Go to the meeting. 

This might seem a little obvious, but if your department or school is paying for you to attend a meeting, you should attend the meeting.  If it’s your own money… you should still attend the meeting. This is part of being a professional. Your peers have put a lot of work into their presentations.  Put yourself in their shoes – and stay to hear their talks. Stay engaged during the sessions.  Don’t be the person in the back row surfing the web on a smart phone during the entire conference. Listen actively and ask questions.  If you ask good questions, people will notice and it will reflect well on you.  However, be gracious.  Always thank the speaker for what they said, and don’t be antagonistic when you ask your question.  That will be noticed, too, and not in a positive way.

Look like a professional.

No matter where you are in your training or practice, you will be making a first impression on people who may play a role in one or more of your future position(s). Start off with a suit and tie (or the equivalent for women) the first day.  If you are a woman, make sure you dress as if you are going to an interview – not a party.  If everyone else shows up in jeans the first day, move to more casual wear… starting the second day.  Don’t dress down too much – even if everyone else is doing it.  It’s never wrong to look professional at a professional meeting.

Take advantage of the social events.

Even though it is tempting to sneak off with a couple of our friends and skip the evening reception, don’t do it.  The social events are where you meet the important people in the field.  If you have time, do a little homework about who is attending the meeting and where they are from – just to be able to start a conversation.  Most of the “celebrities” in the field are delighted to talk to people in training, so don’t be intimidated.  You’ll also meet peers at your level at these meetings who will become lifelong colleagues and friends. Introduce yourself to people you don’t know!  If you are invited to dinner or if there is a formal banquet associated with the meeting, you’ll feel awkward if you don’t know the basic rules (like what to do if there is more than two forks).   If you aren’t familiar with formal dinner etiquette, here’s a great site to learn what to do:  Dining Etiquette Guide.

Be fiscally responsible.

Just because someone else is paying shouldn’t mean you pick the most expensive restaurant and order the most expensive items. If you come in under budget people will notice. If you turn in receipts over budget, they will really notice. Save all your receipts, and turn them within a few days of returning.  It’s always a nice touch to thank the people who paid for you to attend the meeting, either in person or with a note.

Reading maketh a full man; conference a ready man; and writing an exact man  -  Francis Bacon

Attending Professional Meetings for Beginners (a previous post on Wellness Rounds)

Handy hints for attending national meetings from KevinMD.com

The best way to study for Step 1 is to start the process early.  As soon as you can (now, if you are in the first year!) look at examples of Step 1 questions.  This will give you an idea what to expect and will guide you in how to organize your studying.  The strategy for Step 2 will be similar.   Do this systematically – keep notes on your computer or in a notebook, or use the 3×5 card technique to make cards to organize and review later.  Whatever system you choose to use, be consistent.  You really can’t “cram” for the Step exams – it has to be a review.

In addition to developing a systematic approach to preparing for Step 1, it’s a good idea to spend dedicated time reviewing for the exam.  If your schedule allows, taking a full month or two to prepare for this exam is probably a good idea.  If it doesn’t, spread it out over more time, but devote the same amount of time.

The following recommendations are from two 4^th year students on how to review for Step 1.   Use specific ideas that fit you, leave the ones that don’t.  There are many ways to succeed and not all of these recommendations will apply to you.

• First week: Read quickly through First Aid cover-to-cover
  • This reminds your brain of everything you’ve ever studied and gives you the book’s lay-out
  • Read complicated or new information out loud
  • By reading out loud or skimming/reading quickly, it should take  about 6 days

