Celebrating Match Day!

Yesterday was Match Day.  At noon EST, just over 17,000 4th year medical students simultaneously found out where they will go for their residency training this July.

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Medical training is punctuated by ceremonies like convocation, the White Coat ceremony, the donor ceremony (to acknowledge the “silent professors” in anatomy) and graduation.  But of all the ceremonies, the one that is pure joy is Match Day.

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I truly believe that any physician disillusioned with their work, or even suffering from burnout should be “prescribed” attending a White Coat ceremony, donor ceremony and/or Match Day.  I’m serious!  These moments of ceremony allow us to remember the reasons we choose the profession of medicine and the joy of practice. If you are part of a medical school faculty, make a point to attend one or all of these ceremonies next year.  I promise, it won’t feel like an obligation, it will feel like a gift.  If you are not in a medical school, contact the Dean of Student Affairs at your alma mater or a school close to you – we’ll help make it happen.

During the five long days of waiting between Monday, when they find out that they matched and Friday, when they open the envelope to find out where they are actually going, many fourth year students often wish this process would be replaced with an email notification…. until they experience the celebration of Match Day…

 

Congratulations to all medical students graduating this year -  and to your families, friends, and professors!

 

Photos and video from Baylor College of Medicine

 

 

 

 

Why You Should Take a Sabbatical

With all the concerns about “burnout” in physicians, allowing a colleague time to rediscover the excitement of his or her career may just be “just what the doctor ordered.”

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I’m ending up a month long “sabbatical” to work on a writing project.  I’ve become convinced that this is something most, if not all, physicians should include in their professional life.  I’m also sure that the data about sabbaticals are true – the “return on investment” for a practice or university is well worth developing a policy to encourage and support sabbaticals.

The concept of a sabbatical is traced to the Old Testament, but in recent times it has come to mean “any extended absence in the career of an individual in order to achieve something.” The corporate world has learned the benefit of these planned breaks and an impressive number of companies not only support the concept, but pay their employees to take sabbaticals.

Here are some concrete suggestions for taking a sabbatical, based on what I did (and some things I learned to do… and not to do).

Have a Mission.  A sabbatical isn’t a vacation.  It’s supposed to push you to learn something new, but it should be related to your work.  Think carefully about where/what/why you want to do, but don’t be afraid to choose something challenging.  Ideally this should be something that takes you out of your comfort zone into a new way of thinking.   It may be concrete, like learning a new skill in the laboratory, or a new procedure… but take advantage of the time to explore other fields and other ways of thinking.

Advance Planning is Key.  I picked a month that was the closest to “off peak” for my clinical and administrative responsibilities as possible.  I went to my associates six months before the sabbatical to make sure they were ok with the idea, and to give them time to work out any coverage plans that needed to be put into place.

Let People Know.  It’s not a good idea to just “disappear.”  It’s really ok to talk about what you are going to do and why.  I put an out of office message on my email 2 weeks before I left, explaining that I would be “out” for the month in order to avoid surprises for other people who were trying to find me.

Be prepared for pushback, but don’t be surprised if there is none.  Not only was everyone supportive of my plan, numerous people congratulated me on being a good role model for my colleagues.

Decide how to pay for the time away.  Many universities pay for some or all of your time away, so if you are in an academic setting, the first place to start is to learn about your institution’s sabbatical policy. Some non-academic practices also have policies to provide a part of your salary if you are on sabbatical.  If there is no policy, you may have to finance this another way.  You may have accrued enough vacation to cover the time away from work.  Another strategy is to put aside money specifically to support you for the time you are away.  A word of caution, if you take an unpaid leave, make sure your benefits are still in place. Finally, unlike other occupations, physicians have the option of locum tenens work to finance a sabbatical.

If at all possible, disconnect completely.  This is the one thing I would do differently next time.  My initial out of office message told everyone I would only read emails on Fridays, but was otherwise unavailable.  There were, however, a few events that happened during the month that I (and others) thought I needed to handle, and I let them take over some of my time away.  It didn’t detract from the overall goal of the month, but I think the experience would have been even more rejuvenating if I had been able to really leave work behind.

