HAPPY NEW YEAR TO EVERYONE!
HAPPY NEW YEAR TO EVERYONE!
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).
As my vacation is winding down I’m struck again by how restorative time away from work can be, and how much we all need these breaks.
The word vacation has the same roots as vacate (from Latin vacātiō – freedom, from vacāre – to be empty). Vacations – whether daily, weekly or annual are effective only if you really walk away from work. It’s particularly hard to disconnect from email, the internet and texting … but “needing” to stay connected electronically may keep you from connecting with your surroundings and your loved ones. If the idea of emails piling up adds to your stress, compromise by scanning, deleting (and not answering) your emails when you are on vacation.
There’s a tendency to think that vacations have to be a planned trip away for at least a week… but here’s another perspective from WebMD.com: “While it is ideal to have a full week or two off from work, it may not always be feasible, and there’s still the rest of the year to deal with. Weekend getaways are also good for rejuvenation. So is an hour to yourself during lunchtime or a few hours on weeknights.”
Plan a half-hour or hour (on days you can) to disconnect and “vacate” from your work in whatever way makes you happy.
Try to really have a full day off every week (call schedule permitting). There’s a reason most religions in the world build in a day away from work – it’s part of the rhythm of rest we need as human beings.
Plan a long weekend away (or even a day) by yourself or with loved ones every couple of months. Make it time free of electronics – go hiking, sit on a beach, stay at a great bed and breakfast, eat great food.
If you have vacation days you are storing up – start using them! And, when you take those days off work, don’t use them to “catch up” on chores or other tasks…take the time you need to recharge your batteries.
I got home recently after a 14 hour day in the operating room with (predictably) a pair of really tired feet…. which lead me to think about shoes, foot rubs, and the fact that no one ever talked to me about this in my training.
What kind of shoes should you wear in the hospital?
There’s a lot of walking in the hospital, but there’s even more standing. Running shoes don’t provide the right kind of support for standing, which means your feet will suffer if that’s what you wear.
It goes without saying that you should not wear open toed shoes in the hospital. It’s not only against the rules, but it’s going to gross you out one day.
Basic concepts to choose good shoes for the hospital
Look for good support. The classic “nursing” or “operating room” shoe exists for a reason – they are designed to provide the support your feet need during long days of standing and walking.
I have recently become a huge fan of Allbirds. They are amazingly comfortable, incredibly light and even after a long call night my feet really don’t hurt. The website says they can be washed in the washing machine which is obviously a big plus, too! Other comfortable shoes you might try include Clarks, Rockport and ecco.
If you will be standing for long periods on rounds or in procedures, think about getting shoes that slip on and off. When you are standing for a long time, being able to slide out of your shoes becomes important. If you’ve been standing for hours, it really helps to stretch your calves and change the pressure points. It’s also easier to step out of your shoes all together and stand barefoot for a little while. When you are sitting, you can slip them off and let your feet breathe. Dansko professional clogs are expensive but they are the “classic” OR clog.. Sanita clogs are supposedly now made in the original Dansko factory, tend to be a little less expensive and are also loved by many. Birkenstock or Clarks clogs are alternatives to consider, too. Crocs are tempting but have poor support, minimal ventilation and have been banned in some hospitals.
Try to get shoes that breathe. Examples include Merrell’s Encore Breeze (a great OR shoe) or Allbirds. These shoes are not only comfortable, but they can be put in the washing machine (minus the insoles) if they get really dirty at work.
Once you’ve met those criteria, lighter is better.
Long days standing at work also make for stinky feet. Just like long-distance runners, you have to learn some tricks to deal with this.
Foot massage, pedicures, and other foot care
After work, in terms of “bang for the buck” there is nothing that will make you feel better than a little attention to your tired feet.
Take 10 minutes and try some methods to soothe tired feet. If you are lucky enough to have a significant other who will rub your feet … congratulations! (and, by the way, it really is “true love”…)
Even if you are a guy – don’t blow off pedicures. If you’ve had one… you know. If you haven’t… try it before you decide.
Yesterday was the first day of orientation for the new medical students at Baylor. One of our traditions is to announce the winner of the DeBakey Scholar Award at the beginning of orientation. The DeBakey Scholar award is one of the most prestigious awards given at Baylor; it is awarded to the rising senior whose academic success and character best emulates Michael E. DeBakey. This year’s award winner, J. Mason Depasse, was asked to give some advice to the new class of medical students. His remarks were so exceptional I asked his permission to post them here.