• Second week: Start UWorld as arranged in First AID
  • 46 “randomized” questions per set (2 methods of organization below)
    • Choose the organ system on the right hand side of the menu screen but not any subset groupings;
    • Alternatively, do biochem, behavioral science, and micro questions separately (everything for which there is a section in FA)
      • Then move onto organ system and the associated anatomy/physiology/ path/pathophys
• Don’t worry about time at first, but ultimately you should be well under an hour/block
  • Practice good test-taking strategies
  • Read the last line of the question, skim the answer choices, read the full question for necessary buzzwords/data
  • No phone/gmail/chatting etc. during this time (it’s your “exam” time)
• Take a 10 min break after answering all 46 questions
  • Do all the activities you put off – check your texts/email, go to the bathroom, read ESPN/NPR per preference, etc.
• Review the answers from the 46 q block
  • Keep the 45-50 min “ON” study time (no distractions! No phone/email!) & 10-15 min “OFF” (see above)
• Look up anything you don’t know / can’t explain to yourself
  • Make sure you really understand the explanation, but don’t get bogged down
  • Annotate any crucial information into First AID, using First AID as your primary textbook & notebook
• Repeat above cycle until you have completed all q blocks for that organ system
• Review associated First AID chapter (cardio, GI, etc)
  • Go over your freshly annotated chapter by yourself or with a study partner
    • “I sat down with my BFF and we took turns explaining each page & our annotations, covering details the other might have missed and adding mnemonics/stories.”
    • Review related annotations from other sections (micro/biochem/BS, etc)
    • Optional: listen to the related Goljan section while driving/exercising/etc
• Repeat: Q-Block –> Review –> Annotate –> Q-block…etc… until you have completed all organ systems
• Arrange some question blocks by topic (biochem/micro/etc)
  • You will already have completed all of these questions, but it is easier to review the First AID chapters for biochem/micro/BS if you take a couple question blocks to focus your mind
  • If you are consistently performing poorly on a non-organ based section, you can always interrupt your “organ based learning” and focus on your weak area for a couple of days using the above format (qs, review, annotate)
  • Identify weak areas based on score data & personal comfort
    • Retake question blocks, answers & related First AID chapter

• If you have time during the last 2 weeks, as you go through First AID and your annotations in FA, write down everything you don’t know (don’t get stressed out if you end up writing a lot of stuff down…I think I had 1-2 pages handwritten front and back per section at this point). Then study only your notes and stop looking at First AID. The rationale behind this is that you don’t want to spend too much time rereading the stuff that you are 100% sure you know at a time when you should be focusing on what you don’t know. Note: you may need to start this while you’re still going through UWorld questions, but I think it’s worth your time.

• Last Week:
  • Review First AID from start to finish with emphasis on weaker areas
  • Continue with random blocks of questions or NBME purchase exams to keep in “practice question shape”

• Last couple days
  • 2-3 days before:  review behavioral sciences, write down any formulas for memorization, cram “regurg” factoids/formulas/graphs, cram the things in your notes that you still don’t know
  • Day before: NOTHING
    •  Hang out, relax, distract yourself, go to a movie…
    • You’re not going to change your score for the better by studying/stressing now (but it might make you fatigued the next day)
    • Pack your bag with all your documents, directions, First AID, notes for the next day (& lots of food) so you don’t have to worry in the morning
    • Try to sleep (you’ll be nervous but do your best!)

     

PRACTICE EXAMS

• There are many opinions on how to best use practice exams.  The timing of them is as much an emotional consideration as a fact-based or practice based benefit.  Here’s one way to organize the practice exams that has worked for some students:

• 2-3 Weeks into studying: Free NBME practice exam
  • Get a sense if you are on track, this score will underestimate you’re final score
    • If close to your goal, the score can be reassuring that you should keep doing what you’re doing
    • If significantly lower, the score can be motivation to pick up the pace/cut out distractions

     

• 1 week before the exam: 2x 4 block UWorld practice exams
  • I took all 8 blocks back-to-back to simulate the exam experience (timing of breaks, fatigue, etc)
  • Do NOT review the answers on the same day, in fact, you should probably take most of the next day off to recover
  • Use the results as a comfort that you are on track (my actual score was 1 pt off my practice exams —- and despite fatigue & feeling like my second block of 4 was worse, I actually got identical scores throughout)
  • Look at the stats and focus on any weaker areas (my weakest areas became my strongest by the actual exam)

