacy as well as rewriting a medical document to be at a 5th grade reading level (it is definitely as hard as it sounds).

All in all, this month included a lot of lost sleep preparing for clinics and pulling together presentations as well as a lot of moving parts during the day.  But despite the logistical hiccups I complained about on occasion, I can truly say that this class allowed me to see some aspects of medicine that I would not be able to experience otherwise.  I’m not going to be a medical geneticist, but my work as a psychiatrist will likely require some level of understanding of the genetic contribution to disease, as it is known that family history plays a huge role in many aspects of patient care in that specialty. 

Other things that happened this month: my mom came up for part of Mother’s Day weekend to spend time with my relatives.  I’ve started going back to church on Wednesay nights, and despite the fact that I go to bed a little later on those nights, I know for sure that this sacrifice is well worth it, as I have begun to connect to a community that I love and appreciate and that I feel appreciated me.  The “bible study girls” in my med school class resumed our monthly potlucks this month, which are always quite refreshing evenings of fellowship.  And my class held Parent Weekend this weekend, during which families were afforded a glimpse of what life is like for us students, including tours of the hospitals, suturing and knot-tying practice, and–an old favorite–organ recital, where we used to stand in a circle and pass pathological specimens around to learn what disease processes actually look like in the body.

Actually, we are on our way back to Memphis now.  I am taking my next month “off” to study for Step 2 CK, the next part of “the boards.”  I take it on 6/17 (prayers please); I’m a little nervous, but it will be good to go home for a while to study since I haven’t been back in almost 5 months.  In addition, the week after I take the test, I am going to Detroit with my church for the National Baptist Congress of Christian Education.  Before I head back to school, I’ll hopefully have time to attempt to get my driver’s license, figure out where I want to apply to residency (since that’s the question everyone, including myself, has been asking of late), and write my personal statement.  Nashville, I’ll see you in July!

Immersion Phase Update: Child Psychiatry Consult Sub-Intership (3/30/15 – 4/24/15)

Last month, I returned to the psych hospital for my sub-internship (sub-I).  I worked on the child and adolescent consult service and really enjoyed it–miss it, in fact.   Primary teams at the children’s hospital contact the psych consult team to assess patients for various reasons–recommendations for psychotropic medications, evaluation for management in an inpatient psychiatric setting, provision of outpatient psychiatric resources, etc.  We saw child and adolescent patients who had been admitted for suicide attempts, increased aggression, psychosis, catatonia, and more.

I feel like I learned so much from every moment of the rotation.  During my first few days, I marveled at how much I had forgotten about psychiatry and half-joked that I needed to spend my nights and weekends reading DSM-5 or studying pharmacology (something I never thought I’d be interested in doing).  I attended adult morning report and lunchtime case conferences as I had during the psychiatry core clerkship.  My attending often offered quick facts about diagnosis and treatment of various conditions while discussing patients with the team.  I was even able to give a brief, informal presentation to the team on a chosen topic (synthetic marijuana).

The team also let me take on quite a bit of responsibility during my 4 weeks with them, as if I were already a resident.  Sometimes I interviewed the patient while another team member talked to the family for collateral, or vice versa.  Other times, I saw both the patient and the family separately and presented the case to the resident, fellow, or attending afterward.  I wrote several initial consultation, follow up, and brief notes daily.  Although initial meetings with patients or family members proved awkward on occasion–due to multiple interruptions by other care providers, patients being difficult to rouse or “guarded” with respect to their personal information, or nurses confusing me for a visitor because I opted not to wear my white coat–most people eventually became very comfortable with my presence.

I still remember being slightly nervous about how I’d fare on the first day of my sub-I, but those feelings subsided fairly quickly.  The familiarity of the overall environment definitely helped.  I felt like I’d gotten to know a number of the psych residents during my rotation in June/July 2014.  When I returned last month, many of them were genuinely excited to see me–especially after I told them I was strongly considering psych as a career–and continually offered to help me with anything I needed, including the residency application.

Life outside the psych hospital was busy as well.  Due to an unexpected change in the deadlines for the research course, I ended up having to miss the annual national SNMA conference in New Orleans, which took place during the first week of the sub-I (4/1-4/5), although I did play a pretty big role in making sure others from Vanderbilt were able to represent our school and our region well.  I spent the first week writing an abstract, creating a miniature version of a research poster, and giving a “presentation” via iPad to meet course requirements.  In addition, I finished my part of the work on the information needs taxonomy project that I’d participated in during the research rotation.  I had to spend a considerable chunk of the first two weekends in April meeting with the other medical students to meet this goal–including a few hours on my birthday–but reaching the end of the list of 3000 portal messages was extremely satisfying.

I also celebrated my 24th birthday on 4/12!  My parents came up to Nashville for a few hours the day before to accompany me on a Walmart trip and grab fried fish sandwiches at one of our favorite dives.  On the actual day, I went to church (that Sunday saw the congregation all meeting together for a single service at a new time), was treated to lunch by some church friends, and went to the Chapman College end of the year party in Brentwood.  If that wasn’t enough of a celebration, a few nights later my Little treated me to dinner at Sinema, a pretty fancy restaurant in town, and gave me very thoughtful gifts.

