Specialty Search: Pediatrics

Well...THIS IS IT! I finally know what I'm going to do with my life! :)

Coming into medical school, pediatrics was what I 100% wanted to do. Even before medical school, I thought that I "knew" that I needed to work with kids. Before I decided on medicine, I thought that maybe I would be a kindergarten teacher, than a high school science teacher, than a pediatric audiologist...Basically, I knew I needed to work with kids. However, once I got to med school, things changed. I realized 1) liking children wasn't enough to make you like the field of pediatrics, and 2) there were so many fields of medicine that I found fascinating. Specifically, the second I realized how much I loved OB/GYN and how much I enjoyed the 80+ y/o population on my internal medicine rotation, I started questioning everything about what I wanted to do with my life. So, once I FINALLY got to my fifth rotation, I couldn't wait to start the rotation that I knew would ultimately decide my future.

If you have been reading my past blogs (OB/GYN and Family Medicine), you might know that this rotation was really the deciding factor. If I absolutely loved Pediatrics, like I hoped I would, then that would be it. If I hated it, than I would do OB/GYN. If I liked Peds the same amount as OB/GYN, I would consider doing family medicine, as this would give me a little exposure to both fields, along with my beloved 80+ year-old crew. Even though I really don't love adult patients, especially the cirrhotic/heart failure/copd/anxiety/depression/substance abuse male population, I thought maybe the ob, gyn, and peds would make up for it. So, you can see how crucial this rotation was for my life decision making process.

The rotation is basically split in 2: 4 weeks outpatient, 4 weeks in-patient. Further, one week of inpatient is newborn nursery and one week of outpatient is "speciality week." I had a less than ideal schedule, because I started with specialty week and ended with the busiest shift (in patient floor), but what can you do?

Week 1: Specialty Week. Since my first day of the clerkship was orientation, I got 4 days in Specialty week. I was able to rotate through Peds Hematrology/Oncology (which I loved), Peds Orthopedic Surgery, Allergy/Immunology, and Peds Emergency Medicine (which I also loved). Overall, I enjoyed the week, but it was a little weird to start with specialities, as I had yet to actually examine a normal healthy child.

Week 2-4: Out-patient pediatrics. Starting this rotation, I thought the part that I would hate about pediatrics would be well-child visits. From my other colleagues, I have heard that the first few were fun, but they got old fast...well, i couldn't disagree more! I loved everything about out-patient pediatrics. I love that your day is split so that (roughly) half your patients are well-visit check ups and half are sick visits. I loved having a conversation with the parents and the children about what was happening in their lives. I loved how excited new parents were bringing their 4 day old child in to the doctor. I loved counseling parents and children about anticipatory guidance and health maintenance. At this point, I became pretty confident that pediatrics would be my chosen field, but I was not ready to commit until I had a little in patient exposure.

Week 5: Newborn Nursery. THE BEST WEEK OF MEDICAL SCHOOL! Seriously. How can anyone rotate through the newborn nursery and NOT want to do pediatrics? Your day is basically split into three. First, you go in, round on your babies - meaning, you go to the parent's room, ask them how the night was, look at some nursing notes to make sure there we no problems, and do newborn exams all morning. Have I convinced you that its awesome yet? No? Ok, let me keep going. The second part of the day is rushing over to L&D for any high risk deliveries. So, you get to still be involved with both vaginal and cesarian deliveries, but once the delivery occurs, you get handed the baby and provide whatever care the only-seconds-old infant needs. Its. so. fun. Have I convinced you yet? No? Ok how about this... the third part of the day is all procedural. Between Circumcisions and Frenulectomies, the number of mini-surgical procedures you do makes the day go by crazy fast. Finally, guess what happens when there is downtime? You go to the nursery, pick up a baby, sit in a rocking chair and cuddle/feed the babies. Yup, pretty awesome. It truly was the perfect combination of fun newborn exams, patient education (with family discharge planning), obstetrics exposure, and procedures. I LOVED IT ALL.

