I Forgot To Tell You About My New Favorite Breakfast!

This morning I was lecturing to the first year medical, PA and DNP students. At the end of my embryology lecture I included some advice on how to eat well as a busy student. I talked to them about how to set a good example for their future patients, how to increase vegetables in their diet by making Mirepoix every weekend, shopping at the farmer’s market, and how to plan for the week. I also talked about why it’s important to eat breakfast. I told them about one of my favorite fast breakfasts, but forgot the second one!

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MLB BREAKFAST TACOS

Here are the ingredients:

FullSizeRenderThis batch had beans, cheese, a red bell pepper, a jalapeño and some cilantro, but you can add anything!  Spread out the tortillas and divide up the ingredients between the tortillas.

IMG_3511-1024x1016Roll them up, put them in the freezer. Two minutes in the microwave and they are ready to eat!

 

OVERNIGHT OATS

This is SO easy and really delicious.  Put ~1/3 cup rolled oats in a bowl and add twice as much (~2/3 cup) liquid. (You may need more of both depending on your caloric needs)

My favorite liquid is kefir (liquid yogurt), but it can be milk, almond milk, soy milk, etc. Leave it in the refrigerator overnight. Eat it in the morning. That’s it!

You can add any variety of fruit, nut or nut butter the evening before or in the morning. My current favorite is blueberries and slivered almonds added in the morning.

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How To Study in Medical School

Congratulations to all the first year medical students who are starting or getting ready to start medical school.  As you will soon seen, from day one there will be an overwhelming amount of information to process and learn … much more than any you have seen during college. It’s going to take a new strategy!

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Unlike college, the information you learn during your preclinical studies will be important when you take the first part of your licensure examination (Step 1) and when you start your clinical rotations in 2 years or so, and when you start your residency.

It’s not just about learning this information for your exams, it’s also about creating a system to organize this information for the future.

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What should an ideal system let you do?

  1. Hand write or type your notes
  2. Highlight and annotate notes to make them more easy to remember
  3. Import images, pdfs, powerpoint presentations or other digital information
  4. Review the notes on your phone or iPad as well as your computer
  5. Revise or reclassify notes as you learn more
  6. Make sure your notes can’t ever be lost or destroyed

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What “notes” should you use to study?

  1. Use the notes provided by your professors, usually in the form of a powerpoint presentation or pdf of the presentation. Many students download the presentations into OneNote and annotate the slides during the lecture. If you use this system, it will be very important to make a one page summary of the key points. Going back to review each slide is very time consuming and not a good “juice to squeeze ratio”. (the effort you put into it is not worth what you get out of it).
  1. Take notes in class or to review like you did in college (highlighters and all!). If you choose to do this, use the SQR3 method or the Cornell note taking method to prepare i.e. don’t come in cold to class. Write down the big topics to be covered, and come up with questions you expect to be answered in class. The key is active listening!
  1. Try mindmaps. Your brain doesn’t organize things into bullet points. If you use colors, images and this more “organic” organization, it’s amazing how much you can remember. Like mnemonics, the more outlandish the images and colors, the easier it is to remember.   You’ll find an example of a mindmap to learn about pilonidal disease below. Note, for example, that the image for obesity is a stick of butter surrounded by fat globules. It’s creating your own images that makes this so powerful. Even though you can share mindmaps, or use software to create them, it’s more effective to draw your own.
  1. Handwritten may lead to better learning…. Worth thinking about!

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How should you organize your notes?

Here’s where it gets fun. Organizing notes with Evernote is the best way I’ve found (ever) to do this.  Evernote is an app for your computer and phone/iPad that allows you to store “notes”. But, the notes can be a lot of different formats:

  1. New notes, typed directly into the software
  2. Imported notes from OneNote or a powerpoint presentation
  3. Scanned notes. Evernote has an amazing free app called Scannable that converts any document into a pdf using your phone. So. if you draw a mindmap, doodle about the anatomy of the rotator cuff or have a typed handout from someone, you can scan it into EverNote.
  4. Photos of whiteboards, paper notes, images.
  5. Videos, like your professor showing you how to examine the knee for instability.
  6. There is an Evernote “web clipper” that can be used on your computer to download any webpage.
  7. Audio notes. You can record a review for yourself and save it as a note.