Welcome and congratulations on your admission to Baylor College of Medicine. My name is Mason, and I spoke to many of you during your interview day and second look weekend, when I told you why I loved Baylor. I hope that, after your retreat, you are already beginning to love it here as well. You made an excellent choice, and you will appreciate that more and more as you progress. I could go on and on about what makes Baylor great, but today I’m not here to talk about that. Today, I’m here to talk to you about how to succeed in medical school.
I remember my first day of orientation, and I know the mix of anxiety and excitement you are all feeling. I’m sure you have been told about the flood of information coming your way, and many of you may already be bracing yourself for the impact, particularly those who have had time away from biology or those who have an eye for a highly competitive specialty. While nervousness is perfectly natural, I want to stress that, when the material starts building up – and if you remember nothing else from this talk, remember this – you should not panic. Don’t freak out. People from all manner of academic backgrounds do it every year, and no matter what you’ve been doing or studying for the past four or ten years, you will get through it. It might take a little elbow grease, but you’ll make it.
To help you get started on the right foot, I’ve compiled a short list of things to keep in mind as you begin the basic science curriculum.
First and foremost, try to keep up. This is far harder to do than it may sound, but try your best not to procrastinate. The easiest and most reliable way to successfully tackle any seemingly overwhelming task is to break it into stages, and absorbing the enormous volume of information in basic science is no exception. In college, most of the testing in the sciences focuses on concepts, particularly for upperclassmen. You studied a set of rules for how to calculate electric fields and… something about nucleophiles, and you demonstrated that you could apply those rules. You all have the aptitude and the study skills to succeed in those courses, or you wouldn’t have gotten into medical school. Unfortunately, these skills will not be as effective here because you can’t outsmart basic science. You can’t do it. It’s a whole world of knowledge, and as our professors told us, you just “gotta know it.” You have to put in the hours, and keeping up with the material by regular studying makes this manageable. Get into a routine, and try to stick to it. And when you get a bit behind, and we all get behind at times, catch up as soon as you can.
Second, find a way to study that works for you. This may sound obvious, but I’ve seen students become concerned that they are not in a study group, or aren’t making flash cards, etc. But study groups and flash cards may not work for everyone. There is no “wrong” way to study; if it works, then you’re doing it right. Your PRN leaders can give you all manner of suggestions for study tips and tricks, and you should feel free to try them out. You have a practice diagnostic exam before your first set of real exams, and you should use it to determine whether your method is working. But even when you find a strategy you like, your study method may not always work. Medical school is a long haul, and there are a lot of different challenges to face. Keep in mind that succeeding here is about adapting and persevering in the long-term. I wasn’t always happy with my performance, I was frustrated at times, but I found that it’s not worth beating yourself up about it. Adjust and prepare for next time.
Third, use your resources. Your professors will provide you with documents and powerpoints of their lectures, and these will sufficiently cover the material. However, you may find it helpful to supplement your reading with outside sources. Don’t overwhelm yourself, but there are all manner of texts and reviews available. Even looking over a topic in First Aid, the Bible of USMLE Step 1, can be helpful for solidifying your knowledge. Furthermore, don’t be afraid to ask for help. Baylor has a culture of cooperativity. Your classmates, your PRN leaders, upperclassmen, and professors are all here for you and will be happy to provide advice and support.
Fourth, stay balanced. Medical school can be very demanding, and it is easy to burn out if you don’t take care of yourself. Go out with your friends. Join IM sports. Go to the gym. If you’re applying to orthopedics, go to the gym again. Whatever you do, take a break. Two productive hours of studying are far more effective than four hours of staring blankly at the same page. Believe me, I know. There will be weeks along the way during which you will work a ridiculous amount of hours and balance isn’t really feasible, and when those come along I recommend trying to make it up afterwards.
Finally, once you’ve gotten settled into a routine, be aggressive. You’re here because you want to be physicians, and you’re paying through the nose for it – though not quite so much at Baylor. Thankfully, you chose an institution with just about every opportunity for research, service, and clinical experience that you can imagine. Seize them. Join student groups. Email professors you want to shadow or work with in the lab. Go to Ben Taub and learn how to start IVs and suture. When you’re on clinics in what feels like forever from now, I want you to remember that you are the only member of your team who is paying to be there. So get your money’s worth. Know your patients, and I mean really know them, and imagine that you are making all of the decisions. Think of your own treatment plans, and ask questions if yours differs from the final one. Medical school shouldn’t be four years you just have to get through in order to become a physician. Don’t let medical school just happen to you. Medical school is your chance to sample the spectrum of clinical medicine and gain the experiences necessary to begin forming more concrete career goals. So once you’ve got your rhythm going and you’re comfortable with your routine, I strongly encourage you to get out there and explore.