Week 6-8: In-patient pediatrics (1 week night, 2 weeks days).  I really really liked these weeks too! Pediatrics is a really awesome field because you do get to apply the medicine that you learn in the first two years of medical school. I felt like many times when I was on Surgery or OB/GYN, I ignored so much of what I learned in school, because they are surgical specialities and not "medicine" specialties. Even though Pediatrics is still a specialty, the parts of medicine that aren't focused on as much (copd, heart failure, cirrhosis) just happen to be the things in medicine that I don't particularly enjoy anyways. Further, the variety of the patients we saw was quite impressive. From the 6 weaker who was admitted for Failure to Thrive, to the 6 year old with Cardiofasciocutaneous Syndrome, to the 17 year old sickler, to the 4 year old with HSP, the variety of patients we worked with was enough to keep me intrigued and interested, while being able to avoid the adult diagnoses that I don't really care about. Also, although pediatrics is known to be a field with fewer procedures, there was still a good number of caths and LPs that would satisfy some desire in me for procedures, if i do end up choosing the hospital as my chosen area in pedatrics.

So, thats it folks! I am pretty dang excited to finally have a future! Although I have NO clue if i want to do general pediatrics or subspecialize or if i want to work in outpatient or inpatient, at least I know which field i am (hopefully) headed for residency! So, if all goes well, in 1 year, I will be Dr. Van Stavern, MD, Pediatric resident! Cross your fingers!

Specialty Search: Family Medicine

CLERKSHIP #4 = FAMILY MEDICINE 

I had mixed feelings going into this rotation. On one hand, it is known as one of the two rotations (along with Psych) that have SUPER awesome hours. Clinics would be 8:00-5:00 M-F, with the occasional 7:30-5:30 thrown in there. There was also only two half-day weekend shifts! So, I knew life would be good! On the other hand, I had done VERY little out-patient work at this point, so I was a little nervous about what to expect.

Our first two days of the clerkship were school records - SNOW DAYS! MSU is notorious for not every calling snow days, but this year we had two snow days in a row. (Thanks, Polar Vortex!) So, while it was incredibly fabulous to have two full unexpected days off, I was definitely ready to get back to the grind by Wednesday.

When Wednesday arrived, we got our schedules and assigned clinics. I would be spending about 1/3 of my time on campus at the "clinical center" where most of the docs we worked with during our pre-clinical education practiced. This was awesome for two reasons - 1) it was literally 3 minutes driving distance from my apartment and 2) the faculty were very used to working with students. I would be also be spending 1/3 of my time in a community clinic in Lansing with a doc who I heard great things about from our coordinator. Lastly, I'd spend 1/3 of my time in the Family Medicine Residency Clinic in Mason, MI. This clinic was about a 20 min driving distance (which was kind of a bummer), but there would be only 2-3 residents at a time with me being the only student. This meant I would get pulled in to all of the cool procedures and all of the cool cases. So, overall I was pretty stoked about all of my placements.

The rotation was a great one. In just 8 weeks, I felt like I learned A TON. Family Medicine requires you to know bits and pieces of all medical specialities - from pediatrics, to geriatrics, to ob/gyn, to orthopedics, to psychiatry. Although it felt like a steep learning curve at times, every doctor I worked with was phenominal. There were also a lot of extra workshops to be a part of during the clerkship - muskuloskeletal exams, suturing/dermatology clinics, and casting workshops - which were all very fun and educational!

I broke both my wrists :( 

...JUST KIDDING!

When the rotation began wrapping to a close, I realized how much I did enjoy it. I never really thought about being a family doctor, but I could totally see the appeal. 

PROS: GREAT hours, diverse patients, diverse disease processes, and continuity of care. Family doctors are literally the happiest people I have ever met in medicine. They get to see patients from birth until adulthood (if you are practicing long enough). You can tailor your practice to your specific interests. The need for family doctors is everywhere! There are 48 family medicine residency programs in california (yes, i looked this up!). I would be able to do Peds/OB work. Lastly, I actually really did like the out-patient setting, which was a definite surprise to me!

CONS: I really really don't like adult medicine...(is that bad to admit?). Also, anytime you get a patient that is complex (meaning...really cool), many docs that I worked with feel like they should refer. Lastly, I felt like a lot of the time docs were just acting as travel agents, coordinating patient care. In several situations, patients would come in to discuss many health conditions with their PCP, but all of these health conditions were managed by specialists around the city. 

So, as you can see - the pros WAY outway the cons, but there is still something missing for me with family medicine. So, while I haven't totally decided against family med, I think OB/GYN or Pediatrics is still higher in the running for my future specialty choice...but only time will tell! 

Specialty Search: OB/GYN

My 3rd clerkship of the year: OB/GYN.