   

• Last week: fee based NBME Exams
  • I paid for NBME 7, which tells you your estimated score, your percentile in each area, and reproduces the questions you answered incorrectly (but does not give you the correct answer) – again, within 1-2 pts of my final score
  • I worked through many of the exams (some easier, some harder than the my step) during the last week as a way to practice the random mix of qs….I found it helpful
  • Some of the questions on the NBME practice exams were on my REAL Step exam

BALANCE!   You’re job is study and do well on this exam —- but it can be very stressful, even just on a subconscious level.  For most people it works better to really structure your time.

Keep work hours:  go to a library/coffee shop/school on a regular schedule

• 8 am – 5 pm (5/7/8 pm…whatever you decide)
• Taken an hour off for lunch & hang out with friends
• Go home & be DONE until the next day (get good food & sleep!)
• Keep a life
  • Partner, work-outs, family, etc. should be in your life every day
  • Take at least one day off a week at the beginning

RESOURCES

• First AID & UWorld: you must use & love these, everything else is just bonus

• Others (Wiki, BRS, textbooks, Goljan, etc.)
  • Resources other than FA and Uworld will not help your score significantly.
  • Use them to explain specific questions or concepts from UWORLD or FA that you don’t understand or can’t remember
  • Use them if for some reason you have a ton of extra time and already know FA and Uworld like the back of your hand
  • If you choose to use external resources, BRS physiology and the first part of Goljan Rapid Review Path (through the neoplasia chapter) might be worth your while, but seriously don’t worry if you don’t have time to get to them.

Traci Fraser and Natalie Gwilliam, Class of 2012, Baylor College of Medicine

Tuna Salad Lettuce Wraps with Capers and Tomatoes

Not-so-Dumb Salad with Cucumbers, Tomatoes, Onions, Avocado, and Balsamic Vinegar

Mediterranean Tostadas with Hummus, Feta, and Kalamata Olives

Crockpot Double Lentil, Sausage, Brown Rice, and Spinach Soup

But then we went to sleep…. or tried to.  Vital signs, meds, and necessary events were more or less over for the day by 10pm.  The unavoidable noise in the hall, unfamiliar bed, and the events of the day made it difficult to get to sleep, but we both drifted off around midnight.

At 4am there was a cheery “Sorry to bother you, but I’m here to get your weight”.  She couldn’t have been nicer but when I asked why my friend had to be awakened at 4am (!) for a weight (!) she responded, “We have to have the weights, labs, x-rays and vitals all completed before the day shift starts at 6am.”

Not too long after this experience, I admitted a long-term (and adored) patient of mine for an elective procedure.  Her parents reminded me that last time she was admitted I wrote an order to forgo the middle of the night vital signs so their daughter (and they) could sleep.  Coming on the heels of the night I spent with my friend, it made me think about how we manage sleep in the hospital.

Image credit

Why do we wake patients up to weigh them?

There are patients who absolutely must be woken up for medical reasons.  If you are admitted for a hypertensive crisis, you need to have your blood pressure checked during the night. Waking patients up in the middle of the night for things that could easily be accomplished during daytime hours is done for three reasons, none of which are medically necessary:

1) To distribute work to the less burdened night-time staff from the day time shifts

2) To have the data available for morning rounds.

3) Because of pressure to get the patient out of the hospital at a certain time

Is there really no way to off load the busy day time shift without waking up patients?  Would it really change things if stable patients (particularly if they are on monitors!) were allowed to sleep through the night?  Would it change therapy if the daily weights were at 10 in the morning instead of 4 in the morning?

There’s no question it’s nice to have data for morning rounds – but is it really essential?  How much of this is a holdover from the paper chart era? In the era of the electronic medical record, access to data- at any time of the day or night – is easier than it used to be.  Granted, morning report or rounds would be different, but I think it’s something we could figure out.