There were still other fun events, believe it or not.  The a cappella group gave an informal concert at a senior living facility in town; we were encouraged by people ages 60-100+ who had gathered to listen to us and thanked by delicious cookies from the staff.  Also, after missing the opportunity for 2 straight years, I FINALLY got to join some members of the worship team to sing on the steps of the church for the Country Music Marathon runners and walkers (we’re around mile 8); seeing marathon participants mouth the words of the songs, record video of us, or stop and dance were some of the most rewarding moments for me.  All told, it was a month of hard work but also a month of balance and self-care.

Immersion Phase Update: Research (1/6/15 – 3/27/15)

I kicked off Immersion Phase with 3 months of research.  I chose a faculty member in the informatics department as my mentor.  I worked on several projects over the course of this rotation.  

For one project, I worked with a few other students to analyze 3000 messages from the hospital’s patient portal.  We used a consumer health needs taxonomy, essentially a list of distinct medical, logistical, and clinical knowledge needs, to categorize parts of each message by entering this information into a huge spreadsheet.  This required a considerable amount of hours to meet as a group and discuss the content we had independently categorized; I actually didn’t finish working on it with the other students until mid-April when I was already off research.  A smaller related project dealt with unanswered questions written by pregnant women in journals during their pregnancies.

A second project looked at the information needs of pregnant women and their caregivers through interviews and surveys and analyzing the resulting materials.  After observing a few of these research visits I was able to lead them myself.  I also de identified the transcripts for several of the interviews using HIPAA guidelines and analyzed a few of them using the same taxonomy as the first projects.

My third project was kind of my “baby” versus the others that I had merely been added on to.  This project was centered on a pediatric consultation service for health information technologies–anything from websites to phone apps that could be used to manage patient care.  We wanted to see if talking to patients/families and offering them resources would have an effect on their level of engagement in their care.  It took 2 months for this project to be approved by the International Review Board, which was quite frustrating, but it was still nice to be able to do “trial runs” of this service and talk to parents and family members who found it useful and worthwhile to study.  I even attempted to use the concept for a concurrent quality improvement class I was taking.

All told,  I really took too much on in these 3 months.  This rotation was definitely a lesson in standing up for myself and learning how to say no–a lesson that I sill have yet to master.  I had expected to be less overcome by stress in these months, but honestly I felt the pressure of the work.  If I could do it over again I’d figure out a way to do less.

In addition to all of this, I was finally able to think seriously about my future career as a doctor.  After meeting with various providers and spending some time contemplating, discussing, and praying, I decided to choose psychiatry over pediatrics.  Even though I am interested in both, I feel that the former will be more fulfilling to me in the long run and will allow me to pursue “lifelong learning” instead of just throwing the term around.  Feel free to ask me about this decision!

Other fun things I did included potlucks with the girls’ Bible study group, the second annual Dr. Vanderbilt Pageant at which I sang, danced, and served as a “hype girl” for one of the faculty contestants performing an individual rap, the 4th year match day where we (and they) found out where they would be doing their various residency programs, a dance performance at Cadaver Ball, an a cappella performance at second look weekend (in our new Radial Grooves custom scrub tops!), an Odesza concert with a friend from church (now obsessed with both them and Big Wild who opened the show), and much more!

Immersion Phase: Intro

Hi friends,

It’s been a looooong time since the last update.  Sorry about that.  Things have been even busier than I anticipated them being after clerkships finished up.

The Vandy Med Class of 2016 has entered the “Immersion Phase”–a stage in our medical school career that, to me, is all about exploration.  This phase started in January after we finished our core clerkships and will continue until our graduation a year from now.  Each course that we take now is 1 month long.  We have 11 requirements to meet, including at least 3 months of research, 1 month each of primary care and emergency medicine, a “sub-internship” or “acting internship” (where you basically do the work of a first-year resident even though you’re still a med student), and various other types of courses.  We also take longitudinal classes with their own collection of required blocks such as quality improvement, communication, ethics, and problem-solving.  In addition, we have “flex months” that we can use for vacation, Step 2 studying, residency interviews, or more classes.  One great thing about this phase is that, with the exception of emergency medicine, there are NO MORE SHELF EXAMS!  Gone are the days of putting in a full day’s work at the hospital and then coming home to hit the books like a traditional student (or thinking about studying while not actually studying).  For anyone who’s in medical school now with a more traditional curriculum, think of this as an extended 4th year.

Aside from this and the next 2 posts, my Immersion Phase updates will likely come at the end of each 4-week block, provided that I can get and keep my act together.  Keep reading to follow along. 😉

2014 in review

No, this isn’t exactly a med school related post, but I wanted to share with you all.  It boggles my mind how many people tell me they read what I post here.  And knowing that I’ve got readers in other countries is awesome.  Shoutout to everyone who made these stats possible, whether you manage a page where the link was posted, shared my posts with your followers, read my update emails, or just happened to stumble upon the site somehow.  I hope you found it helpful or at the very least entertaining.

