Starting medical school is one of the most exciting moments in a physicians career… but it can be a little daunting! This talk is one I gave recently to the college students in the Baylor College of Medicine Summer Surgery Program. In addition to talking about how medical school is different from college, I also included my top 10 tips for successfully making this important transition.
The “clean slate” of a new year almost always leads us to think of resolutions … things we could change to make our lives better. This is a great time for reflection to realize what you have accomplished, where you’d like to be in a year, and what changes you need to arrive at that goal. I just finished reading Making Habits, Breaking Habits: Why We Do Things, Why We Don’t, and How to Make Any Change Stick by Jeremy Dean which provided some useful ideas about making resolutions.
Know why you want to make the change
“There has to be an ultimate goal that is really worth achieving or the habit will be almost impossible to ingrain.” Jeremy Dean
Let’s take one example – losing weight. It’s fine to say you want to lose weight… but why? Wanting to fit into your clothes is not a trivial reason, but will it really motivate you when it gets tough as much as these?
- Being able to “walk the walk” when you talk to patients about losing weight
- Reduction in your risk for diabetes, heart disease, cancer and a variety of other health problems
- More energy, better mood, less pain…
What’s important is that you find reasons that resonate for you. Do a little research and write down why you want to make the change. Plan to review this, and revise it when needed, on a regular basis.
Make the resolution then make a plan.
To continue the losing weight example, what are the specific new habits you want to develop? Are they “SMART” changes? (Specific, Measurable, Attainable, Realistic and Time-Based). For example…
- I will eat 8 servings of fruits and vegetables every day.
- I will set the alarm clock 15 minutes early to do push-ups, crunches and squats before I go to the hospital.
- I will plan my meals and shop once a week so I can take healthy food with me to work.
- I will schedule my workouts every weekend so I can attend at least two spin classes a week.
- I will cook one healthy dish on the weekend that I can eat for at least 4 meals during the week
Develop the “what if” plan.
The next step is to imagine all the things that might derail you and write down a specific plan for each of them. This will be an ongoing process… as you come up with new excuses to not follow through with your new habit, add it to the list.
Back to the example of losing weight….
- If I forget to bring fruit/veggies with me to work, I will go to the cafeteria or lounge to get at least 2 servings to eat at work.
- If I walk by MacDonald’s and feel drawn in by the smell of the fries, I will remember that I’m trying to set a good example for my patients
- If I hit snooze on my alarm clock, I will move it across the room.
- If I think I’m too tired to go shopping for the week, I will remember that this is the key to having healthy food at work.
“Making healthy habits should be a voyage of discovery.” Jeremy Dean
Self-monitoring is critically important to maintaining a new habit. It doesn’t matter if you use an app like My Fitness Pal, a calendar, a spreadsheet or a system like the Bullet Journal… stay accountable by keeping track.
As the habit becomes engrained, change it a little to keep it interesting.
Working out with exactly the same routine quickly becomes boring. It’s one of the reasons people love group classes like spin classes – the instructors are always changing the routine. Be mindful and creative… but stay out of ruts!
“Making or breaking a habit is really just the start. To develop a truly fulfilling and satisfying happy habit, it’s about more than just repetition and maintenance; it’s about finding ways to continually adjust and tweak habits to keep them new; to avoid mind wandering and the less pleasurable emotional states that accompany it. There is great enjoyment to be had in these small changes to routines. When life is the same every day, it gets boring.” Jeremy Deans
Looking for inspiration? Here’s a list of New Year’s Resolutions for medical students, residents and busy docs. Pick 1 or 2 and start working on your plan, your what-ifs and how you will monitor them!
- Learn to meditate and spend at least 10 minutes every day meditating with HeadSpace. (Here’s the TED talk that introduced me to this great app.)
- Eat fruits and veggies with every meal.
- Walk 10,000 steps per day.
- Take the stairs instead of the elevators.
- Learn the names of all the people you work with… the guy who mops the floor, the clerk at the desk, the person who works in the blood bank.