 

Other advantages to using Evernote

  1. You can share notes with others
  2. You can find information by searching. Both typed and handwritten words will be recognized.
  3. When you store a link to a video it’s active, so you can click and go directly to the site.

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What should I do before I set up this system?

  • Start the notes now – even though you don’t have the system in place.  Listen actively and take notes actively. Make sure you create one page summaries of every lecture. Keep these to scan in when you start your account.
  • Download Evernote for your Life | A Practical Guide for the Use of Evernote in Your Everyday Life by Brandon Collins and read it before you create your system. This ebook is concise, easy to read and will explain why you can’t think about EverNote as a “filing” system in the usual sense.

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A few other words of advice

  • Create your Evernote account with an email address that will follow you through your training. (By the way, if your personal email now is sexyguyfromthecity@gmail.com, it’s time to get a new and more professional address!)
  • I’d create one huge notebook called “Everything I need to know to be a doctor” (just kidding.. but don’t fall into the trap of creating a lot of different notebooks, either.)
  • When you start, be very deliberate about your tags. You don’t want to end up with “Penicillin”, “penicillin” and “penicillinV” as three tags for penicillin… Decide how to standardize your tags before you start i.e. when to capitalize, generic names of drugs only, etc.
  • Evernote is not HIPPA compliant.  Don’t EVER put any patient information (including photos) that could be identified.
  • Go ahead and spend the money for Evernote premium. You’ll be using all the storage and the bells and whistles.

Lamentation for the Lost

Like so many others, I can’t believe the hatred and evil that has manifested itself in Orlando, Louisiana, Minnesota, Dallas, Nice and Baton Rouge.  I grieve with the families and friends of those who lost their lives. I embrace those who are devoting themselves to healing this hatred and the wounds it has caused.

As someone who teaches embryology I can tell you that all of us – no matter what race, religion, sexual orientation, or gender are fearfully and wonderfully made. We all start as one cell and become human beings through an amazing dance of cells that become eyes to see, hearts to beat, arms to hold and brains to understand and love. There are no differences between us until we are born and labels are applied.

As a surgeon, I can tell you that all blood is red.  I also can assure you that all hearts break equally when faced with hatred, loss or grief …. and all souls soar with birth, healing and love.

May we all become healers in this time of sorrow.

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My New Favorite Recipe – Quiche With a Healthy Crust!

It’s not often I share a single recipe, but this one is so delicious, so healthy and so easy that it warrants a separate post.

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Although the recipe as written has spinach filling, you can use other fillings. Just to give you a few ideas…

  • Sausage (regular or vegetarian), bottled red peppers, cheddar cheese
  • Canned artichoke hearts with parmesan cheese
  • Ham with Swiss cheese
  • Fresh tomatoes, mozzarella and basil
  • Any leftover veggies and/or meat in your refrigerator

This “quiche” makes a great dinner, but can also be put in your bag for breakfast or lunch for a busy day or call night. Quiche freezes well, so you can make several, freeze them and have breakfast/lunch/dinner for days!

 

What Big Magic Can Teach Those Who Serve

“Do what you love to do, and do it with both seriousness and lightness.”*

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On the flight home yesterday I finished Big Magic: Creative Living Beyond Fear by Elizabeth Gilbert (She’s probably known to you for her NY Times Best Seller Eat, Pray, Love). For me, one of the overarching messages of her book was this – When you see what you do as your vocation (from Latin vocātiō, meaning “a call or summons”), and not just your job, it will transform how you view your work – a concept which I believe may be necessary (but not sufficient) to treat or prevent burnout.

As I read her thoughts on how to live a creative life, I realized that there were other ideas  that applied to physicians, physicians in training and others who serve:

 

Just show up. Every day.

“Most of my writing life consists of nothing more than unglamorous, disciplined labor. I sit at my desk and I work like a farmer, and that’s how it gets done. Most of it is not fairy dust in the least”

Learning and practicing medicine (or any other field) means showing up – really showing up – every day. Everyone in the first year of medical school learns that it is different than college. Cramming for exams is not only ineffective, it’s just wrong. You are no longer studying for a grade on a test…. it’s now about the patients you will take care of in the future. The same holds true during residency and when you begin your practice. It’s not just when you are a trainee.  Part of the “work” of medicine remains “unglamorous, disciplined labor”… keeping up with the literature, going to teaching conferences when you could be doing something else, finishing your hospital charts, being on call.

