It’s the First Day of Medical School – What Should I Do?

I’ve written before about what to do before medical school starts, how to study in medical school and strategies for succeeding in the basic sciences. But how do you put this information about organizing your studying and your day into a system that works?   Everyone will have variations on how they do this, but there are some fundamental principles that apply to all.

FullSizeRender(5)

Don’t get behind

From day one, the material matters and, from day one, it is voluminous. If you get behind, it’s really hard to catch up.

Study, don’t just read and reread.

You have to actively engage this material and review it (multiple times) to really learn it. You are no longer studying for a test, you are studying to take care of other people. The SQ3R method is used by many students, but there are other systems as well. What is important is to develop a system that works for you.  One tool used by many students is Anki, software that allows you to create electronic flashcards to review key points.

Tips on active studying from UCSD

Tips on active studying from the University of Utah

 Use going to class as time to “study”

One of the important components to active learning is to review the lecture material before it is presented.  This is the opposite of what most of you experienced in college, but it’s key.   Survey the handouts or slides and make a list of the important points to be covered. Stay actively engaged.

p.s. You can’t learn medicine if you are on Facebook in class.

Create a summary page for each lecture

Include the big concepts, and key points. Include specifics that are stressed by the professor, but avoid listing all the details. You may choose to hand write this, but most of you will come up with an electronic format and will organize the class notes, and your summaries using One Note, Growly or an equivalent software. Although your personal notes are fine on the cloud, don’t put copyrighted material or your professor’s slides where other people can see them (it’s illegal).

Begin with the end in mind

In the long term, what you are learning (yes, all of it) will be applied to taking care of patients. In the slightly less long term, you will be tested on this information on the USMLE Step 1, a high stake exam and the first part of your medical license.   Although some dedicated time to study for Step 1 is important, having a system to really learn the material in your basic science courses is by far the best way to do well on this exam.

Don’t sacrifice sleep.

If you don’t sleep you don’t learn as well. Organize your schedule so you get at least 7, but preferably 8 hours of sleep every night.

Eat well, play hard and stay connected.

Clay Goodman,MD the Associate Dean of UME at Baylor, tells our first year class that the first year of medical school is a 60 hr/week job. They need to get up in the morning and “go to work”, using the afternoon and evening to study. He then points out that if they work 60 hours and sleep 56 hours (8 hours a night) they still have 52 hours to work out, spend time with family and friends and do whatever else they want.

4357228667_8f03047bd9_b

Photo credit

 

So, what should you do the first day of medical school?

 Sleep Photo

Photo credit

 

Here’s what your schedule might look like…

The night before – pack your breakfast for the morning break and lunch for the next day. Review any posted slides – survey them to understand the “big picture” and use them to start your summary of the lecture. Write down what you don’t understand from the slides (yes, at this stage it may be every line… but that will get better!).

7am – wake up (If you prefer morning workouts, you can get up earlier and workout before class)

7:30 Grab a piece of fruit or a smoothie if you don’t like to eat an early breakfast. (If you are ok with it, eat the full breakfast now, but whatever you do, don’t skip breakfast)

8-12 Attend class – Stay engaged. Take notes, make sure the questions you asked yourself in the review are answered, raise your hand and ask questions if they weren’t. Eat your breakfast or a snack at the 10 am break.

12-1 – Lunch with your classmates. Play foosball, talk, or just eat, but take a real break.

1-5 Study. One hour of studying for each hour of class is about right for most people.   This may need to go until 6 or 7 if you have afternoon labs.

7 – Workout and then make and eat dinner. Working out is an important part of self-care. Exercise is essential to decrease stress and also will help you avoid the “freshmen 10”. Your dinner should be healthy, not processed, and definitively not Ramen noodles. Make sure you have fruits and/or vegetables at every meal.

9-10 Look over tomorrow’s lectures and start your summary pages for those lectures. Once you are a week or two into this, you’ll be adding in reviews of material from previous weeks on a schedule.

10-11 Read a novel, watch TV, decompress.

11 Go to sleep!

You are starting on one of the most amazing journeys any human being can have… enjoy it! Don’t forget to keep a journal and take photos (but not of patients). The first time you actually interview a patient, put on your white coat, hear a heart murmur or take a test in medical school are just that … the first time. Write about the experience.

Let me know in the comments what other advice you have for the students starting medical school this summer!