This is one that I could not WAIT for! Between my first and second year, I did an externship at St. John's Hospital in Grosse Pointe, MI (See here) where we rotated through various sub-specialties and I got my first glimpse of the beauty of OB/GYN, so I couldn't wait to start! On the flip side, Ob/gyn at our hospital doesn't have the best reputation -- its known for being quite catty and for having many residents/doctors who pick favorites. Part of our grading includes evaluations from residents/doctors and this clerkship was known for people getting low evaluations that excluded them from honors (which I know isn't the most important thing, but it was still worrisome). Lastly, I was nervous because of the horrible hours associated with this clerkship. More so than any other clerkship, the amount of night shifts/24 hour shifts during OB/GYN would pretty much take up all of my weekends available in the clerkship to study/stay sane.

On the first day of the clerkship, we were handed our schedules and walked through what would be expected of us. My schedule was as followed: 1 week of orientation/lectures, 2 weeks of Gyn Surgery, 2 weeks of Labor and Delivery, 2 weeks of out-patient clinic,  1 week of oral exam/written exam/random wrap-up things and (of course) the dreaded 24 hour weekend shifts sprinkled in between. Overall, I was very happy with this since it meant I was ending on out-patient clinic (which had super relaxed hours) and I would have plenty of time to study! Also, just talking about the clerkship made me excited - finally something that I was truly interested in!

GYN SURGERY - My two weeks on gyn surg were great! Having just come off of an 8-week surgery clerkship, I was kind of ready for a break from the OR, but it turns out gyn surg and gen surg are totally different! Yes, there are some long procedures (ex: hysterectomies) in gyn surg, but I just loved that a large proportion of the surgeries were 45 minutes long. Get in, get out - get the patient home! I also loved that Gyn Surg is specialized surgery from the start. Learning specialized surgical areas to select body parts is way more interesting to me than learning general surgery. At the end of the two weeks, I was not ready to leave Gyn Surg... I wanted more! That has to be a good sign, right?

LABOR AND DELIVERY - This was definitely a roller coaster of emotions! It was high stress and you really had to put a lot of effort in to know what was going on when. Unlike surgery, live births aren't scheduled...obviously. So, if you weren't waiting outside your patients rooms at the right time, no one would call you and you would miss the delivery. Also, I had several moments where I really thought I screwed up bad, which is such a horrible feeling. Ex: my very first cesarian section (ever) was right when I was coming on at sign-out of my first L&D shift. The resident told me to run and introduce myself to the patient so that I could go in on a Cesarian section secondary to severe pre-eclampsia. So, I did as I was told. I walked into the patient's room and proceeded to say "Hello! My name is Kailyne and I am a medical student. I would like to observe your c-section today." At that moment, the nurse gave me a death stare and stated "She hasn't been told she was having a c-section yet." Worst. Feeling. Ever. In the end, it turned out fine, but still I felt like a piece of bleep. On the other hand, the L&D can be the happiest place in the hospital. What is more beautiful than watching somebody come into this world? I think the highlight of my whole medical school career thus far is doing my first solo delivery, knowing that I just helped a baby successful gain life. So overall, I really really enjoyed these two weeks. Even though its extremely high stress, you adjust. Once I got my footing and felt comfortable in L&D, it was my absolute favorite place to be!

OUT-PATIENT CLINIC - This semester, I have had VERY little time in the outpatient setting. Going from IM to Surgery to OB/GYN, I had maybe 10 clinic days total up until now. So, I really didn't know if I would like this or not. Well, I loved it! I love that ob/gyn clinic is also semi procedural. I love that there is some continuity of care. I love that this element is also so predominant in the field, because of how diverse the field of OB/GYN is. I had a really great experience and got to perfect my ability to do a pap smear, while also being able to rotate through subspecialties. I also wasn't ready for this to end.

FINALS WEEK - After my 7 weeks of the clerkship, it was finally time to face the music and test out what I had learned. This week, we would have both our oral and written exam. Up until now, I had screwed up the written by a few points to not allow me to honor the rotations, so I was ready to finally get that H. Also, I knew if I was really serious about maybe going into OB/GYN, getting that mark would be important....and sure enough...I honored!!! Finally!

What a great rotation. I loved every (well, at least almost every) minute of it! But, like every field, there are definite pros and cons:
1) PROS: Women's health is an interesting and important field, continuity of care potential, procedural field, diversity of patients and diversity of settings to work in, and the incredible rewards of obstetrics. I was never EVER bored and went home every single day with a smile. I looked forward to going to work every day and was very sad when the clerkship ended.
2) CONS: The two most obvious are 1) the unpredictable hours and 2) malpractice insurance. The only other real con is that you really do just have to give the babies away immediately. I will never ever see a pediatric patient, which I don't know if I can handle.