- Write down three things you are grateful for every night before you go to bed.
- Log all cases (if this applies to you) the same day and finish medical records within 24 hours.
- Use a system like the Bullet Journal or Remember The Milk to become more organized and never miss a deadline (including the birthdays of your family and friends)
- Cook your own meals at home (take a class if you need to).
- Be on time to conferences, rounding, meetings, classes, etc.
- Spend at least half a day a week “unplugged” and use it to play.
- Keep a journal to remember the important events of the day, vent about things that upset you, and make plans for the future.
- Read something that is not medical every day.
- Stop eating fast food.
- Drink less alcohol or stop all together.
- Get at least 7 hours of sleep any night you are not on call. (and have a plan post call to sleep more)
- Cut out all added sugar.
- Drink more water.
- Keep your house neater… or at least a part of your house!
- Stop texting while driving.
- Learn about motivational interviewing to help your patients.
- Read a major textbook in your field in one year.
- Learn something new from every patient you see
- Try a new way to exercise every month
- Set your intention for the day every morning.
- Eat breakfast every morning.
- Set limits on checking email, Facebook, Twitter, Instagram and other social media sites.
- Practice mindfulness.
- Plan your meals for the week on the weekend to make sure you have great food on call and at work.
- If you have to sit a lot at work, come up with a plan to not be so sedentary.
It’s the holiday season in a very short time, so I thought I’d put together a list of last minute presents! These are presents that would work for anyone, but are particularly suited for medical students, residents and busy physicians.
A really good water bottle
None of us drink enough water at work …. having a water bottle does help! There are many out there but make sure the one you choose doesn’t have BPA in it. Glass and steel bottles are probably the safest, but BPA free plastic bottles are fine, too. As an added bonus, you can put something in the bottle before you wrap it… chocolates or another favorite candy, gift cards to Starbucks, etc.
Listening to music you like without commercials is a great gift for listening while studying, in the clinic or in team rooms. Pandora can be played on any computer but also has apps for mobile devices. There are other sites, too, but this one is my personal favorite.
I am a total fan of my new iPad Pro, which has taken over as my computer on a lot of days. Because of it’s amazing power, there are medical apps, like this anatomy app that won’t run on other iPads. But the iPad mini may be a better choice for students and residents …. mostly because it fits in the pocket of a white coat. Make sure you get a cellular network plan with the wireless option, if this is the gift you choose.
Anatomy Coloring Book
This is a great combination of the proven stress relief of adult coloring books and learning anatomy. (or reviewing it, even for docs in practice) Don’t forget to order the pencils, too!
Electric Pressure Cooker
Pressure cookers in general are an amazing kitchen tool… but the modern electric pressure cooker is also a rice cooker, slow cooker, steamer which makes it the single best kitchen appliance for students and residents.
Prepped meals (ready to cook)
If they like to cook, but don’t have the time to find the healthy recipes and prep the meal, this is a great idea. Check out Green Chef, Blue Apron, and Hello Fresh as examples. You might want to search locally to see if there others close to you.
A gift card to get them started with Stitch Fix
Stitch Fix is perfect for both men and women that either a) hate to shop for clothes or b) love to shop for clothes but don’t have time. It’s a service many of my friends use and love, so I can personally recommend it. After you sign up, they send 5 items a month (or at whatever cadence you want). You send back the ones you don’t want and get billed for the ones you keep.
A membership to a local museum
If there are museums in the area that correspond to an interest this could be a great gift. Museums like the Houston Museum of Natural Sciences, the Museum of Modern Art in New York, etc. are a great way to enjoy time off. Include a note that says you are giving this to them as a break from their studying or work!
Best wishes for a joyous holiday season, peace in your lives and on earth and a New Year filled with health, happiness and joy!
This is a truly wonderful piece from Emily Gibson, re-posted here with her permission from her beautiful blog, Barnstorming. Enjoy!
