Half MD

Well, second year is officially over. I just finished my last couple of finals on Thursday and now have a three day weekend of glorious freedom to spend with my family and celebrate our son’s first birthday before Step 1 studying starts.

It’s crazy how fast our son is growing up. He is definitely becoming his own little person, and I get the impression he knows more about what’s going on around him than he lets on at times. This has actually been a really fun stage – he was cute to look at when he was a few months old, but now he likes to play in blanket forts, be chased around, roughhouse, roll balls back and forth on the ground, read books, press weird key combinations on my computer while I’m studying that change the screen orientation, and generally stir up mischief around the house. Even though school is busy, you just can’t beat coming home at the end of a day to a smiling four-toothed little rascal who wants to backwash in your water and then get chased around the living room.

I haven’t written much over the past few months. That’s partly been because second year has been increasingly hectic, but also because it’s really fairly boring and monotonous. Don’t get me wrong – I've been enjoying it, and honestly the last few months (with the exception of these past couple of weeks that we've had various finals) have actually been quite pleasant – once you hit your stride with regards to studying, everything becomes pretty manageable (hint – weekly to-do lists are a must!). That being said, though, each day isn't too different from the last. Wake up, listen to lectures, maybe work out, study those lectures, make Anki cards, review Anki cards, tackle any random other projects that have to be taken care of, maybe go into school for a few hours depending on the day, call it quits around 6 pm, rinse and repeat the next day. And the next day. And the next day. So there really hasn’t been much to write about, honestly. That will change come third year, I’m sure (although time will become even more of an issue, probably. Ah well).

But for now, we have the long weekend. So far, it’s been a glorious reprieve. The fun starts back up again on Monday, though. My test is in June, so I’ll have five weeks to study. I’ll probably write another post later about my study strategy, etc., once it’s all said and done. For now, though, I’m basically planning on going through UWorld, First Aid, Pathoma, SketchyMicro, and the Lange pharm cards. Our school provided a practice test a couple of weeks ago to give us a baseline of where we are at, which went pretty well. They’ll give us another one later on, which I’ll probably take about a week out from the real thing. I know some people are really into taking as many tests as possible, but my personal feeling is that they are best used for assessing where you are at rather than wasting time (and money! They are expensive – about $50 a pop) answering questions that, when you are done, you don’t even really get much feedback about. Anyway. I could be way off base, but I’ll write more about that stuff later.

That’s all I've got for now. I may try and get a few short posts in over the next couple of weeks. Or not. We’ll see how things go. In any event… see you on the other side. 

Breaking Radio Silence and Career Conjectures

Hello there, internet people. It’s been a while.

Second year has obviously been kicking my butt. In between trying to not fall too behind in school (harder than you might think) and spend as much time as I can with my long-suffering wife and our rapidly-developing eight month old son, life has been particularly hectic these past few months.

We just finished our first week back from winter break (which was excellent; albeit too short. One more week would have been awesome…), and school has started back up in full force. It didn’t help that a few lectures were reshuffled thanks to the wonderful Chicago weather (it has literally been colder than Mars as of late), which made for a couple of particularly busy days.

We’ve finished up with cardiac, pulmonary, and renal path before break and now are starting gastrointestinal pathology this week, with neuropath after that. In PCM, we’ve been learning EKG interpretation and just started chest x-ray stuff a little before break, which has been interesting.

I also registered for Step 1 last semester, which was a bit sobering. As of right now, I’ll be taking it in early June. I’m planning on taking five weeks to study for it – six seemed a little long (and it would be nice to have some more time off afterwards before third year starts) and four seemed a bit short for a test that plays a large role in determining your future. In terms of preparation/studying, I’ve been doing Pathoma throughout second year – before we start a block, I’ll watch the relevant videos so I get the “big picture” and an idea of what’s important. Then, as I go through the lectures, I’m making Anki cards out of the relevant Pathoma and First Aid sections, plus random material from lecture that isn’t in those sources but seems important. In my dedicated period, I’m planning on going through Pathoma and First Aid again along with the UWorld question bank, but that’s still somewhat fluid – I’ll update with more about that as the time gets closer.

Second year has been difficult. It’s not so much that the content is difficult or that I’m struggling grade-wise. It’s more that the sheer amount of constant effort required to stay afloat in the face of a constant barrage of new material (while also balancing school with family and life in general) can be draining after a while. I’ve still been trying to take weekends and evenings mostly off to spend time with my family, other than reviewing any Anki cards that come due and with the exception of the weekends right before tests, but that makes the weekdays pretty cram-packed. If you haven’t seen the “Pancakes Every Day” video put out a while back by the students at St. Louis University’s medical school, it’s worth a watch. It describes pretty well the volume of medical school – and how quickly you can get buried if you don’t keep up.

That said, I’m still enjoying medical school – the material itself is really satisfying and learning more clinically relevant things like exam maneuvers, EKGs, CXRs, etc., keeps things interesting. I’m also incredibly thankful to have my wife and son – they are both an incredible support system (though my son might not know it yet!) and I’m thankful for my wife’s patience and encouragement, particularly on those days that are rougher than others.

Since this blog doubles as a bit of a journal for me – it’s interesting even now to look back and read posts from a few years ago (including my somewhat cringe-inducing personal statement for medical school) – I wanted to mention that I’m still trying to decide what I want to be when I grow up. I came into medical school thinking that I would go in to Emergency Medicine, and to be honest that’s likely where I’ll end up. I have been trying to explore different specialties, but nothing really seems to fit quite as well as EM does. I’m looking forward to getting better exposure to some of the other specialties in third year.