Coffeehouses (and tea houses) are great places to write.  I know that many of my students and residents routinely study in coffeehouses, but I never “got it”.  Now I do.  A good coffeehouse has just enough background activity that you have to focus to work… but not so much that it is distracting.  You are also protected from the day to day distractions of your office or home.  One of the great secondary gains of my month was learning about the great coffeehouses and teahouses in Houston!

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From Pre-Med to Med: Making the Transition to Medical School

Making the transition from college to medical school is one of the biggest academic “leaps” a student can make.  I was recently asked to address the Texas Association of Advisors for the Health Professions on how to best advise students getting ready to start medical school.

There are more details in the slides I presented (Here’s a link to the slides:Transition to medical school), but the following are the “top ten” pieces of advice I passed on during my lecture:

1.  Arrive a week early (at least).  It’s important to build in time to move into your new home and make it a space you enjoy.  Make sure your electricity and cable are working.  Meet your neighbors, find a gym, stock your kitchen with healthy food.  It’s tempting to stay with your family (or add to your trip to Europe), but don’t – the time you spend getting ready to start medical is time well invested.

2. Buy a good computer (and the appropriate software).  Check on line to see if your school has specific requirements and make sure you meet them.  You’ll want a laptop, not a desk computer – you’ll be taking notes in class and carrying your computer around to study.  You’ll also be taking National Board exams on your own computer.  Most medical students at Baylor organize their notes with One Note (PC) or Growly (Apple).  You might want to buy the software and get used to it before you start.

3. Set up your study space before the first day of class.  You’ll be studying hard from the first day, so don’t put this off.  Most students buy two monitors and hook their laptop to the monitors to study (usually with a supplemental keyboard and mouse, but this is optional). Buy a really good chair for your desk.  If you listen to music while you study, invest in good speakers for your computer.  Keep your desk organized. Put some reminders on your desk of why you are doing this for the times it’s not so easy.  Consider a standing, walking or biking desk for your primary desk – or as a alternate desk.

4. Learn about active study skills and apply them from day one. Your study style in medical school will be different than what you used in college.  You have to learn all the material, as in really learn it.  It all builds on itself, so you can’t skip parts that aren’t interesting.  You’ll never cram for another test in your life – it’s all about learning, reviewing and repeating.  To get ready, learn about methods like the SQR3 method of studying as well as other systems.

5. Go to class (and be really present).  Unlike college you’ll need to use class time as active learning time.  Review the notes before the lecture and make notes during class.  Ask for clarification during class.  Most medical schools record the lectures as streaming video so you can review them later.  It might be tempting to skip going to class but don’t.  It’s easier to stay actively engaged if you are in class.  You’ll be able to ask questions about the things you don’t understand.  And, most importantly, if you don’t go to class you’ll miss out on the social benefits of being with your classmates.

6. Start with studying 1 hour for every hour of class.  Adjust up if needed.  The amount of material you cover in a semester of medical school is the equivalent of 30+ hours of undergraduate courses.  Medical school as a 60 hour a week job.  Schedule your “work” on a calendar to make sure you make your 60 hours.  When you tackle your hours of studying, use “study reps” – 45-50 minutes of all out studying followed by 10-15 minutes of absolutely no studying.

7. Exercise at least 30 minutes every day.  The real goal should be an hour a day, but the minimum should be 30 minutes.  You can “multitask” by riding your bike or walking to school.  Daily exercise is a great way to decrease stress, help prevent future work related injury and prevent the medical school equivalent of the “freshman 10”.

8. Plan your day so you can sleep 8 hours a night.  No sleep = poor synapse formation.  Poor synapse formation = no learning.  It’s that simple.  Don’t believe yourself or anyone else who says they “don’t need” 8 hours of sleep.  It’s just not true.

9. Eat real food.  Good fuel is necessary for your brain to make the synapses that are necessary for learning.  Eat well and often enough (every 4-6 hours) to keep you blood glucose stable.  Shop on the outside of the store (where they real food is) and learn to cook!  If you don’t cook, at least make conscious choices to buy prepared food that is healthy.