J. Mason Depasse, MS4
The summer is the time that the roughly 16,000 new doctors in the United States start their residency training. For all new interns, even though it doesn’t feel like it, you are ready! The first year of medical school gave you the “vocabulary” you needed for this new language. The second year gave you the “grammar.” Your rotations in the clinics taught you the “language”. Now you get to actually use it every day!
This year will be one of the most profound transitions you will ever make…. and it will also be a year of intense and fabulous memories. Take some time to write down the stories, or take some photos (but not of patients unless you have their permission!). These notes and images will be precious memories in the future.
In talking to other physicians and thinking about my own experiences, here are a few words of advice for you as you start your internship:
Learn from every patient.
As an intern, you will need to know a lot of detailed information on your patients. You’ll need to use a system to keep track of all this information so that when you are asked, you know the last potassium level, which antibiotics were ordered and what the ID consultant said. If you have a system you developed as a 4th year medical student, great! If not, start with 3×5 cards. Keep one card per patient, clipped together or held together with a metal ring. In the era of the EMR, much of the information you need can be easily accessed… but not really organized the way you need it. If you have developed a good system that doesn’t require physical cards, please send me a message so I can see it!
That covers the information, but not the learning. Learning is something that should be actively integrated into your day, not something you do at night when you are falling asleep. Work on a system that lets you record what you are learning during your daily tasks in a way you can review later. 3×5 cards are a simple, cheap and very effective system for studying medicine, which I’ve described in a previous post. Make a separate card (or use the back of your rounding card) to list something (anything) you learned from every patient you see. p.s. Don’t lose your cards!!!! (HIPAA violation)
Don’t confuse gathering information with studying information. Taking notes is a critical part of learning. Don’t just store chapters and articles in your Google drive… summarize them to review later by taking notes.
Be the doctor for your patients.
This may sound obvious, but in the everyday world of the hospital, it is really easy as an intern to get lost in the details of patient care… and forget about caring for the patient. Stop every once in a while and remember that you really are their doctor. Take a few deep breaths and put yourself in their shoes for a minute to ask something about their family, hold their hand, or just sit with them for a minute.
It’s very easy to get swept away by the velocity of the work most interns experience and lose the “big picture”. When you are confronted with something you haven’t seen before, push yourself to make a plan before you call your upper level resident or the attending. What if you were really the only doctor around? What would you do? Spend 2 minutes on UpToDate if you have to, but don’t just be a clerical worker – be their doctor.
Part of being a good doctor to your patients is to recognize your own limitations. You should never feel bad about calling someone with more experience, no matter how “dumb” you think the question is. It’s the right thing to do for the patient.
Be deliberate about learning your field.
From day one, commit to an organized plan of study to cover everything you need to learn in your field. Make a plan to read (and then study to learn) a textbook every year. Make notes that are easy to review, so you don’t have to go back to the textbook to review the material. Whatever system you use, make it easy to integrate the notes you are making in the hospital (e.g. the 3×5 card on each patient) with your organized study system. Adding articles into the mix is fine – but only after you have mastered the basics. Don’t let reading the latest finding take the place of really learning the material in the textbook.
Be kind and be part of the team.
Hard work is made easier when it’s done with your friends. You will all be tired, you will all be stressed, but be kind to each other. Staying 5 minutes more to help out a fellow intern is an investment that will help both of you. Look for ways to apply the golden rule of internship: “Help others the way you would liked to be helped”.
Make your bed.
Do this simple act every morning to remind yourself to take care of yourself. Find time to consciously take care of your emotional, physical and spiritual health. Take good food to the hospital for your nights on call. Find ways to get stress reducing exercise into your weekly schedule, or at least find ways to increase your activity while you are at work. Watch your weight – if you are losing or gaining, it’s a sign that you need to focus on your own well-being by improving your nutrition and working on your fitness. Nurture your relationships – make your family and friends a priority. Take care of your spiritual needs in whatever way is best for you, but don’t ignore this important aspect of self-care.
You have the enormous privilege of caring for other people and learning the art of medicine. Take a little time every day to notice the moments of joy in this work and, if you can, write them down to look at on the days you are tired.