 

 

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

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

clock-and-stethoscope

Photo Credit

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

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

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

 

 HAPPY HOLIDAYS TO ALL!!!PEACE_ON_EARTH

Photo credit

Last year’s suggestions on wellnessrounds.org

Organizing Notes in Medical School and Residency

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

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

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


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

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

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

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

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

 

 

Photo credit

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

 

Photo credit

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

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

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

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

 

Twitter for Physicians

I was asked to speak today on using Twitter in medical education at the 44th annual meeting of the American Pediatric Surgical Association. I used Status Present, an incredibly cool software designed by Fred Trotter.  As I talked using these “slides”, they were tweeted at the same time.  It’s interesting to me that using this technology felt like a return to the era before Power Point, when talks were given by following “talking points” rather than slides.  It’s not going to be applicable to all talks, but this was really fun!

Twitter in #meded for #pedsurg – a presentation which will be live tweeted and will then be posted on my blog wellnessrounds.org

I blog and microblog (Twitter) because I am a teacher. #meded

Once you learn the details (easy) Twitter becomes a new platform to teach (and learn) #surgery

Why don’t more #physicians use Twitter?

4 reasons #physicians don’t use Twitter 1/4: “I don’t get it” Link to my post on Blogging, Microblogging and Time

Twitter is NOT email.  Twitter is NOT Facebook.

The best word to describe Twitter is “ephemeral”

Twitter is the surgeon’s lounge.  Walk in.  See who is there. Eavesdrop or join the conversation. Leave when you want.

4 reasons #physicians don’t use Twitter 2/4: “I don’t know how”

Two steps to start on Twitter.  1/2: Pick your @name (handle). Short is better.  Professional is essential. How To Choose a Good Twitter User Name

Two steps to start on Twitter. 2/2: Dive in. Follow a few people, then look at who they follow. Getting Started on Twitter

#hashtags can be a specific event or topic (#pedsurg) or for fun #ihaveglutealischemia How To Use Hashtags in Twitter

Retweet = repeating the conversation you heard in the surgeon’s lounge.

Filter Twitter conversations by making or following “lists” How to Create and Manage Twitter Lists

Twitter 101:  @name, follow @whoeveryouwant,, retweet what you like, follow (and unfollow) as you like, make lists  #havefun

4 reasons #physicians don’t use Twitter 3/4:  “I don’t have time”

Twitter is not email. You don’t have to read it all (you can’t).  #lesstimethanyouthink

Minimizing wasted time on Twitter: 1) Make lists 2) Follow specific #hashtags

4 reasons #physicians don’t use Twitter 4/4: “I don’t think it will help me”

5 ways Twitter helps #physicians. 1/5 Breaking news. @cnnbrk @msnbc_breaking @BBCBreaking

5 ways Twitter helps #physicians. 2/5 Medical (and other) emergencies. @CDCemergency @Houston_Weather @BCMHouston @TexasChildrens

5 ways Twitter helps #physicians. 3/5 Following meetings and thought leaders @APSASurgeons @AmerAcadPeds @BAPS1953 #pedsurg

5 ways Twitter helps #physicians. 4/5. Efficient way to follow journals & journal clubs. @NEJM @JAMASurgery http://bit.ly/10W3Q17

5 ways Twitter helps #physicians. 5/5 Discovering important information in your field or other fields.

Ex: @JAMA Surgery Comparison of #CT scan and #Sestamibi for #parathyroid localization bit.ly/ZrZeMu #PTH #endocrinesurgery

Twitter is particularly powerful for #physicians in #meded

Twitter links #physicians to #meded topics, resources and people

Ex (tools for #meded)  @amcunningham Electronic Clinical Logs/Portfolios for students lnkd.in/_vJPBM

Ex (resources) @bnwomeh Get free copy of ‘Paediatric Surgery: A Comprehensive Text For Africa’ at #eAPSA2013 reg desk img.ly/uuDF

Ex: (GME info) @TheNRMP Match Results Statistics for Pediatric Surgery & Pediatric Hem/Onc ow.ly/kBVAg ow.ly/kBVCS

Ex (meetings) @BrianSMcGowan Please join our #eapsa2013 conversation 2-4 PMET via Twitter – as we help pediatric surgeons embrace #SoMe! #hcsm #meded #eapsa2013

Twitter is an important tool for #meded

You can’t stay with a rotary phone in a smart phone world… especially if you teach. #Meded

“When medical students see an attending with a newspaper they think it is quaint” @LouiseAronson #DontBeADinosaur

Duty Hours, Interns and Training Doctors

For most people, talking about a 16-hour workday is outrageous.  For doctors in training, it may not be enough.

