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!

 

 

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.

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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.

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

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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!

 

 

Top 10 Holiday Gifts for Physicians and Physicians in Training

The holiday season is rapidly approaching.   Here’s my top ten gifts for medical students, residents and physicians…. or any busy friend!

  1. Mark Bittman’s new book How To Cook Everything Fast.

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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.

 

  1. An electric pressure cooker.

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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.

 

  1. Coffee or Tea

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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?

 

  1. A FitBit

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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!

 

  1. A maid or housecleaning service

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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.

 

  1. Anything that helps make it easy to get more exercise

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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?

 

  1. “Date night” packages

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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.

 

  1. An “over the top” alarm clock

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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!

 

  1. Great books by, for and about doctors.  

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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)…

Cutting for Stone by Abrahan Verghese

How Doctors Think by Jerome Groopman

House of God by Samuel Shem

The Immortal Life of Henrietta Lacks by Rebecca Skloot

The Emperor of All Maladies: A Biography of Cancer by Siddhartha Mukheries

Being Mortal: Medicine and What Matters in the End by Atul Guwande

William Osler: A Life in Medicine by Michael Bliss

The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures by Anne Fadiman

 

  1. The always appropriate gift of money

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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!

 

 

Organizing Notes in Medical School and Residency

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

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

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

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

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

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

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

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

 

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

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

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

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

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

 

The Secret to Medical School is Practice

The first official event for new students at Baylor College of Medicine is Convocation.  One of the highlights of the ceremony is when a rising fourth year medical student is named as the DeBakey Scholar. The DeBakey Scholar Award was conceived by the Baylor College of Medicine faculty in 1973, as a tribute to Dr. Michael E. DeBakey, one of the founders of the Texas Medical Center and a medical icon, who was revered throughout the world as the most famous surgeon of the 20th century.  It is awarded by a select committee of faculty at the college’s Convocation Ceremony to a currently enrolled medical student, who has completed all but their last year of medical education. The recipient is considered to be “living model of excellence” in residence for the incoming freshman class and the other underclass students and is chosen because of demonstrated excellence in scholarship, integrity, academic leadership and service.

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This year’s award winner, Nader Zamani, delivered an inspiring talk to the entering class which he called “ The Secret to Medical School is Practice”. I asked his permission to share the text of his speech with you here.

 

I’ve been asked to speak with you briefly this morning to tell you what I wish I had been told during my own orientation. Though I am hardly in a position to impart any advice, I can definitely tell you about my experiences over the last 3 years and what has been beneficial for me. And let me be among the first to acknowledge that the emotions of excitement, anxiety, intimidation, and even fear that you may be experiencing right now are normal.

They are normal because you know that medical school will not be easy. Yes, you will be pushed. You will experience physical and emotional challenges. And at times, your patience, and even your compassion may be tested.

However, through it all, you will thrive. And when you succeed, not only will you appreciate the journey that much more, but you will also realize how much you have accomplished.

Given the challenges of medical school, you are here because you deserve this opportunity. Though I completely understand that this in itself may be intimidating to know that you are now among a class of incredibly bright and driven students, this is actually one of the best parts of medical school. And to help calm some of your anxiety, please recognize that doing your best does not mean that you have to be the best in any one subject. Doing your best is simply an obligation to yourself to set realistic goals, to ignore the external concept of ranking, and to realize that it is acceptable to say “I don’t know.” In fact, this is only in this way that you will continue to learn and to adapt to the challenges that you may encounter.

Over the next few weeks, you will receive great advice from upperclassman and our wonderful faculty about how to do well. And over the next few months, you will develop study habits that allow you to digest and process the material that you are being taught. You’ll learn how to seek out opportunities that supplement your interests, and to collaborate with faculty mentors to develop a balance in your lives that not only fulfills the demanding aspects of medical school, but also caters to your own health. As I quickly realized, taking care of yourself is one of the most important aspects of medical school, and as you will see, we are lucky to be in an environment that not only realizes that, but makes it a priority.