10. Make friends and work to maintain those friendships.  Social connections are one of the strongest antidotes to the stress of medical school.  Make friends among your classmates (because they really understand what you are going through) and maintain your friendships out of medical school (for the perspective they will give you).  Your significant other is your most important friend – so pay special attention to the time and effort you put in to supporting him/her.

Compassion: Lessons from Roshi Joan Halifax

It’s not often that a talk completely changes the way I think about something.

I’ve been thinking and speaking about compassion fatigue for many years.  I recently had the privilege of hearing a wonderful talk by Roshi Joan Halifax. She made a strong and convincing case that “compassion fatigue” is a misnomer… and that we should think about this in a very different way.

We can never have too much compassion nor can true compassion result in fatigue.  

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Empathy and compassion are not the same thing.

Empathy is a necessary prerequisite for compassion, but compassion goes beyond empathy. Empathy is the ability to be with someone who is suffering, to be able to feel what they are feeling. Compassion, on the other hand, is being for someone who is suffering, being moved to act and find a way to relieve their suffering.

compassion joan halifax

Link to Roshi Joan Halifax TED talk “Compassion and the true meaning of empathy”

Self-regulation is the key to being able to remain compassionate and this skill can be taught.

We all respond to situations of suffering with “arousal”, a state that varies in intensity depending on the severity of the suffering, and our own memories and experiences.   How you respond to this state determines whether you can stay present, effective and compassionate.  Roshi Joan Halifax offered the mnemonic “GRACE” as a way to teach this skill to medical students, residents, physicians, nurses and other health care professionals.

G:  Gather your attention. Take three deep breaths.  Be present.

R: Recall your intention.  We choose careers in medicine to help heal the sick and to reduce suffering.  It’s not easy to remember this intention when we are overwhelmed.  But, in the moment we are faced with a human being who is suffering, we must let our own response (and the demands of the day) go and remember why we are here.

A:  Attend to yourself.  Being able to detect what is going on in your own body is the same “wiring” you use when you feel empathy.   After gathering your attention and recalling your intention, pay attention to what is going on in your body.  Watch your breath, feel where there is tension, pay attention to sensations.

C:  Consider what will really serve.  Moving from empathy to compassion is defined by considering the actions that will relieve suffering.  Really consider the person and the situation and decide what is most likely to improve the situation.

E:  Engage ethically.

“Developing our capacity for compassion makes it possible for us to help others in a more skillful and effective way. And compassion helps us as well.”  Joan Halifax

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This Year’s @drmlb’s Top 10 Gifts for Medical Students, Residents and Busy Docs.

This time of year, family and friends of docs and/or docs in training are looking for the last minute holiday gifts (if you are trying to have them shipped) or planning the trip to the store(s) for gifts.

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The one thing any busy person doesn’t have enough of is time.  If you think about it in that context, you can find presents to support interests, fitness, studying (or just having fun) in a thoughtful way.