As we drown in the overwhelm of modern day health care duties, most physicians I know, including myself, fail to follow their own advice. Far too many of us have become overly tired, irritable and resentful about our workload. It is difficult to look forward to the dawn of the next work day.
Medical journals and blogs label this as “physician burnout” but the reality is very few of us are so fried we want to abandon practicing medicine. Instead, we are weary of being distracted by irrelevant busy work from what we spent long years training to do: helping people get well, stay well and be well, and when the time comes, die well.
Instead, we are busy documenting-documenting-documenting for the benefit of insurance companies and to satisfy state and federal government regulations. Very little of this has anything to do with the well-being of the patient and only serves to lengthen our work days — interminably.
Today I decided to take a rare mid-week day off at home to consider the advice we physicians all know but don’t always allow ourselves to follow:
Sleep. Plenty. Weekend and days-off naps are not only permitted but required. It’s one thing you can’t delegate someone else to do for you. It’s restorative, and it’s necessary.
Don’t skip meals because you are too busy to chew. Ever. Especially if there is family involved.
Drink water throughout the work day.
Go to the bathroom when it is time to go and not four or even eight hours later.
Nurture the people (and other breathing beings) who love and care for you because you will need them when things get rough.
Exercise whenever possible. Take the stairs. Park on the far side of the lot. Dance on the way to the next exam room.
Believe in something more infinite than you are as you are absolutely finite and need to remember your limits.
Weep if you need to, even in front of others. Holding it in hurts more.
Time off is sacred. When not on call, don’t take calls except from family and friends. No exceptions.
Learn how to say no gracefully and gratefully — try “not now but maybe sometime in the future and thanks for thinking of me.”
Celebrate being unscheduled and unplanned when not scheduled and planned.
Get away. Far away. Whenever possible. The backyard counts.
Connect regularly with people and activities that have absolutely nothing to do with medicine and health care.
Cherish co-workers, mentors, coaches and teachers that can help you grow and refine your profession and your person.
Start your work day on time. End your work day a little before you think you ought to.
Smile at people who are not expecting it, especially your co-workers. Smile at people who you don’t think warrant it. If you can’t get your lips to smile, smile with your eyes.
Take a day off from caring for others to care for yourself. Even a hug from yourself counts as a hug.
Practice gratitude daily. Doctoring is the best work there is anywhere and be blessed by it even on the days you prefer to forget.
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.
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!
It’s hard for those that haven’t been there to understand how medical school, residency and/or long hours in the hospital changes what and how we eat. There isn’t time to sit down to eat, there aren’t good choices and often, the only thing to eat is the “free” food at conferences. But…. Free food isn’t free. There’s a reason it’s cheap (poor ingredients) and that it “tastes good” (lots of fat, sugar and salt)… but it makes us feel terrible after we eat it. (Beware the middle of the night french fries!) More importantly, we aren’t providing the nutrients we need to take care of other people and ourselves. So, what’s the answer?
Spend the money and the time to invest in your health! Grabbing donuts or bagels in the surgeons’ lounge in the morning, pizza at noon-day conference and a hamburger at MacDonald’s in the middle of the night is terrible. (You know it’s true).
So what’s the alternative? Here’s a five-step, easy plan that will let you eat better, feel better and avoid gaining weight in medical school and residency. This is predicated on cooking your own food but you can use this plan if you don’t cook by buying prepackaged foods. But really…. If you can learn how to take out a gallbladder or care for ill patients in the ICU don’t you think you can learn how to sauté a few vegetables???