I have heard many times throughout the course of medical school that to be successful as an academic physician, one needs to devote 1/3 of their day to reading, 1/3 to writing, and 1/3 to thinking. And most recently at the Department of Surgery’s Inaugural Research Day, Dr. Malcolm Brock of Johns Hopkins University told us that it is the thinking part of this formula that ultimately results in the quality research and discovery that has the potential to impact our practice of medicine. 

The formula for medical school, however, has to be a little bit different. From my experiences, the 3 factors that would have to be in the formula are:

1) Studying – which includes actively keeping up with the material, asking questions, reviewing, really thinking about what you are learning, and trying to apply these concepts to a clinical setting.

2) Taking care of yourself – which includes eating well, exercising, trying to get enough sleep, and maintaining your social support systems.                                       

3) And one of the most important factors — Service. 

Similar to the thinking part of the equation of a physician’s day, the service part of the student’s formula can easily be deferred, especially considering our academic priorities. But I want to use this opportunity to urge you that this is the part of the formula that ultimately makes the difference. Taking time to reach out to others has provided me with the motivation to continue through this journey when it is easy to get bogged down by the stress associated with being in medical school. Whether service to you means working at a clinic, spending time at a shelter, tutoring, or helping your classmates, each one of us can serve our school and community by volunteering our time.

But as with anything else in medical school, you don’t have to do it yourself. By learning to work together with the amazingly talented people around you, you will grow as not only individuals, but also as a class. You will become a community with a sense of obligation toward each other, which is essentially a responsibility to help one another manage the trials that lie ahead. Ultimately, our life experiences may shape our practices, but it is our interaction with others and our service for our community that molds our profession.

I’m lucky to have attended DeBakey High School, because it was while I was there that I first became impressed by Baylor’s community outreach initiatives. Whether Baylor is working to eradicate disease on an international stage, supporting its relationships with undergraduate institutions throughout the state, or enhancing education throughout our local community, it is clear that many of our paths have led us here because of Baylor’s very own outreach programs.                                                             

It is in this very sense of community that I urge you to give back as well. You’ll be surprised at not only the inspiration, but also the perspective that you will receive as a result of your efforts. You will realize why you are spending so many hours studying, and you will begin to reevaluate what is truly important to you. In fact, your defining moments in medical school may very well be those in which you actually take a break from studying to reconnect with others.

It’s that very kindness and compassion required in medicine that truly makes our profession an art, one that requires a lifetime of practice. And it is this PRACTICE of medicine that demands so much of us. If there is a secret to doing well in medical school, it is to always keep practicing – practice your studying; practice asking thought-provoking questions; practice your self-care; practice your kindness; practice your service.                       

The Irish poet John O’Donohue wrote that with inspiration, we are able “To enter each day with a generous heart. To serve the call of courage and love.” We are all truly lucky and fortunate that we are here. We have been given an opportunity to learn not only how to help, but also how to heal. Despite the challenges that lie ahead for all of us, please remember that the road we are on is a privilege…so take advantage of it!

Congratulations, good luck, and we are all excited for you and for what is to come on your journeys here!

Residency Interviews Part 2: The Flights

Unfortunately, the big airlines haven’t caught on to the market of residency applicants, so they don’t issue month passes or an equivalent (any airlines out there paying attention?).

Airline travel is by far the most expensive and most complicated part of arranging your interviews.  As a medical student embarking on the 2-3 month tour of somewhere between 8 and 20 programs, you are probably most concerned about saving money while keeping as much flexibility as possible.  Here’s some strategies and ideas to help:

Strategy 1:  If you live in a hub city, consider whether the long-term payoff for gathering miles on one airline will be worth it.  Right now it might cost more, but if it may make a difference a few years from now. If you get the credit card associated with the airline, there may be other benefits.  But, on the downside – the tickets will usually be more expensive. The other big downside to using most of the “hub” airlines is the relative lack of flexibility.  If you need to change tickets at the last minute, you’ll have a change fee that varies from $75 to $300.