1. Someone to help clean their home.  It is the most amazing present to come one once a week (or even once a month) to a house that has been cleaned by someone else.  If there are family members who are willing (and it’s appropriate) you can put together a gift of cleaning supplies with a certificate for monthly housecleaning.  If not, word of mouth to find the best person is usually the best way, and will often help you find someone who also does laundry and ironing.  (a true gift!).   There are professional services in every city as well that can be found with an easy internet search.
2. Something to help integrate fitness into their every day activities.  If they don’t have a good bike to commute to school or the hospital (and this is something they would like) this is a great present.  Don’t forget the helmet, reflective vest and very bright lights as part of the package!
3. A fast computer.  If they have the same computer they had in college and you are able to do this for them, the time they will save in uploads will be very appreciated!
4. A smart phone or mini iPad (especially the new iPad air).  Like the computer, if the phone they have is more than 3-4 years old, the upgrade will be much appreciated.  The mini iPad (instead of the regular size) fits in a white coat pocket, which is why it’s ideal for anyone who wears a white coat.  If they have an iPad, think about some of the more expensive medical apps. (or a certificate for the App store
5. Kitchen appliances to save time (and promote healthy eating).  My favorites on this list would include a rice maker (which can also be used to steam meat and vegetables), a pressure cooker a slow cooker or the Krups multi-cooker.  A blender is always a good gift (to make smoothies and soups).  If you are feeling particularly generous, a VitaMix instead of a blender is much more versatile (and makes much better smoothies!).
6. Prepared meals. If you have family who love to cook, you can make a “certificate” for homemade food in freezable portions.  If you can afford it, there are personal chefs who do the same thing.  You can also give them a gift certificate for a grocery store like Whole Foods that has healthy prepared food or companies that deliver healthy meals (In Houston, it’s companies like MyFitFoods – but this varies from city to city).
7. Fitness equipment for home.  For medical students who are spending a lot of time studying think about a FitDesk, FitBike or a treadmill desk.  The standard stationary bikes, treadmills, etc are another option, but they are expensive and you have to really know that they are preferred over going to the gym (see #8).  A less expensive but very effective gift would be a “fitness care package” with resistance bands, FitDeck cards, a gift certificate for running shoes, and other small less expensive gifts.

8. A membership in a local gym. You can also consider a certificate for group classes in spinning, yoga, or whatever they enjoy.
9. Time with family and friends.  Think about a “certificate” for time together – maybe with restaurant gift cards or movie gift cards attached.  A “certificate” for a monthly home cooked meal?  If you aren’t in the same town, think about how to make it easy for them to spend time with their friends.  If you know their favorite restaurant or hangout, see if you can get a gift certificate.  If not, go for tickets to the local theater, one of the movie chains (find out which one is closest to where they live), or their favorite restaurant chain. If they have children, babysitting is a wonderful gift.
10. Whatever you can think of that makes gives them more time and/or will support them during times of stressful and busy work!

 

 HAPPY HOLIDAYS TO ALL!!!PEACE_ON_EARTH

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Last year’s suggestions on wellnessrounds.org

Gratitude, Thanksgiving and Being On Call

Thanksgiving week is here. Our families will gather together to eat our traditional meal, swap stories, argue about whether cornbread or white bread dressing is better and nap on the couch while watching football. I’m in charge of the corn bread (my great grandmother’s recipe) and the corn bread dressing (my grandmother’s recipe).  It’s a great time to recharge and to be thankful for family, food on our table, and the many gifts in our lives.

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I’m not on call this Thanksgiving, but I have been in the past.  I have a fond memory of Thanksgiving when I was the Chief Resident in our county hospital Emergency Room.  I bought the traditional dinner, including a large turkey, for my team… and then realized we didn’t have enough microwaves to heat it up properly.  I won’t go into the details of how we handled the problem…. but it turned out that the rarely used autoclave in the ER was big enough for a turkey.  We were grateful for ingenuity and a hot dinner!

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I will be thinking of the physicians, in practice and in training, who will sacrifice time with their families this year to take care of others.  To the physicians, nurses, hospital staff, police officers, fire fighters, soldiers, clerks and anyone else who spend this holiday helping others – thank you.  We are grateful.

 

“Gratitude can transform common days into thanksgivings, turn routine jobs into joy, and change ordinary opportunities into blessings.”  William Arthur Ward

Organizing Notes in Medical School and Residency

Among my other educational roles, I have the real pleasure of teaching embryology for the Baylor College of Medicine MS1 class.  Recently, while visiting with students before a lecture, I happened to see a set of notes on several of the students’ laptops. They had the slides from my lecture with additional notes, all organized to study efficiently.  I asked them if they would mind sending me information so I could post it here since I thought this might be useful to other medical students.

The following is a guest blog from Samuel Buck and Sara Fish, both first year medical students at Baylor College of Medicine with assistance from Sam Rogers, an MS3.