- Make a plan
- Make a shopping list
- Shop once for the week and (when you can) prep ahead
- Use your day(s) off to cook things that might take a bit more time and freeze some for other days
- Keep a few “instant” healthy meals in your pantry
Make a plan
Map out your week’s meals and snacks using the “pizza rule” (nothing you cook should take longer to cook than it takes to order a pizza). Pay special attention to call days. It’s important to have really delicious food which can be grabbed in a minute when you are on call. I use Evernote to make my list for the week so I can share it with my family:
If you like to cook, you probably already know where to find recipes you’ll like. If you don’t cook regularly, I post recipes on @drmlb with #CallFood that meet the “pizza rule” and would be delicious on call. Here are few other sites I use regularly: Eating Well, Cooking LIght, My Recipes, Food Network, Kayln’s Kitchen, Skinny Taste. If you use Evernote to organize your list, it gives you one other advantage – you can download their add-on and clip recipes from the internet directly to Evernote. Each “note” (i.e. recipe) in Evernote can then be shared with whoever you cook with (i.e. whoever gets home first can start dinner!). It also lets you search all your notes so you can easily find your recipes in the future.
Make a shopping list
I use Grocery IQ for my shopping list. This app lets you organize your grocery list by the aisles in your favorite stores to make shopping faster. It also allows you to share the list with your significant other which means that whoever is able to get to the store first has the updated shopping list! I don’t really use the “coupon” feature or the barcode scanner, but if you choose to use these functions, please use the FoodEducate app with it to make sure your choices are healthy!
Shop once and (when you can) prep ahead
Planning lets you spend less time in the grocery store and absolutely means less food wasted. When you get home from the store think about the meals you are going to cook later in the week. If your carrot soup on Tuesday calls for sliced carrots, diced fennel and chopped onions, chop them when you get back from the store on Sunday and put your “mise en place” in baggies or containers in the refrigerator. Cooking is not that time consuming…. but prepping is!
One other good trick is to make “mirepoix” on the weekend for the week. Diced onions, carrots, celery, bell peppers, etc can be prepped and put in a bag. It can be an instant stir-fry on nights when you need something fast. You can also put a handful in soups, omelettes, or wraps to get extra vegetables in your day. Mix it with leftover rice or other grains to make an instant salad (you can add tuna, if you want, too).
Use your day(s) off to cook things that might take a bit more time and freeze some for other days.
You need good “comfort food” when you are working hard, but it can be both comforting and healthy. For example, this recipe for spaghetti squash lasagna. The preparation for this recipe isn’t that hard (you can steam the spaghetti squash in the microwave instead of roasting it in the oven, for example) but it’s a little too long for nights when you get home late and are really tired.
Learning to use a pressure cooker (my favorite) or a slow cooker like a crock pot is a great way to cook up a batch of something when you are home and doing other things without spending a large amount of time in the kitchen
No matter what you make or how you make it, make enough to freeze individual portions and then store them so they will stay fresh. Don’t forget to mark the containers with a Sharpie and eat them within 3-4 months!
Keep a few “instant” healthy meals in your pantry
Despite my best efforts to plan, there are weeks when I’ve miscalculated amounts, don’t have enough time or just don’t want to eat what I had planned. When that happens, it’s great to have a go-to “instant” meal, which usually comes out of the freezer and pantry. Here are some to get your list started!
Moroccan Lentil Stew – (particulary good with harissa and served over couscous)
The holiday season is rapidly approaching. Here’s my top ten gifts for medical students, residents and physicians…. or any busy friend!
- Mark Bittman’s new book How To Cook Everything Fast.
This is an amazing cookbook and it is perfect for busy people. The recipes are interesting, delicious and healthy. The instructions are easy for a novice without being simplistic and the layout of the book in innovative and makes it really easy to use.
- An electric pressure cooker.
Slow cookers are often suggested for medical students and residents but I don’t think they are as good as a pressure cooker. You have to be there when slow cookers are (slowly) cooking, which is usually your rare day off. Also, it’s hard to cook vegetables in a slow cooker. Pressure cookers on the other hand cook broccoli in 2 minutes (perfectly!). I’ve been told that the electric pressure cookers take a little longer to come up to pressure, but it seems a small downside for a device that also lets you slow cook, steam, sauté, and cook rice.
- Coffee or Tea
There are several options to consider if they are a serious coffee or tea drinker. A Starbucks or Teavana gift card in a cute “medical” coffee mug? A Starbucks Verismo coffee brewer? Nespresso? Keurig?