But the work of medicine is also about showing up every day in another sense, too – truly showing up for the people who rely on you – no matter what. That, too, can be “unglamorous, disciplined labor” when you are tired or stressed.

“Work with all your heart, because—I promise—if you show up for your work day after day after day after day, you just might get lucky enough some random morning to burst right into bloom.”

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They are your patients… from the first day of medical school until you retire.

Most of all, there is this truth: No matter how great your teachers may be, and no matter how esteemed your academy’s reputation, eventually you will have to do the work by yourself. Eventually, the teachers won’t be there anymore. The walls of the school will fall away, and you’ll be on your own. The hours that you will then put into practice, study, auditions, and creation will be entirely up to you. The sooner and more passionately you get married to this idea—that it is ultimately entirely up to you—the better off you’ll be.”

Caring for others gives us joy but also gives us the responsibility to know the best thing to do for them. Whether you are a first year student, 3rd year resident or a PGY35 attending, we are all still learning. “Life long learning” is not just a phrase, it’s the reality of what we do.

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It’s called the practice of medicine for a reason.

“It’s a simple and generous rule of life that whatever you practice, you will improve at.”

Learn the art of deliberate practice early. Deliberate practice, to use a musical analogy I learned in Cal Newton’s fantastic book So Good They Can’t Ignore You: Why Skills Trump Passion in the Quest for Work You Love, doesn’t mean playing the piece from start to finish 20 times in an hour. It means spending 55 minutes on the small section that you struggle with, repeating it 100 times before you play the piece through once. It means instead of reading the comfortable material on the anatomy of the kidney, you deliberately tackle how the nephron works. It means that instead of doing the computer-simulated cholecystectomy 10 times you spend an hour tying intracorporeal knots in the trainer. Find the thing that is not easy and practice it over and over until it becomes easy.

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There is Peril in Perfectionism

“There are only so many hours in a day, after all. There are only so many days in a year, only so many years in a life. You do what you can do, as competently as possible within a reasonable time frame, and then you let it go.”

One of the greatest attributes of those who care for others is their devotion to the people they serve. But perfectionism, taken to its extreme, is dangerous. Extending your time to study for Step 1 beyond what is reasonable to try to get a higher score, revisiting decisions about patient care to the point of anxiety, worrying that your GPA has to be perfect are all counterproductive. The motivation to do well is like a cardiac sarcomere – a little worry will make you more effective, but stretched too far, there won’t be any output at all.

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Curiosity can overcome fear.

“No, when I refer to “creative living,” I am speaking more broadly. I’m talking about living a life that is driven more strongly by curiosity than by fear.”

It’s something most students don’t realize, but no matter how long you practice medicine, there are days when you are afraid. It takes courage to do what we do. Remember, being courageous is not an absence of fear, it’s being able to do what’s right despite the fear. I agree complete with Elizabeth Gilbert that curiosity helps. When you have something that doesn’t go the way you expect or frightens you, instead of beating yourself up (“I should have studied more”….”I could have made a different decision”…etc…etc) become curious. If you are thinking about a complication, commit to finding everything you can about the procedure and how to prevent complications. If you didn’t do as well on your test as you thought you should, look up different techniques to study, take notes, and remember information, and go back to make sure you really understood what was being tested.

Even more powerful than curiosity is gratitude. Fear and gratitude cannot exist at the same moment. Try it – the next time you are about to snap because your EMR freezes be grateful that you can see the computer, be grateful you have work, be grateful you have been trained to help other human beings …and see what happens.

“We must have the stubbornness to accept our gladness in the ruthless furnace of this world.”

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Your worth is not the same as your “success”.

“You can measure your worth by your dedication to your path, not by your successes or failures.”

Wow…. This one is so important.

It’s not what you make on Step 1. It’s not how many cases you do, how many patients you see or how much money you make. This concept is taught by every religion and philosopher I know – for a reason. Be devoted to doing the best you can and to forgiving yourself (and learning from it) when you fall short.

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One last thing….for medical students trying to choose a specialty – forget about finding your passion.