I’m sure we can make 2015 just as great. 🙂

Here’s an excerpt:

A San Francisco cable car holds 60 people. This blog was viewed about 1,000 times in 2014. If it were a cable car, it would take about 17 trips to carry that many people.

Click here to see the complete report.

Post-Medicine Rotation Update: On Studying and the Shelf

The internal medicine shelf exam was a rough one. Thankfully, I expected as much. Several upperclassmen and classmates who had taken this test before me warned me that it would feel less like “an internal medicine shelf” and more like a hodgepodge of questions from all subspecialties. They weren’t kidding. I was really glad I had taken 5 other shelf exams before this one. My main (read: only) goal last Friday was to finish all 100 questions on the test and not run out of time like I did on surgery. I met that goal with a few minutes to spare–in fact, after I made sure I had bubbled in all the intended spaces on the scantron, I watched the remaining 2 minutes tick away on the online clock being displayed on the projector screen. Even though I was still sitting in that chilly classroom, surrounded by the sound of papers rustling and pencils tapping, counting down those seconds was like counting down the time on New Years Eve.

Because of the expectations of the clerkship, there wasn’t as much time to study compared to other rotations. Like many students before me, I focused on the 1300+ internal medicine questions in UWorld instead of trying to read through a review book or two as I’d tried to do on previous rotations. Aside from the time I spent flipping through the Pocket Medicine “purple book” (so helpful I’d call it the must-read of 2014) and scrolling through UpToDate when I had a question, UWorld was just about all I used to study for this shelf. I won’t see my score for another 6 weeks, but I feel like this strategy helped me to retain a bit more than if I had tried to keep with my more ambitious approach from other rotations–less is more, if you will.

You’re all caught up on my life now. Immediately after the exam on Friday, we third years gathered in the student lounge for an “end of clerkships” party with catered hot chicken (a Nashville favorite) and ugly Christmas sweaters galore. I went out for Indian food with a few friends that night and headed home the next day. I’ll be with my family from now until the first week in January, and I plan to catch up on books, family time, music projects, and sleep while I’m off campus.

After we went our separate ways that Friday afternoon, some of us realized that that would really be the last time all of us would be together as a class until we graduate in 2016. The next stage of our medical education allows us to take more ownership of our schedules and meet requirements at different times and at various places across the country and world if we so choose. For example, when I return to Nashville after my break, I will be starting my 3 month research rotation, but others will be staying home to take Step 2 or to just relax for a month before starting again. I think I’ll have a lot more free time during January, February, and March than I’ve had over the past 9 months, and I plan to take advantage of that for sure. But I’ll miss the moments of class solidarity that having a more structured course schedule afforded us. Perhaps we’ll find creative ways to keep in touch while we’re all out carving our own paths over the next year.

Post-Medicine Rotation Update: Weeks 7-8

We finished up Internal Medicine by spending several half-days in clinic over the course of about 2 weeks. The clerkship director described this as the “diastolic phase” of the rotation to complement the pressure of the “systolic phase” of the inpatient services.

Each student was assigned to work with a few attendings in several subspecialties. We weren’t evaluated for these two weeks, so it really gave us a chance to learn about common reasons for outpatient visits and see examples of ways that a clinic could be run. The attendings had differing expectations for us medical students; some wanted us to see patients independently, others wanted us to simply shadow them.

I was assigned to work with two attendings: one in primary care and one in endocrinology. They had completely different approaches to my role in clinic; the former suggested that I see particular patients independently (for new visits, hypertension followups, acute complaints of cough, etc) while she saw others and had me write one brief note each day that I worked with her, while the latter had me simply observe him in each patient room while we saw patients coming for workup of potential thyroid dysfunction, maintenance of poorly controlled diabetes, and other chief complaints.

I kept fairly busy outside of clinic as well. Throughout the week before the shelf exam, third years were required to take part in a 6- or 7-hour in-person and online assessment of our progress with topics from various specialties. We saw a total of 6 standardized patients, with chief complaints dealing with each specialty, received feedback for our encounters, and took a basic science test online afterward. It was an exhausting experience, but it was really cool to see how our 9 months on the wards had allowed us to perform better in these sessions than we had in the much less thorough ones we were required to do during our first year.

On the same day as my scheduled assessment event, we got a small group together to participate in the National White Coat Die-In, a “black lives matter” demonstration organized and supported by medical students across the nation in light of the events surrounding the deaths of Michael Brown in Missouri and Eric Garner in New York, as well as other unarmed black men who have been killed by police in the recent past. We had a small turnout due to our decision to participate at the last minute, but we were all proud to be a part of a movement like this.

A few days later, I joined a few classmates for a free aerial silks class at a local fitness venue. I was pretty horrible at it due to fear of flipping upside down and/or falling and hurting myself, but I was able to strike a few poses. My entire upper body was sore for days afterward–in fact, I still can’t lift my arms all the way above my head a full week later! I’m on the fence about whether I’ll take more silks classes and work on overcoming my fears, but a classmate and I are considering showing up for a few pole dancing classes at the same facility, just for kicks.