There is financial (and other) pressure to get patients out of the hospital.  But have we looked at ways to manage this that don’t involve waking up patients?  For example, there are hospitals that count the “day” in the hospital by the patient census at midnight.  As long as you are out of the bed at midnight you don’t get charged for the day.

Sleep is important for recovery from illness or injury.

There are numerous studies that suggest that the immune system in particular is affected by disruption of sleep.  The data are not conclusive, but many physicians, nurses and scientists have published work suggesting that protecting sleep for ill or injured patients might be important:

• “When tissues have been damaged, the rate of healing is greater during sleep.”

• “Hospitalization may severely disrupt sleep, which can worsen pain, cardiorespiratory status, and the psychiatric health of acutely ill patients”

• “Immune system dysfunction, impaired wound healing, and changes in behavior are all observed in patients who are sleep deprived.”

• “Disrupted sleep is associated with immune system dysfunction, impaired resistance to infection, as well as alterations in nitrogen balance and wound healing.”

• “Sleep deprivation has been shown to be associated with an increase in inflammation that is also involved in the development of neointimal hyperplasia (or restenosis).”

• “Indirect epidemiological and experimental evidence suggest that the severity of injury during stroke is influenced by prior sleep history.”

• “Both acute and chronic intermittent sleep deprivation exacerbate colonic inflammation.”

Sometimes it’s not about the patient.

In babies with necrotizing enterocolitis, we order abdominal x-rays every 8 hours for at least a day or two (to look for air in the abdomen.).  If the x-ray shows “free air” (like the one below), it means they need emergency surgery to deal with the perforated bowel.

The standard schedule in our hospital for q8 (every 8 hours) x-rays is 6am, 2pm and 10pm.  Here’s the problem with that schedule as far as hospital efficiency goes:

• The 6am xray, if it shows a problem, will result in action around 7.  If the baby needs surgery, the operating room is already set up for the 7:30 cases.  Because the OR schedules is usually very full at the beginning of the day, we often then have to “bump” (postpone) a patient to do this emergency case.
• The 2pm x-ray will result in the surgery being posted around 3,  a complicated time in the OR since day time nursing staff is leaving and the remaining cases are being juggled.
• The 10pm xray will start the process rolling at 11 or so – putting the surgeon in the OR in the middle of the night.

Since the timing of the x-ray has a big effect on the timing of the surgery, it becomes a variable that really affects what happens. Here’s what happens if you change the schedule to 3am, 10am, and 8pm

• The 3am xray, if it shows a problem, will result in action around 4. Surgeons are the early-birds of the hospital. Since they will be waking up early anyway, the case can easily be started at 5 or 6, which helps with the OR schedule and keeps the surgeon from being up all night.
• The 10am x-ray will result in the surgery being posted around 11 – this is a time when “holes” in the OR schedule are easier to find, and getting the baby into the operating room will be easier.
• The 8pm xray will start the process rolling at 9 or so – which means the surgeon is more likely to get some sleep.

Photo credit

What’s the bottom line?  We don’t think about some of the unintended consequences of our orders.  Sleep is important – for both patients and the people taking care of them. It’s worth thinking about.

Advice for interns

Why I hardly ever drink diet drinks

How to choose your specialty

What to do on your day off

Studying basic sciences – strategies for success

Studying clinical medicine

Getting (and staying) motivated to exercise

How to succeed on clinical rotations

Gifts for medical students and residents

Why I’m spending more time on Twitter

How not to have sore feet after a day in the hospital

]]> http://wellnessrounds.org/the-best-of-wellness-rounds-2011/feed/ 1 http://wellnessrounds.org/how-to-succeed-in-clinical-rotations/ http://wellnessrounds.org/how-to-succeed-in-clinical-rotations/#comments Thu, 29 Dec 2011 12:34:20 +0000 mlbrandt http://wellnessrounds.org/?p=1889 Next week will be the start of clinical rotations for students at Baylor College of Medicine.  It’s an exciting time, but a big transition!  After seeing this a few times, I thought the following advice on how to approach clinical rotations might help.