This is a little longer quote than the others, and mirrors a similar message in So Good They Can’t Ignore You: Why Skills Trump Passion in the Quest for Work You Love .

Find something, even a little tiny thing, that makes you curious (or fills you with wonder) and follow it. Dedicate yourself to following that curiosity and it will likely lead you to your career.

“May I also urge you to forget about passion? Perhaps you are surprised to hear this from me, but I am somewhat against passion. Or at least, I am against the preaching of passion. I don’t believe in telling people, “All you need to do is to follow your passion, and everything will be fine.” I think this can be an unhelpful and even cruel suggestion at times. First of all, it can be an unnecessary piece of advice, because if someone has a clear passion, odds are they’re already following it and they don’t need anyone to tell them to pursue it…..I believe that curiosity is the secret. Curiosity is the truth and the way of creative living. Curiosity is the alpha and the omega, the beginning and the end. Furthermore, curiosity is accessible to everyone…..In fact, curiosity only ever asks one simple question: “Is there anything you’re interested in?” Anything? Even a tiny bit? No matter how mundane or small?….But in that moment, if you can pause and identify even one tiny speck of interest in something, then curiosity will ask you to turn your head a quarter of an inch and look at the thing a wee bit closer. Do it. It’s a clue. It might seem like nothing, but it’s a clue. Follow that clue. Trust it. See where curiosity will lead you next. Then follow the next clue, and the next, and the next. Remember, it doesn’t have to be a voice in the desert; it’s just a harmless little scavenger hunt. Following that scavenger hunt of curiosity can lead you to amazing, unexpected places. It may even eventually lead you to your passion—albeit through a strange, untraceable passageway of back alleys, underground caves, and secret doors.

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*Italics are quotes from Big Magic: Creative Living Beyond Fear. Since I read this on my Kindle, I don’t have page numbers!

 

 

Residency Applications: The Curriculum Vitae

Other than the personal statement, there is nothing more distressing to medical students applying for a residency than putting together a Curriculum Vitae (CV).

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So, what exactly is a CV?

 “The original Latin meaning of curriculum was a course, but of the kind that one runs around (it came from currere, to run).   Even more recent — dating from 1902 — is curriculum vitae, literally “the course of one’s life” (from World Wide Words)

Your curriculum vitae is a document that serves as a summary of what you have accomplished as a professional.

 

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What’s the difference between my CV and what I put on my ERAS application?

Your CV and what you put in ERAS differ in two important ways – the content and the format. ERAS will generate a CV from the information you enter, but it’s not in a format that is usually used for a professional CV.  In addition, the ERAS generated CV will not have the same information you will want on your CV.  For example, ERAS “experiences” don’t translate well into a professional CV.

 

Why do I need a CV in addition to what I put into ERAS?

  • You will need to give your CV to any faculty writing a letter of recommendation.
  • You may be asked to send a CV when applying for away electives.
  • It’s a good idea to take your CV with you on interviews to provide a copy to the program, especially if you have updated it since your application was submitted.
  • If and when you send emails to programs after you interview, it’s a good idea to attach your CV if it has changed at all. Bcc yourself when you do – if there is a problem with the email or the attachment, you’ll know it quickly.

 

What do I need to include in my CV and what should it look like?

There is no absolute “standard” format for a CV, both in content and in style, but there are some guidelines. In general, in addition to the “heading” with your name and contact information, the following sections (if they apply to you) should be included in the order they are listed.

  • Education (degrees, institutions)
  • +/- Place of Birth
  • +/- Citizenship
  • +/- Languages
  • Military service
  • Work experience (this is not summer jobs unless the pertain to your application i.e. don’t list being a waiter, etc!)
  • Volunteer experience (make sure it’s significant. There is no advantage to listing 20 things that all lasted a week or two …. again, unless it’s specifically related to your application… see “don’t pad your CV” below)
  • Other training (eg BLS, ACLS, special courses to learn a skill)
  • Professional memberships (including leadership positions, committees)
  • Honors and awards
  • Publications
  • Presentations
  • +/- Personal interests (drop after you match if you include it)

 

It’s a good idea to show your CV to mentors in your specialty to get their feedback since there can be subtle differences in CVs between specialties.