So thats it! It was a great rotation and definitely a possibility for my specialty of choice! :)

Specialty Search: General Surgery

The months of September and October were definitely a challenge. With the start of my 2 month long surgery clerkship, I knew that I was in for a long period of little sleep, high expectations and little sympathy for my complaints. Although I knew it would be difficult, I had absolutely no idea how to prepare myself. Even though S is a surgeon and he gave me as many pointers as he could, there isn't much you can do to learn the etiquette of an OR without just sucking it up and living through the trial and error.

The first week of the clerkship was kind of a joke. It consisted of lectures, suture clinics and IV drawing workshops. The hours were super easy and I loved every minute of it!

Too bad the easiness didn't last...

The next two weeks, I was on Trauma surgery; one week on days and one week on nights. These weeks were pretty good. The mornings consisted of rounding, upon rounding, upon rounding. Around 1PM everyday, the other med student and I would sneak away from even more rounding to go hang out in the ER and wait for trauma activations to roll in. There were a lot of MVCs, some GSWs, and a few burns/explosions. Overall, it was pretty cool! My week of nights was really awesome; when you are on nights, your team is responsible for everything surgical that goes on in the hospital. So, we covered all the traumas, all the pre-op and post-op surgical patients and anyone coming in with emergency surgical problems that needed to be operated on over night. So, we stayed busy and had a decent amount of responsibility, which is good enough for a medical student. Overall, I enjoyed my time on trauma service, but was ready to really get into an operating room and get my sterilized and double-glove-protected hands dirty with surgeries.

For the next 5 weeks, I spent my time alternating between the general surgery service and the "specialty" services that included plastic surgery, pediatric surgery, orthopedic surgery, colorectal surgery and many more! The first few days were awesome...the surgeries were cool, the gave us a decent amount of responsibility, and the majority of people were welcoming to students, which was a happy surprise on this rotation.

The rest of the rotation can be summarized in the good v. bad.

THE GOOD:
Overall, the cases were very cool. I really really liked the OR. I liked having patients that would come in with problems that you could take into a room, cut it out, sew them back together and occassionally fix the problem. It was a big change from Internal Medicine, in which a lot of the cases I just felt like we were playing a waiting game, without actually helping the patients. So, in that sense, I really did enjoy surgery. I also liked that during surgery, medical students have a job. It might just be cutting sutures, or retracting, or occasionally closing the skin...but we were able to use our hands and be apart of the action.

THE BAD:
While I did enjoy a lot of the rotation, there were definitely a lot of negatives. First, and most obvious, were the horrible terrible ridiculous hours. On a good day, we could show up at 6 AM and would be released by 6PM. However, Wednesdays and Thursdays we would have morning didactics, so we would have to be there and start work at 5 AM. What made this even worse, is that every few days, we were on call until 9PM-ish. I was a lucky student that happened to have a lot of Wednesday night calls. So, I would wake up at 3:45 AM, start work at 5 AM, stay until 9PM, get home at 9:30ish, and would have between 9:30PM-3:45AM to get everything I needed to do taken care of, eat and sleep. Yeah. It sucked. I knew that I could survive that short term, but man oh man I could never be a surgery resident that lived that every day. The second thing I didn't really like was everyone's attitude. Even though the residents and attendings were (mostly) all nice, you could just tell they were angry. It has nothing to do with the individual people...its just the culture of surgery that makes you that way. I know that it doesn't have to be that way and that there are many surgeons that this is not true for...but compared to Internal Medicine, there sure seemed to have a larger proportion of angry surgeons than IM docs. Finally, I didn't love the lack of continuity of care. Yeah, sure...there was some. There were patients that came to the service A LOT...like, several times in the two months that we were there. Also, doctors will see clinic patients, operate on them, and see them again for follow-up...BUT, it just wasn't the same. The care, for a majority of patients, seemed fragmented...and I didn't love that.

So, overall....I did enjoy the rotation. I'm 99.9% sure General Surgery is NOT my chosen field...but it was still a good experience. I learned a decent amount..and hey, you have to go through a lot of specialities to cross things off before you can figure out what you're calling is! Right?

Thats all for now!

Specialty Search: Internal Medicine

My first rotation of 3rd year: Internal Medicine.

I had requested this clerkship to be in slot #1 for a few reasons. First, I figured I would hopefully not sounds like a total idiot, having just come off of Step 1 studying; this unfortunately didn't matter and I now realize that I was going to sound like an idiot no matter what, but at least I tried. Second, I figured having this first would set me up well for all of the rest of the clerkships. Finally, I didn't think that there was any chance that I would like Internal Medicine enough to make it my lifelong profession, so why not take it first?