- A FitBit
Anyone in medicine loves gadgets and loves data. The fitbit has become a socially acceptable piece of “jewelry” in the hospital and it unquestionably changes behavior to increase activity. Having washed three of the “clip on” Fitbits with my scrubs, I would recommend one of the wristband Fitbits!
- A maid or housecleaning service
Doing housework has to be on everyone’s lowest list of fun things to do on your day off, but it’s especially true for people who are studying extensively or taking call in the hospital. My parents helped finance someone to come occasionally to help clean my apartment when I was an intern. It was without a doubt the best present I’ve ever received.
- Anything that helps make it easy to get more exercise
Another great gift is anything that will promote more exercise… a bicycle to commute to school or work? Yoga classes? Spin classes? A gift certificate for new running shoes? Resistance bands for the call room? A membership to a YMCA or a gym close to where they live? Certificates for post workout massages?
- “Date night” packages
Whether they are single or have a significant other, being able to socialize is an important part of stress reduction for busy people. Create combinations of gift cards to movie theaters and restaurants to support “date nights”. If they love art, music, or sports think of season tickets (or ticket packages) to museums, music venues or professional sport teams.
- An “over the top” alarm clock
It’s not easy getting up at “dark thirty” to make it to rounds, but being on time is important. The snooze button is not a good idea… but it’s so easy to hit. This alarm clock is my personal favorite to make sure you get out of bed. After a few hits of the snooze button, it rolls off the table and around the room until you turn it off!
- Great books by, for and about doctors.
If they are a serious reader, think about a Kindle (or other eReader). The Kindle paperwhite is small, lightweight, back lit and has a great battery life – which makes it great for the occasional times on call that you can find 30 minutes to escape into a good book. You can also read it outside in bright sunlight (unlike tablets like the iPad) On my list of great reads for doctors (in no particular order)…
- The always appropriate gift of money
If you are going to give gift certificates or money, “package” it with some humor (in a pill bottle with a “prescription”) or a context (this is to help you buy good food for times you are too busy).
Please let me know (comment or email) anything else to add to this list! Happy Holidays to all!
I’m always looking for websites with great recipes that meet the “pizza rule” for medical students, residents and busy docs. (Food that takes take less time to prepare than it does to order a pizza).
Naturally Ella is a website by Erin, who “grew up on fast food” but, along with her family, made significant changes when her father had a heart attack at age 45. Her blog has healthy vegetarian recipes that are easy to prepare and make great #callfood*. Even if you aren’t a vegetarian, these recipes will convince you to join the Meatless Monday movement!
*Search for #callfood on Twitter for other “pizza rule” recipes that are great to take to the hospital for call!
The senior class ends their formal education at Baylor with a capstone course called “APEX”. In addition to reviewing critical medical information, communication skills and other important aspects of becoming an intern, there are also wonderful lectures from faculty on “how to be an intern”.
One of the APEX speakers this year was Dr. Sally Raty, who stressed how important it was to take time to care for yourself.. but that you had to look for efficient ways to do it! She promised to share recipes that are easy and take very little time to cook. I’ll share the rest of the recipes on future posts… but here is the first one (which she adapted from this recipe).
These bars have a ton of ingredients, but they are easy to find, and this bar is way better for you than those processed, chemical blobs you’re spending $2+ on. I keep all of the dry ingredients for these bars in a basket in my pantry. I just pull the basket out and make the bars. The crumbs are amazing on vanilla ice cream….not that I would ever do that, but I’ve heard it is good.