Congratulations to you for all you’ve accomplished thus far! Enjoy this incredible journey!
Gift ideas for college graduates who are getting ready to start medical school and medical students getting ready to start their residencies are surprisingly similar. Medical school and residency are both times of hard work, less free time and increased stress. The following are gifts that should make life a little easier (and more enjoyable) for medical students and residents:
One of my New Year’s resolutions this year was to come up with monthly “resolutions” for myself and for anyone who follows this blog. Cooking Light magazine (which is one of my favorite sources of recipes and ideas for healthy living) had the same idea, so I am shamelessly borrowing their healthy habits!
Last week I had a fairly common conversation with one of my residents. She told me that with her schedule it’s almost impossible for either parent to cook for the family. Secondly, she said when she does shop for food, she buys everything she thinks she might need… and half of it goes bad in the refrigerator. They have resorted to picking up take-out as their solution to the problem. There are at least two major problems with this strategy (and a lot of other minor problems): 1) It costs a LOT more and 2) It is clearly not going to be as healthy.
I know this is a common scenario, hence why this month’s resolution is to cook at least 3 meals a week at home. It’s doable! Here’s how to get started:
Change your mindset about cooking.
Cooking is not hard and it doesn’t take as long as you think. There are some basic skills you have to know, but you can start small and add new skills one at a time. Make up your mind that you are going to acquire this important skill and practice! Start with one simple act – sautéing an onion. Here’s how to cut up an onion and how to sauté. If you get this one simple skill down, you’ve learned the beginning of many, many recipes!
Make a plan
Decide ahead of time what you are going to cook and write it down. You can map out the whole week if you are a “gunner” – but, at a minimum a) find 3 recipes for the week b) make a shopping list for the ingredients in those three recipes and c) go shopping. If you plan ahead, you’ll have everything you need – but not a lot more (so no more growing interesting molds in the back of the refrigerator). You’ll also be able to really eat well when you are on call (which is the hardest day to plan for).
Remember the pizza rule.
No one who is really busy has time to do fussy cooking. You should look for recipes that take less than 30 minutes (the time it takes to order a pizza). I’ve posted a lot of recipes that meet this requirement (use the tag marked “recipes” to the left of this web page). Another strategy is to pick a cookbook, one issue of a magazine, or a website (some of my favorites are listed below) to choose the week’s recipes. Another option is to subscribe to a site that will send you weekly menus (and will also automatically make your shopping list) – like Six O’Clock Scramble ($54.50/year) , Send Me Recipes ($65/year), Dinner Planner, ($60/year), or Make Dinner Easy (free).
Cook ahead for the week
It’s boring to eat the same thing over and over… but it beats buying fast food on the way home. If you cook a big casserole or stew on the weekend, you’ll have it for meals on call, late at night or lunches. If you really want to cook just once for the entire week, you can double the recipe or make two different dishes at the same time, and freeze portions for later in the week.
Supplement your main dish with lots of fruits and vegetables
If you don’t have a steamer basket, this is a cheap piece of kitchen equipment that is really worth having. Almost any vegetable can be sautéed or steamed and it’s really easy to do. Buy vegetables fresh, wash them, dry them and then store (clean) in the refrigerator (one less thing to do when you are tired). Refrigerator to plate will be less than 10 minutes for most veggies. (Here’s a table of cooking times for vegetables.) Leftover steamed vegetables make a great “salad” by themselves (just add some olive oil, vinegar, salt and pepper) or as an addition to other salads. You can also toss them into scrambled eggs or an omelet. Having steamed potatoes in the refrigerator is particularly helpful – they are great in salads, with eggs, or just as a snack. Frozen vegetables are more expensive, but are perfectly fine, too.
Make a list of “emergency” meals (<5 minutes) for nights you are completely exhausted and really, really don’t want to cook. (And keep these items in your pantry and/or refrigerator.)
Here are some ideas to get you started:
1. Scrambled eggs or egg whites (with leftover veggies and/or cheese if you have them) with toast.
2. Angel hair pasta (takes 3-5 minutes) with bottled spaghetti sauce with a green salad
3. Veggie (or regular) hamburgers (from the freezer) with a green salad
4. Couscous with canned beans, canned tomatoes and any leftover (or frozen) vegetables you have
Websites for “pizza rule” recipes
My favorite magazines to cook from
Cookbooks worth buying
This is a wonderful post from Lauren, who is married to a medical student. Her very important advice applies to medical students, residents and practicing physicians. If you want to read more of her writing, she blogs at http://medicalwife.wordpress.com
While you’re busy becoming a doctor, don’t forget the person who is holding your hand.