Training doctors is not easy.  It’s not just a matter of learning what is in the books or latest articles. Under the supervision of attending physicians, young doctors learn the art of doctoring by staying with and caring for their patients.  Because of the work they do while they are learning, resident salaries are supported through Medicare… mostly.  That’s another issue, but not unrelated to the issue of duty hours.

Twenty years ago, it wasn’t unusual for an intern to arrive at 5 or 5:30 in the morning, work all day, stay up all night on call, and then work the following day until evening rounds were finished.  That meant 36-hour shifts and many weeks with more than 100 hours in the hospital.  It was clear that this wasn’t sustainable, nor was it safe.

residents-sleeping

Photo credit

After much debate, in 2003, the initial duty hour regulations were put into effect.  In a nutshell, residents couldn’t work over 80 hours a week (on average) and they weren’t allowed to stay longer than 24 hours.  If they worked all night, they had to go home the next day.  In 2011, the regulations were revised.  The major change was that interns (residents in their first year of training) could only work 16 hours in a row instead of 24.  On the surface, this made sense.  Fewer hours should mean more sleep.  More sleep should mean rested interns and fewer mistakes.

I wasn’t surprised to read the article published by Time magazine entitled “Fewer Hours for Doctors-in-Training Leading To More Mistakes.”  This report, summarizing the on line JAMA Internal Medicine article from this week, noted that “interns working under the new rules are reporting more mistakes, not enough sleep and symptoms of depression.”  In the same issue, authors from Johns Hopkins reported the results of a prospective, randomized crossover trial comparing the new regulations (16 hr work day) to a 24 hours work day with the next day off. They showed no significant difference in the number of hours the interns slept per week between the 16 hour and 24 hour shifts.  However, there was a marked decrease in educational opportunities, a significant increase in the number of handoffs, and less resident satisfaction with the 16 hour work day.  Most importantly, both the interns and the nurses caring for patients felt that the quality of patient care was decreased by the 16 hour duty hour regulation.

Why would there be more mistakes? Patient care is usually transferred in the morning (to the entire team) and in the evening (to the resident covering the patients at night).  That’s roughly every 12 hours.  When a portion of the team is rotating on a 16-hour schedule, it results in more handoffs (usually to fewer team members). Increasing the number of times information is transferred between doctors means increasing the risk of communication errors.

If they are working fewer hours why are they not more rested?  The new regulations almost require a “night float” system to insure that the patients are taken care of.  Working nothing but nights for one week a month followed by 16 hour days is not conducive to being rested.

Why are interns depressed? Remember, decreasing intern work hours didn’t change how much work there was to do in a day – and most hospitals didn’t respond by hiring more people to help.  Interns worry that they are “dumping” on their colleagues because they are being required to leave earlier than the other residents.  Less obviously, they are learning to be professionals but are being treated like they can’t “take” the hours of the residents one year above them. The message is subtle but real.  There’s also a perception that the quality of patient care is decreased by the new system – which is reason enough for a young doctor to feel bad.

Education is clearly impacted.  These studies document what we have all observed on the wards.  Interns working 16 instead of 24 hours admit and follow fewer patients.  In the surgical specialties, they participate in fewer cases.  They also attend fewer teaching conferences.

The solution to this complex problem isn’t going to be easy.  It’s an ongoing struggle to balance service vs. education, fatigue vs. experience and, maybe most importantly, how we pay for the incredibly important mission of training doctors.

I’m working hard to be part of the solution – along with everyone else in medical education.  We owe it to the future physicians we will train and the patients they will take care of.

Getting Ready to Start Medical School

It’s one of the most common questions asked by soon to be medical students…. “What should I do to get ready to start medical school?

Set up your environment

The amount of material you will be asked to master in your first year of medical school is more than you’ve ever been asked to master before.  You have to approach it with a different strategy than you used in college.  One critical component of this strategy will be to keep up with the material – starting from the first day.