Don’t sit in the back of the plane.

The basic sciences are important to learn the vocabulary and grammar of medicine.  Clinical rotations are different – it’s where you learn to speak the language.  There are tricks for learning clinical medicine but fundamentally it’s about realizing you are still in school and not just observing.

If you use the analogy of learning to fly, there’s a simple concept that summarizes learning on the wards: You cannot learn to fly a plane by sitting in the back.  In basic sciences you are studying the book on how to fly the plane.  In your clinical rotations you are in the plane, watching and learning from the pilot.  Which means you have to be in the cockpit.

In every situation you encounter in the hospital, imagine that you are “flying the plane.”  When the resident starts to write the admission orders say “Do you mind if I write them and you show me how?”  On your surgery rotation, get to the holding area early and ask the anesthesia resident if he/she will explain how to intubate, show you how to intubate, or even let you try.  When you are writing an admission H&P on a baby in the ER, imagine you are the only doctor who will be seeing that patient.  Let the adrenaline of that thought guide you to the computer to look up more about the condition, how to treat it and what you would do if you were the only person making the decisions.

Yes, you need to be pushy and, yes, sometimes it will backfire.  Be reasonable, but stay engaged. If it’s not an appropriate time to be assertive, stay in the game mentally by asking yourself what they will do next, what you would do if you were making the decisions, or what complication might occur from the decisions being made.  Write down questions you will ask after the smoke clears if it’s not appropriate to ask during a stressful situation.

Know what you are expected to learn before you start.

If learning objectives for the rotation are done well, they are very helpful, but many people don’t take the time to do them well (or don’t know how to do them).  For the rest of your professional life, you are going to have to define your own learning objectives.  So, in a way, learning how to do this early – during your core rotations – is also part of the skill set you need to know.  (Word of advice, though – even if they are very poorly written, you need to read any objectives you are given and make sure you accomplish them.)

To define your learning objectives for the rotation, start with a basic textbook.  Textbooks are written for residents and practicing physicians so don’t get overwhelmed – You will NOT be responsible for learning all the details in the textbook!

The strategy:

1.     Make a list of the topics covered in a general textbook for the field.  There are usually 2-3 good textbooks for every specialty.  Ask other students or residents which one(s) they recommend.  You will probably rotate on sub-specialty services during your core rotation, but don’t get bogged down in looking in sub-specialty textbooks.  Stay with the general textbook.

2.     Plan to skim and make notes on every major topic.  These should be “big picture” notes, not every detail.  If there are 60 chapters in the book and your rotation is 2 months long, you should be shooting for one chapter a day.  Keep track and make sure you get them all covered during the rotation (not after).  When you are done with the rotation, these notes should be all you will need to review for the shelf exam. These notes will also be incredibly helpful when you are studying for your Step 2 exam.

3.     Don’t read the chapters in order – read them as you see patients (see below). But, make sure that all the chapters are covered since it’s unlikely you will see patients with every disease in the book.

Practice being professional.

It’s really important to be professional and to be seen as professional in all your interactions.  First of all, it’s the right thing to do.  Secondly, a bad interaction with a nurse on the floor can lead to a poor evaluation by your attending.  Make learning how to behave as a professional one of your learning objectives.  Learn from those around you.  Which residents and attendings are the most professional?  Why?  When you see bad behavior (and you will), think about it – what would you have done differently?

Learn from every single patient you see.

Use every patient to learn about their specific disease.  Even if it’s the 30^th patient with hypertenion you’ve seen you’ll still learn something new.  (or use it to learn about a different problem they have instead)

The strategy:

1.     Keep a notebook with an entry for every patient you see.  You can use 3×5 cards, if you prefer.  In fact, many hospitals have 3×5 cards with the patient info available in the patient’s chart for docs to take. (don’t lose them or leave them lying around though – which is a violation of HIPPA!)