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What should I do to avoid common mistakes in creating my CV?

  • Pick one font and stick with it. (11 or 12 font and something really standard).
  • List items in each section in reverse chronology (most recent first)
  • Number your publications and presentations.
  • Leave plenty of “white space”
  • Don’t “pad” your CV with trivial events or accomplishments – it’s more important it’s accurate and appropriate than long.
  • Go ahead and list “hobbies and interests” as your last topic for the residency application, but remove it as soon as you match.
  • Double (no, triple) check spelling and formatting. Your CV is often the first impression a program will have.
  • NEVER put any designs, photos or logos on your CV.
  • If you put your personal email address, make sure it’s a professional email address. If it’s not, it’s time to get a new one.
  • Don’t EVER lie or exaggerate.

 

Where can I find examples or templates for my CV?

Many medical schools have examples on line and all schools have help in the Office of Student Affairs or through other faculty mentoring programs.  You can also sign into Careers in Medicine to see examples of CVs, which are also here.

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 What should I do with my CV after I match?

Remember, your curriculum vitae is a record your professional life… so it’s a “living” document that will need to be updated as new things happen. There is no one else who will every know exactly what you do and what’s really important more than you will. Keep a list somewhere of everything new that should go on your CV and sit down at least every month or so to review and update your CV. After residency when you “graduate” to having an assistant of your own, it’s still probably better to update your CV yourself. The AAMC provides a good example of a typical Faculty CV here which gives you an idea of what your future CV will look like!

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Overwhelmed by Email

“Email is both a miracle and a curse. At no other time in human history have we been able to exchange messages instantly globally; but at the same time, our ancestors didn’t spend hours each day sifting through memos, missives and newsletters we probably should just unsubscribe from.” Kadhim Shubber

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In the last few weeks, I have spent time counseling colleagues who had real issues after missing one or more critical emails.   I totally understand why… the volume of emails, and particularly of spam we all get is totally out of control. But the volume doesn’t really matter when you miss a critical deadline or, in the case of some medical students this year, an offer for a residency interview.

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Young man receiving tons of messages on laptop

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The key is to have a system – and to change the way you look at email. 

When you open an email message you only have three options and one of them is not to keep it in your inbox! Don’t use your inbox as a “to do” list – the emails will stack up and it becomes unmanageable.  The simple way to avoid this is to open each email message and immediately do one of three things:

  1. Delete it
  2. Answer it
  3. Create a task

Other important things to know about deleting (or not deleting)

Microsoft has recently introduced a new function for Outlook called Clutter.  It’s a good thing – as long as you know it is there and how it works!  In a nutshell, this function uses your behavior to decide if you want to see the email or if the email should automatically be sent to the “clutter” folder.  Beware – you need to either check the folder or disable this function, particularly at first.

The two other critical tools to help “debride” your email are to unsubscribe to emails you really don’t want to see, or block the sender (for true spam).  For other great tips, check out How to control your inbox from lifehacker.com and these tips from The Observer

Create a task? I am a big fan of Remember the Milk, but there are many other “to do” programs out there that would work, too. When I get an email that I need to turn into a task I send it to the “inbox” of my Remember The Milk account. Once it’s there, you then

  • Put it in a list (the four lists in my account are “Today”, “This week”, “Projects” and “Ideas”, but you can create any lists you want)
  • Give it a priority
  • Give it a due date
  • Set a reminder (if you need to)

Check your list! However you choose to make your task list, check it every evening to organize the next day’s tasks. This is critical to making this work. Don’t list 20 things either. Be realistic and put the top 3-5 things on this list!

Check your email! Check your email at least once a day, but not all the time… and NOT at your most mentally active time! For most people that means checking email in the afternoon or evening.

Change your mindset. Email is how professionals communicate, so we all have to learn how to handle our inbox without becoming frustrated or angry.

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I learned a very valuable approach from a friend one day when we were talking about email. I said there were times I just dreaded sitting down … and even got angry because of the volume of emails I have to answer. Her solution? Turn answering email into an exercise of gratitude. Be grateful that you have hands to type, eyes to see the screen, and the privilege of work..  As simple and potentially silly as this seems, it is a powerful tool to change how you look at answering emails. (p.s. it also works for the EMR!)

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