I am not a doctor. I am not a medical student. I am not in any way a medical professional. But I have everything to do with the medical profession. I am the wife of a medical student.
My own “medical” career began in 2007 when my husband entered medical school. We dated long distance for two years, got married, and have spent the past year and half more or less living in the same city, same house, finishing out his medical school career. If you as a doctor in training could take any lesson from my experience it would be this: Don’t forget the person who is willing to go through all this with you- your wife, your husband, whatever. Don’t forget, or neglect, that person.
Being your spouse or significant other is hard. You work long hours, study all the hours you are at home, and often spend days and weeks away on rotations or on-call. Your career dictates where we live and when we get to have a family bigger than our dogs and us. Your job makes you tired and stressed out, all too often leaving us to clean up after you even though we too are tired and stressed out from working at our own job. We sometimes snap at you in frustration because we want our weariness and sacrifice to be acknowledged too. It’s not easy being married to you, a medical student.
I say this not to complain, but to remind you of the sacrifices made on your spouse’s (or significant other’s) part. We make these sacrifices willingly. We married you (hopefully) knowing what our life would be like for a long, long time while you learn and train and build a career. To be clear, this is NOT a complaint, only a gentle reminder.
Wellness doesn’t only refer to your physical and mental well-being, but to the state of your relationships as well. The last thing a stressed out medical student or resident needs is a failing marriage or relationship. Take time to cultivate your marriage. Take time out of your busy life to enjoy your significant other, and appreciate them and their role in your career. This can be done in any number of ways, some more time consuming than others, some more costly than others, but all are ways in which you can help your spouse know that they are appreciated, cared for, and loved. Below is a list of ways my medical student husband has gone above and beyond to make sure I feel valued and our marriage is secure. As the wife of a medical student, I can assure you that these work.
– Exercise together, if that’s your thing. My husband and I, when he’s not away on rotations, run/walk together with our dog on Saturday and Sunday mornings. He is far more capable than I (far, far more), but he takes the time to do my measly walk/run workout with me every weekend. When he IS away, he makes sure to ask how my workout went and chat with me about my most recent small achievement. He always reminds me that he’s proud of me.
– Commit an act of service. Big or small. When my husband does the dishes. Or runs a load of laundry. Or vacuums (which I hate to do), I know he is doing his best to help out in spite of his busy work and study schedule. I see that he cares, even if it is just a chore or two, and I see that he doesn’t expect me to be his maid. It doesn’t take much to make your spouse feel their housework is noticed and appreciated, and one of the best ways to do that is by giving them a break from it.
– Go on a date, even if it’s just for coffee. Yes. I know. Cliché, but so true. We like to go on dates on weeknights when he isn’t working. It breaks up the monotony of life and is a bright light in the middle of a long week.
– Read together. Sometimes, when my husband has a ton of reading, he’ll suggest we lie in bed together and read. Me on my Kindle, him his latest textbook for a rotation. We play footsy and simply BE together in happy contemplative silence.
– Make them a part of what you do. My husband shares what he’s learning with me. He has me ask him practice questions when studying for exams. By making me a part of what he does every day I never feel put off by it.
– Surprise them! Flowers! A small present! A tasty treat! Any unexpected surprise is reaffirming and welcomed.
Most importantly, tell your spouse/significant other thank you. Tell them that you appreciate all the sacrifices they make to be with you while you go though this. Tell them you know it must be hard for them to get shafted out of time with you because you have to go to the hospital, again, but that you will make up for it soon (and follow through with that promise!).
Remember that (hopefully) your spouse/significant other makes this whole process a little bit easier by being the warm arms you come home to after a long night, by being your number one fan and constant encouragement, by allowing your career to come first sometimes. Remember the person holding your hand through all this, and take time to care for that relationship properly.
I know I should study for the Absite this weekend, but I haven’t had a real day off in over a month”.
Here’s the scenario. It’s Friday evening. You’ll be back at work on Sunday. You’re sleep deprived because you are a resident. You haven’t spent any quality time with your significant other, friends or family because you haven’t had any real time off. Next week has plenty of call and it would really help if you planned out good food for the week and cooked something. And, by the way, you have the inservice exam coming up, so you really should study.
There is no one answer how to balance these things. Everyone will be a little different in what is most important to them, and different weeks will be different, too. But, there are some basic concepts to think about that might help you plan how to spend your time off.