2.     Make yourself read something about every patient you see.  If you haven’t read the textbook chapter on the subject, that’s where you start.  If you have read the textbook, review your notes and read something new (UpToDate, PubMed, or a journal article for example)

3.     Make yourself write down a minimum of 3 things you learned from the patient in your notebook (or on your 3×5 card).

Be the doctor for patients that are assigned to you.

You will be assigned patients to follow during your rotations.  When this happens, make up your mind that you are going to “wear the white coat”.   What if you were the only doctor taking care of Mr. Smith after his surgery?  In addition to reading (see above), ask the residents to help you write all the orders.  Write a daily note and make sure your notes are at the level of the residents (ask them to review and critique your notes).  When a drug is prescribed, know the dose you are giving, the effects of the drug and the potential side effects.  When a x-ray is ordered, be the first person to actually see the image and know the result (and make sure you call the resident as soon as you do!).  Don’t get any information second hand – make sure you see the results and the images yourself.  At any point in time, if the attending asks, you should be able to present your patient as though you are his/her only doctor, which means how they presented, their past history, social issues, test results, procedures performed and how they are doing now.

Prepare for conferences.

Every service has at least one or two weekly teaching conferences.  In most cases, the topic (or cases) are known before the conference.  Ask your residents or attendings the day before the conference for the topics and/or cases that are going to be discussed.  Use the strategy outlined above to prepare e.g. consider these “vicarious” patients and learn from them as if they were a patient assigned to you.

Come early, stay late and keep moving.

Taking care of patients in the hospital is a team sport.  The best medical students become part of the team early and are taught more just because of the relationships that are developed.  It’s human nature and it’s just the way it works.  Don’t brown nose, don’t show off…. just show up.   If there are labs to look up before morning rounds, be there 10 minutes early and look them up for the residents. If you don’t know the answer to a question the best response is “I don’t know, but I’ll find out!” If there is scut work to be done that you can help with, volunteer to help before you go home. Trying to show off on rounds will backfire. It’s particularly important not to try to one-up your residents.  You will have more time to read than the residents, so you may actually know more than they do about a specific topic.  But, if the attending asks a question and the resident gets it wrong, don’t correct them in front of the attending.  (Unless it’s a critical issue and you think the patient might suffer in which case you have to speak up!)  Whenever you can, set up the resident to succeed.  “A rising tide floats all boats” – if you help them look good, you will look good and the team will look good. Take breaks when you are tired but don’t sit in the lounge waiting for someone to come tell you what to do.  There are patients to see, conferences to attend, rounds to do, labs to look up… the hospital never sleeps!

Practice having a balanced life.

Compassion fatigue is a constant threat to practicing physicians.  Taking care of yourself, staying connected to family, friends and the outside work are all critical components of preventing compassion fatigue.  This, too, is a skill you need to learn during your rotations so you can carry it with you into your residency and your practice.  Use this time to develop strategies for how you will eat a healthy diet, including when you are on call, and find time to develop an exercise habit.

Wear the Right Shoes

Dressing correctly is part of professionalism, but shoes deserve a special note of their own.  The hospital is not a place to worry about how your feet look.  At the end of a long day, you’ll appreciate picking the right shoes to wear in the hospital.

Enjoy!  You are finally a “real” doctor!’’

Your experiences on your clinical rotations will be among the most special of your life. Buy a new journal and take time to jot down the funny and not-so funny occurrences of daily life in the hospital.  You will see some extraordinarily beautiful moments of human life. and some horrendous examples of what people can do to other people. We all learn to deal with these extremes by telling stories.  Make sure you find the right people and the right setting, but realize that this is an important way to cope with the transition you are making.

It’s a special world you are entering.   You’ll want to remember it by taking notes, recording stories and with pictures of your team and unique sights around the hospital. (No patients, though – remember HIPPA!)  Don’t forget to record your “firsts”… the first time you set a fracture or hear a murmur of aortic stenosis will be the only “first time” you have.