3 cups raw oats (nothing fancy. Quaker 3 minute (not instant) oats are fine)
1/2 cup whole sesame seeds, or shelled sunflower seeds
1/2 cup shredded coconut (unsweetened is best, but sweetened is easier to find)
1 teaspoon ground cinnamon
1 teaspoon salt
1/4 cup brown sugar
1 cup vanilla Greek yogurt
1/4 cup + 2 tablespoons pure maple syrup or honey
1 cup peanut or almond butter
1 teaspoon vanilla extract
1/4 cup coconut oil, liquefied if solid (or just use canola oil)
1/2 cup chopped chocolate chips (> or = 70% cacao is best)
1/2 cup chopped nuts (almonds, walnuts or pecans)
1/2 cup chopped dates, raisins, figs or other dried fruit–optional (I don’t typically add these)
1 cup vanilla or chocolate whey protein powder– Garden of Life Raw Protein is a good one and is available at Whole Foods Market
½ cup egg whites (or add a 3rd egg)
Heat oven to 350F. Spray an 11 X 7 inch glass baking dish with nonstick stuff. Throw everything in a big bowl. Mix well with your hands. Place in the baking dish, press into the pan to eliminate bubbles and try to get it level. Cook for about 20-25 minutes. Let cool completely to room temp. Refrigerate for a few hours before cutting into bars. Cut into about 48 bars. Refrigerate the cut bars.
Like our residents (but not nearly as frequently), my group has started taking “in house” call. For every one who is currently or has been a resident, this is an experience we all know…. and one that’s hard to describe to those that haven’t experienced it. Spending 24 hours on call in the hospital can be emotionally and physically draining, but it has moments that make it a special experience, too.
There are ways to make the experience easier. Here are my top 10 ways to survive (and maybe even enjoy) being on call:
1. Drink water. Put a water bottle in the lounge refrigerator, drink from every water fountain, put your water bottle next to your computer, or come up with other ways to stay hydrated. If you want more flavor, bring a zip-lock with cut up lemons or limes to put in your water or add a splash of fruit juice.
2. Be kind. No matter how stressed or busy you are, knock on every patient’s door and enter their room with the intention to help. Sit down or put a hand on their arm when you are talking to them. Smile.
3. Take breaks. On purpose. No one really expects you to work non-stop for 24 hours and it’s not good for your patients. Deliberately stop to do something else every few hours, even if it’s just for 5 minutes. Go outside for a few minutes for a short walk to catch some natural light and breathe some fresh air. Get a good cup of coffee or tea, listen to some music or just sit. If you want something more active, climb a few flights of stairs, stretch, or even do a light workout.
4. Eat well and eat often. Do not rely on fast food or the hospital cafeteria. By far the best plan is to bring really good food from home. You need to have “comfort” food on call. If you don’t cook, buy really good prepared food that you can look forward to. Make sure you have “plan B” ready if your call day gets completely out of control by having an energy bar (my favorite is Kind bars), peanut butter sandwich or other “quick” food in your white coat pocket.
5. Be part of the team. Notice and encourage the unique camaraderie you share with everyone else who is on call. It’s a small “band of brothers” who find themselves in the hospital at 3am. Be kind to each other, help each other, and use this unique opportunity to get to know someone you might otherwise not get to know.
6. Wear good shoes. If you are in house for 24 hours, bring a second pair that’s completely different (clogs and running shoes for example). Ditto socks. Buy really good socks and change them after 12 hours if you can.
7. Use caffeine wisely. It’s practically essential for many of us at the beginning of the day, but beware trying to “wake up” with caffeine after 2pm. Not to mention that if you “caffeinate” all night, you’ll have that sickly post-call-too-much-caffeine feeling in the morning.
8. Take naps. Any sleep is good sleep on call. If it’s possible, 20 minutes will make you more alert and effective in your work.
9. Make your beeper a “Zen bell”. Use your pager or phone as a tool for mindfulness. When it goes off, take a deep breath, relax the muscles in your face and shoulders and be present. This is a proven practice to decrease stress – try it, it works!
10. Learn. Take advantage of the unique educational opportunity of being on call. The fact that there are fewer people around at night and on the weekends has a real impact on how and what you learn on call. If you are a student or junior resident, you are more likely to be the first person evaluating new consults and admissions. You are also more likely to have one on one time with your senior resident or faculty as you care for patients together. If you are further along in your training, the “down time” on call (if there is any!) is a great time to catch up on reading.