 Strategy 2:  Go with the cheapest possible ticket through one of the third party providers like Travelocity, Expedia, Kayak , or Orbitz.  When you are booking these tickets, remember a lot of big cities have more than one airport.  When you do the math, a much cheaper ticket plus a rental car to drive an hour may put you ahead. Make sure you read the fine print on these “deals”.  This is probably best for the last minute ticket – there isn’t much flexibility if you have to change your flight.

Strategy 3:  Fly Southwest Airlines.

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I try not to endorse specific companies, but it is really clear to me, after talking to a lot of students, that there are some real advantages to flying Southwest Airlines for your residency interviews.  The biggest is that there are no change fees.  This means that you can book SW Airlines, check for dramatically cheaper fares elsewhere and then cancel the flight with no fees.  Since SW Airlines lets you keep a “bank” for these unused tickets, you can just apply it to the next trip (or to the well earned vacation at the end of the interview trail).  Check out their flight routes to see the cities they serve.

Try to organize your interviews geographically

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This isn’t always possible, but when it is, it will really save time and money.   On the East coast, don’t forget that the train is a good option to get from city to city.  If you have more time and less money (and are interested in a great story you can tell) you might think about taking a bus between cities.

There are a lot of myths about early vs. late interviews.  In my experience, it doesn’t really matter.  Most programs have really taken the time to pick the best candidates for their program.  No matter what date you come, they are going to be interested in you.  You may want to think about clustering the “early” interviews in one geographic area and the “late” interviews in a different part of the country.

Despite what you wanted originally, you may find that you have been “forced” to book back to back interviews on opposite sides of the country.  There is nothing wrong with politely calling the program coordinators to explain the situation and ask if there might be any flexibility to move you to another date or put on you a waiting list.   Don’t push – remember, being rude to people who aren’t in charge is considered a huge red flag by most program directors. (Not to mention that it’s just not right.)

Build in flexibility for weather

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Residency interviews happen during the winter months.  If you are flying through or to the northern states, there is a real risk of flights being delayed or cancelled.   Don’t book tight connections and last minute arrivals.   Many programs have a social event the night before the actual interview day.  This is really important to attend (more on that later).  In order to make sure you arrive in time, try to book flights early in the day.  If there are weather delays, you will usually still have some options that let you get there in time.  If you make the early flight and arrive early – enjoy a new city that might be your home for the next 3-7 years!  Find a good museum, have a great lunch, go for a walk in a local park.

Avoid red-eye flights

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Yes, they are cheaper.  But – you will arrive crumpled, tired and not at your best.  This is not the time to cut corners.  Take a flight that gets you there rested, in time and able to be ready.

Other advice (from poormd.com, flyertalk.com, businessinsider.com)

  • Shop Tuesday at 3pm Eastern for the best prices
  • Prices stay low Tuesday, Wednesday and Thursday
  • Sale prices are removed from websites on late Thursday
  • Some flights are discounted at night, so check in the early morning
  • Airlines start discounting tickets 3.5 months before departure
  • Airline ticket prices dramatically increase 14 days before departure
  • Tuesday, Wednesday and Saturday are the cheapest days to travel
  • Monday, Friday and Sunday are the most expensive days to travel
  • Sign up for every frequent flier, frequent driver (rental car) and frequent sleeper program (hotels) you can
  • Follow airline Twitter accounts for last-minute deals
  • The first flight of the day is often the cheapest

Getting Ready to Start Medical School

This morning we had a group of medical school applicants at Baylor for a “second look”. They asked some very good questions including the question that prompted me to write this post:

“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 will meet 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.

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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 you 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.

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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!

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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.

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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.

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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!

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