Congratulations! You are well on your way to the privilege and joy of practicing medicine. Enjoy the journey!

Photo credit

Cranberry bread on Christmas morning is a special part of the holiday for my family.  This is really delicious bread and makes a great gift, too.  Enjoy!

Mix dry ingredients together in a bowl:

2 cups  flour

1 cup sugar

1/2 tsp salt

1 1/2 tsp baking powder

1/2 tsp baking soda

Combine in a Pyrex measuring cup:

2 Tblsp melted butter

Juice and grated rind of one large orange

Fill with boiling water to make 3/4 cup then add to dry ingredients

Add

1 egg

1 cup nuts (chopped walnuts)

1 cup raw cranberries (cut in half)

Bake in a 2 lb loaf pan (325° for metal pan, 300° for glass pan) for ~ 1 hour (or a muffin tin if you prefer)

Test with toothpick to know when they are done

If you want to make a larger recipe to make enough to give others, the easiest way is to multiply by 9 which gives you this ingredient list (the directions are the same as above)

1   5 lb bag  flour

1   4 lb bag sugar

1 1/2 tblsp salt

4 1/2 tblsp baking powder

1 1/2 tblsp baking soda

1 1/8 cup melted butter  (2.25 sticks)

Juice and grated rind of nine large oranges

9 egg

9 cup nuts (chopped walnuts) = 3 lbs

9 cup raw cranberries (cut in half) = 3 12 oz bags

photo credit

 Expensive – but they will be eternally thankful

• A maid or housecleaning service once a week.  No one in medical school or residency has time to clean (or likes it)!  This will be one of the most appreciated gifts you’ve ever given someone.

• A smart phone (if they don’t have one).  Not only for the usual reasons, but because of the apps available that can help students and residents.

• A new computer that really meets their needs.

• An iPad.  There are a lot of uses for the iPad in the hospital… and even more personal uses!  This is a great gift for any medical student or resident.

• A Kindle Fire.  Not as many apps for medical uses as the iPad, but a wonderful gift if they are an avid reader.

• Membership to a gym for a year.

• A new bicycle to ride to class or the hospital.

• An iPod nano or other mp3 player to listen to music while studying   Electronic speakers for their computer will also help provide music while studying.

• A good (large) computer screen for studying.  Even better – two screens (or add a second screen to their system if they already have a good screen)

Not expensive – but very appreciated

• A year’s subscription to EverNote premium (to allow them to store notes on a cloud server)

• A really good alarm clock.  This could also be an exceptional practical joke gift if you choose something like the world’s most diabolical alarm clock or the carpet alarm clock

• A gift certificate for yoga classes, spin classes or other exercise that they like.

• Exercise bands.  There are a lot of companies, but many people think Bodylastics are the best buy.

• A subscription to Pandora One to create and listen to internet radio stations without commercials.

• A gift certificate to Whole Foods (or any grocery store that makes take out food), or a healthy prepared food service.  In Houston, we have My Fit Foods, Snap Kitchen, Diet Gourmet, Real Meals 365 and several other services.  These types of businesses exist in almost every major city and can be easily found with an internet search.

• A gift card from Starbucks. Along the same idea (if they drink coffee), they might like a personal coffee maker like the Black and Decker brew and go coffee maker, or the “k-cup” brewers like Keurig or Tassimo.

• How Doctors Think, by Jerome Groopman. This is a great read for anyone in medicine, but especially for students and residents.

• Any (or all) of Atul Gawande’s books

• Cutting For Stone by Abraham Verghese

• A Crock pot (slow cooker)

• A rice maker that also steams food

• iTunes gift card

• A gift certificate for cooking classes

• A gift certificate for a masseuse or a day at a spa (even the guys will like this if you pick the right one)

Variably expensive and not too serious…

• Plush anatomy dolls? Plush microbe dolls?

• Serotonin earrings?

• Stethoscope cufflinks?

• Silly mugs, t-shirts, etc like this one

 Happy Holidays to everyone!!!