One thing about Emergency Medicine that concerns me is the potential for burn out, which can stem from a variety of factors. I think people used to say that EM physicians burned out because, as a young specialty, those who were practicing it weren’t necessarily doing what they thought they would be doing – and to be successful in the specialty, you really do need to have a certain type of personality. And to some extent, that might have been true.

But it’s still happening. It’s still a concern for physicians today – residency-trained physicians who thought from the get-go that this is what they wanted. I think it is multifactorial – certainly, the shift-work aspect, which is often considered to be a benefit of the specialty (and can be, to be sure), can become a curse when you are 50-plus years old and still working on Christmas day or are unable to bounce back from night shifts as well as you used to. Obviously things vary from group-to-group in terms of how the practice structure is set up and how you progress through the ranks, but there are no guarantees. Also, something that’s somewhat unique to EM is the fact that, while some small groups or the rare larger corporation might provide some satisfaction in terms of how you can take part in influencing the group’s future or practice, all too often some physicians find themselves as cogs in a wheel for large corporations that care more about their bottom line, door-to-doctor times, patient satisfaction scores, and the like than they do about the physicians in their employ or even good patient care. That can understandably be frustrating for physicians.

There are a lot of great things about emergency medicine. It is appealing to me to be a jack-of-all trades and yet a master of acute medical care. The shift work, despite its negatives, is also nice – I’d rather work 3-4 busy shifts a week and go home than spend 80 hours in the hospital or be on call. The environment suits me well, and it pays pretty nicely to boot.

That said, I’m also considering a fellowship to give myself an “escape hatch” if needed, or at least to mix things up and hopefully keep things interesting. EM physicians recently became eligible to take part in a one-year pain medicine fellowship, which would allow them to work in an office-based settings (read: more predictable hours) in a stable group of physicians and use a variety of procedures and medications to, well, relieve pain. That sounds like a perfect yang to emergency medicine’s yin.

It can be difficult to get a fellowship spot as an EM physician and I’m not sure how the week-to-week practice of both specialties would play out (maybe 3 days/week of EM + 1 day part time in clinic? Perhaps locum tenens EM as desired + a couple of days in clinic? Who knows…), but it seems like it would provide a nice balance as well as a sustainable option that I could switch over to if I ever desire more predictability and more of an office-hour type job. We shall see.

Who knows what the future will look like? In the meantime, the week is over and the weekend is here. I’m looking forward to a bit of rest with my wife and son, and we’re all already looking forward to the next break!

Medical School: Round 2

Image from here

I’m sure you could tell from the distinct lack of posts over the past couple of months, but second year has started. In fact, we’re already about half-way through the semester and in the middle of our week-long fall break (the existence of which is probably one of my favorite things about Loyola). Finally, a chance to catch my breath.

Our pace has essentially doubled compared to first year. For example, last year we had about one test per month per class, and each test covered maybe 20-25 lectures. Not too bad, really. This year, though, we've had a test every two weeks, with each test covering about the same amount of lectures. So that’s been fun.

As I've talked about previously, the first year at Loyola – especially the first half – is sort of a hodge-podge of classes meant to get everyone up to speed and then cover some of the fundamentals. We started off with two classes that ran for about a month covering behavioral sciences and basic cell biology/genetics, followed by anatomy, and then picked up after winter break with physiology and added in immunology near the end of the spring semester. All throughout the year, we had our patient-centered medicine course (which covered things like patient interviews, basic physical exam skills, and various other topics that didn't quite fit in elsewhere).

Second year is a bit more systematic. We essentially have two courses – pathophysiology and pharmacology – that run simultaneously and complement each other throughout the year. So, for example, right now we are learning cardiac pathophysiology and also learning the relevant cardiac pharmacology as we go along. And of course we still have our patient-centered medicine course that runs throughout the first three years.

Although it’s been busier, the actual information has been quite a bit more interesting. Also, I’ve finally given up on going to classes. I essentially went to classes religiously all throughout first year, except for the last few weeks when my wife had our son. This year, though, keeping up on studying while also making sure that I can take evenings and most weekends off means that time has become even more of a precious commodity, and the time spent going back and forth from school, waiting in between classes, etc., could be better spent.

So, to try and be a bit more efficient, I purposely put myself a day behind so that I watch the previous day’s lectures each morning. The advantage of that is that I can get started a bit earlier than classes actually would normally start – and thus finish my day earlier as well. So far, it’s working out pretty well. I usually have to go in once or twice a week or so for various small groups and things, but that’s fine.

As far as resources go, I HIGHLY recommend Pathoma for pathology and SketchyMicro for microbiology, at least for the bacteria. Incredibly helpful. I’m still using Anki – I’m trying to really only make cards for so-called “high-yield” information. I’m basically converting the Pathoma lectures into cards, along with stuff from First Aid as we cover it, plus whatever information from lectures I think is worth including. Hopefully this will all come in handy for Step 1 – which, really, is not all that far away at this point. More than that, though, my hope is that this will drill this information in for the long term. We’ll see.

My son is about five months old now, and really starting to develop his own little personality. He’s also growing like a weed – he’s a little over twenty pounds and fitting into twelve month clothes now. Still not quite sleeping through the night, but hopefully that will come soon. Hopefully.

Although things have been busier, it’s been a good year so far. I’m thoroughly enjoying the time off with my family, and finally having the opportunity to catch up on all those little things that get pushed to the back burner when life gets crazy.