If you try to hook up your cable, organize your electricity and straighten out parking at your apartment during the first week, you will fall behind.  Take the time to come explore your new environment and get settled in at least a week before classes start.  A week doesn’t sound like much to miss, but it’s a significant amount of information in medical school! One of the important tasks to check off the list during the week you are settling in is to set up your study area.  Make sure you have a computer that meets all your needs and an area to study that is pleasant, ergonomic and comfortable.  Most students find a dual screen to be very helpful as you are moving through notes and slides to study.

You’ll be spending 1-2 hours studying (at a minimum) for every hour of class.  Given the number of hours you’ll spend studying, you might want to think about an “active” desk that lets you stand, walk, or pedal as your study.

Develop (or strengthen) an exercise habit

Use this summer to develop a daily exercise routine that you can take into your new (and crazy) schedule.  Your goal for the summer should be to develop a balanced exercise program (cardio, strength training and flexibility) that works for you.  If you’ve never done any strength training, hire a trainer and learn about it. If you develop a balanced exercise routine this summer, it will be much, much easier to continue this once you start medical school or your internship. Commit to doing at least 30 minutes of exercise a day this summer and it will be a lot easier to continue once the pressure of school really kicks in.

Link to a Beginner’s Guide to Running

Running is one of the best (and most convenient) cardio exercises for medical students and residents (because it’s cheap, efficient and effective)  Use this summer to become a runner. If you hate running, find another good cardio exercise habit to develop instead – but pick one!

Link to 9 Ways To Make Bike Commuting Easier

If you don’t own a bicycle, think about getting one.  There will be places to ride for fun when you have time off.  You can also use your bike to commute to school which is a great way to sneak in exercise and save money.

Link to Learn to Love Cooking (and Save!!

If you don’t know how to cook, learn.

Good nutrition is an important part of doing well academically.  It’s hard to concentrate and learn if you are eating junk. There is one simple trick to eat well during medical school: Learn to cook.  This is a skill that will become progressively more important as you enter your clinical work in medical school and then move on to your residency training.

Learn some basic skills to cook simple things.  If you have good cooks in your family, have them teach you.  If you don’t have family members who can teach you, find cooking classes near you and sign up.  Many high end grocery stores and gourmet stores offer classes for beginners – look on line for classes near you.

Why Doing Nothing Is One of the Most Important Things You Can Do

Come to medical school rested.

Do not study. Seriously.  We will give you what you need and nothing you can do this summer will make it any easier.  It’s far more important to arrive rested and ready to go than to try to learn material that may or may not be relevant. Take a real vacation (or two). Visit family and friends – take a road trip and connect with people you haven’t seen in a while  Hang out on a beach, go for some great hikes, read some great novels.  Sleep in late, eat well, and just rest!

Photo credit

Attending Medical Conferences

When you first start going to professional meetings, it’s easy to feel a little awkward.  If you are a student or resident, you will hopefully be with a faculty who will be able to act as a guide for you.  But, if the attending doesn’t make it (or isn’t really helpful) you may find yourself on your own… so I thought some guidance might help.

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 of Wellness Rounds 2011

HAPPY NEW YEAR TO EVERYONE!

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

How to Succeed in Clinical Rotations

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 30th 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!

 

This Week’s Highlights from @drmlb

Twitter has become a wonderful way for me to send out a variety of ideas and links that I think are helpful (and/or interesting).  Here are this week’s highlights!  If you are new to Twitter RT means Retweet (just “forwarding” it as is) and MT means Modified Tweet (“forwarding” it with a comment).

  • “This is definitely a 15 minute video every medical student should see.” The art of the physical exam bit.ly/nnmaTN @drmlb
  • Comments one makes to colleagues: as important as the interview. Professionalism = doing the right thing when no one’s watching. RT @MedPedsDoctor
  • Beginner’s mind in medicine. How to keep what we do exciting! MT@KevinMD bit.ly/qle7SJ
  • One flight of stairs = 16 calories burned. One day on call = ?10 flights ?20 ?30)..it adds up! @drmlb
  • Epidemiologist with humor?!? This is a great talk about drug development. bit.ly/ovkPyS @drmlb
  • “…small things often adds up to produce a far greater impact than any of us realize.” Surgery through different eyes bit.ly/q5XUkh  @drmlb
  • “..those of us who spend our emotions at work are not the kind to view our work as “just a job.” MT@Kevin MD bit.ly/pRAbmm  @drmlb