Photo credit

Every year at Thanksgiving as I mix the ingredients for this cornbread, and then make the stuffing for the turkey, I have the delight of remembering my great-grandmother.  It always leads to a sense of gratitude for her, all my ancestors and my family.

I don’t want you to just sit down at the table.
I don’t want you to just eat and be content.
I want you to walk out into the fields
Where the water is shining and the rice has risen.
I want you to stand there far from this white tablecloth.
I want you to fill your hands with mud, like a blessing.

-Mary Oliver

Mix together with a big spoon

1 cup corn meal

1/2 cup flour

1 tsp soda

1/2 tsp baking powder

1/4 tsp salt

Make a large “hole” in the middle of the dry mixture with the spoon

Beat one egg with a fork, add 1 tsp oil add into well in the middle of the dry mixture and mix with a fork

Add 1 cup of buttermilk

Let rise while heating the oven to 425 degrees (about 10 minutes)

Gently whip down with a fork

Grease a one layer cake pan, cast iron skillet or 8” square pan with butter

Bake 20 minutes

Both my Twitter account and this blog serve the same purpose – to  serve as a “tool kit” for medical students, residents and practicing docs.  But it’s really interesting how different they are in accomplishing this goal.

Twitter is the equivalent of  the “surgeon’s lounge” – comments about interesting things you’ve seen or heard, showing people something in the news, or short pieces of advice.   Writing for a blog is more like sitting down in a quiet space with a colleague to discuss a topic, work on a project or give advice.

There is one important aspect of Twitter that is particularly interesting for physicians. If there is serious breaking news, Twitter will probably hear it first.   A good example is how the CDC uses Twitter. It can also be used to update everyone in a medical school or hospital.  Another interesting use of Twitter for physicians is “tweeting” medical meetings.

There is a learning curve for all social media.  Twitter, in particular, can become a remarkable time waster with little benefit.  If you are a busy student, resident or physician and want to use Twitter efficiently, here are some ideas that might help

• A busy resident told me that he uses Twitter only for the news.  He gave up reading the newspaper and watching CNN to follow them on Twitter.  He reads the headlines and uses the link to read only the articles that interest him .

• It’s not Facebook.  Anyone who starts tweeting about where they are going to get coffee gets “unfollowed” immediately.  For busy professionals, Twitter is not the best way to connect with friends.  It is, however, a fantastic way to connect you to communities, causes, issues, etc.  The way this is done is with hashtags (markers for a common theme).   For example, people interested in medical education use #meded.

Healthcare hashtag project

Medical hashtages on hashtags.org

• It’s not email.  You don’t have to read them all.  If you have a minute, skim what’s there, but don’t worry about the rest.  Twitter is supposed to be ephemeral.

If you aren’t on Twitter and want to get started here are a few links to help: Newbies guide to Twitter from cnet.com, Twitter 101 from twitter.com, Twitter tutorial

On last (but incredibly important) thought. Using Twitter (or any social media) is different if you are in medicine. Every company has guidelines about using social media.  In medicina, we have a standard for how we can discuss what we do that is different than the rest of society.   Here’s some rules that will keep you safe.

• Do not (ever) discuss a patient, post a picture of a patient or put anything online that could identify a patient.  This is the law (HIPAA) and it is our ethical and professional obligation.

• Do not give medical advice via social media.  If you are contacted by a patient that you are really worried about, the only thing you can do is tell them which office/hospital to go to or where to call.

• Do not put negative comments about a colleague or institution on social media.  If you need to ventilate, find a friend and go out somewhere.  Think of social media as the “microphone in the elevator”.  Don’t put anything online that you wouldn’t want someone in the future to “overhear”.  Digital = permanent.

One of the best guides on the use of social media in medicine comes from Austrialia and New Zealand.  It has some very illustrative scenarios and is beautifully (and succinctly) written.  If you are in medicine and using social media, it’s well worth the time to read this document.