There are several apps that make studying easier in medical school.  In retrospect it would have been great to know about this the first day of class, so I’m happy to share them now.  I use OneNote and EverNote but there are other apps I know other students use like Growly Notes. Here’s the key notetaking apps (and a few others):

One Note
OneNote – This is the program that I use for notes during class. Using OneNote, you can import entire power point presentations (even the notes at the bottom of each slide) into a single document and add your own notes and drawings as well. OneNote allows you to organize all the lecture materials and slides in one place.  Word documents, powerpoints, PDFs, images, and Excel sheets can be placed in tabs in your “notebook”.  From here, you can easily navigate, add your own notes and text, highlight, or draw on the slides.  I usually use the draw functions to add arrows to radiographic images or to circle important points on slides.  I usually organize my notes by subject but other students organize by date, with tabs for each block, each week within the block, and day of the week, and individual note pages for each lecture that day. Other students organize notes into separate digital “notebooks” by block or by course (i.e one for embryology, one for anatomy, etc)  The most convenient thing about OneNote is that all of your notes are synced to a Microsoft SkyDrive (their version of the iCloud) so that you can access your notes on the iPad and phone. If I’m studying and ever need to consult my notes from class, I can just take out my iPad or if I’m on the go, my phone and reference the lectures or notes in a really organized fashion.  Having OneNote on my iPad let’s me review notes when I am on the bus or in other situations where it’s hard to get your computer out.  This is one feature that Mac users with Growly Notes (basically the OneNote equivalent) do not have since there is no Growly Notes app for the iPad. One of the most useful tools in OneNote is the find function.  You can type in a keyword and OneNote will search your entire notebook and show you every instance when that word is used.  This is very helpful because a huge number of documents can be scanned at once.  Since many concepts in our classes overlap, it helps to make connections between subjects.  For instance, if something is mentioned in embryology and you feel like you have heard that word before, but you don’t know where, you can search it and find the lectures in which it was previously mentioned.

Here are links to additional “tutorials” on using OneNote in medical school from the University of Kansas and UT Health Science Center in San Antonio that will give you more details on using OneNote to organize your studying in medical school.

som.uthscsa.edu/StudentAffairs/documents/OneNote_Presentation.pdf

www.kumc.edu/Documents/…/kumc-onenote-instructions.pdf

One of the most useful tools in OneNote is the find function.  You can type in a keyword and OneNote will search your entire notebook and show you every instance when that word is used.  This is very helpful because a huge number of documents can be scanned at once.  Since many concepts in our classes overlap, it helps to make connections between subjects.  For instance, if something is mentioned in embryology and you feel like you have heard that word before, but you don’t know where, you can search it and find the lectures in which it was previously mentioned.

 

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EverNote – Although there are some students who use Evernote to organize their notes in medical school, I found that format is not really conducive to good organization of notes. I do really like the mobile layout of the app and I use EverNote extensively for “every day” note taking. Grocery lists, work out programs, random ideas, to do lists, jotting down an email or name I want to remember. One thing I really like about EverNote is that when you make a note, it generates a time and location stamp for the notes.

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Growly Notes – This is probably the most popular note taking program for our class because it is made for Apple computers. I personally don’t have any experience with it as a PC user, but it has a great organization format as far as I can tell.

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DropBox - Online file storage and sharing service that is very useful for sharing study materials between students. Our anatomy buddies group uses this extensively to share quizzes and study guides. It is a really great service, and DropBox will load thing directly to and from your personal DropBox, which is very convenient . One thing to remember is that it’s not HIPPA compliant, so if there is any patient information, it shouldn’t be put in DropBox

Google Drive - Not to be overlooked is the tried and true Google Documents. Whether it be study guides or notes, it’s hard to beat the convenience of Google Drive if your goal is mass editing and sharing. Sharing the link to your document is easy, and it can be set up so that anyone who views the document can also edit it. Just like DropBox, this isn’t HIPPA compliant, so don’t share patient information.

TurboScan – This is an app that takes pictures of documents and turns them into PDF files that you can email to people (or yourself) or upload to DropBox. I do this for all class handouts to have an immediate digital copy of any paper items we get in class or study groups. I can email files to myself and post them into my OneNote documents. I also use this app for personal finances. I take a picture of my receipts from grocery shopping and going out as well as my bills so that I can better budget myself and keep track of purchases.