What I loved:
1) Amazing diversity of cases - Every patient was so different; loved seeing the rare and and interesting diseases I didn't think actually existed in my patients!
2) In patient setting - The really really really sick patients (meaning interesting/complicated cases) are all in-patient. So, the fact that the clerkship was 6 weeks in patient, 2 weeks outpatient was a BIG plus for me!
3) Knowing everything about your patients - IM doctors are the main provider for their patients. So, these doctors know their patients medical history inside and out. Unlike the other fields I have been exposed to, which only really care about the organ they specialize in, IM peeps look at the patients as a whole and know every little detail...its pretty awesome actually.
4) Flexibility on what/where you practice - IM has about 123928109 different sub-specialties and about 230432840 different settings you can work in. From a general internist that works mostly out patient to a cardiologist who does mostly in patient procedures, IM truly has so many paths. So, for someone like me who is indecisive on what they want to do, this is very appealing.

What I didn't love:
1) No pediatrics/obstetrical patients - Lets be real. I LOVE babies. I love teenagers. I love pregnant women. I love sexual health. So, the biggest thing that turns me off on IM is that this is the field that has none of these patients. Any time there is a kid, they are sent to family med or peds. Anytime there is a pregnant lady, they are sent to family med or OB/GYN. So, literally my two favorite patient populations are not included in IM. Big bummer.
2) No procedures. None. I literally did not do a single procedure on my two months of IM. I know there are some sub-specialities like cardio and GI that are more procedure-based, but getting to that means a lot of non-procedural rounding days. Don't know if I can handle that.
3) Talking, instead of doing: So.Much.Rounding. Literally all day is rounding. Sometimes it felt like we were discussing problems really thoroughly and spending a lot of time conceptualizing what was wrong with the patient, but that work didn't really translate into much improvement in the patients care. Obviously thinking about medical problems is important and the basis of medicine, but all day? It was too much.

So, overall...Internal Medicine was a great experience. I actually really did enjoy it a lot. I am unsure that this is my future profession, but I havent completely ruled it out!

First Few Days of Internal Medicine

3 days down, hundreds of day to go left of third year!

It has been quite the crazy last few days. From having my first clerkship orientation, to learning everything I would ever want to know in a 2-day 8 hour ECG work-shop, to having my first patients, to learning to navigate the EMR, and to finding out my score of just a little thing called Step 1 (but I'll get to that later).

Day 1: Monday morning, I went to Sparrow Hospital at 8 AM (which seems so late in the day now). We met with our incredibly nice clerkship coordinators in the morning to go over 1) the clerkship calendar, 2) all of the requirements, 3) how to honor, and many more important topics. It was amazingly informative. After the orientation, our little group of 5 students on the Medicine clerkship had 5:2 attention during a 5-hour ECG workshop (part 1) with two amazing Internal Medicine docs. They used the socratic method and basically put up and ECG, called us up to the overhead and made us interpret them even though we had absolutely no idea what was going on. Eventually, however, ECGs became (dare I say it) fairly easy to read and I know feel (somewhat) confident in how to interpret them! Who would have guessed? After the ECG workshop, we got a quick introduction to all of the different cases and logs we would have to complete on various websites and then got to have the rest of the afternoon to start reading and register for all of the millions of websites and research tools we needed to register for.

Day 2: Our first day with patients!!!! Gahh...I was so nervous. I went up to the 8th floor of Sparrow Hospital at about 7:10 AM. We were supposed to be there by 7:15 for morning report (where the night shift docs hand off the patients in a very systematic way to the daytime docs). I didn't really know what was going on for the first hand-off, but I think I did a good job pretending by jotting down notes in the margins of our patient list. After hand-off, the resident looked at me and told me to "go see the patient in room ***." And that was it...no shadowing, no introductory patient... I was just told to go see the patient and report back when it was time to round with the attending. I spent 1.5 hours with my first patient. I know, I know this sounds like an ABSURDLY long time to spend with one patient...but I am not efficient yet and I don't know whats important, so I pretty much got this guy's life story, which was quite fascinating. After doing a history and physical exam on my patient, I headed back to the resident room, checked some of his info on the EMR, went to meet with the attending, and gave my first real oral presentation (talk about nervous!!!). Much to my surprise, the oral presentation went really well! After all of the patients had been discussed and we had come up with plans for each of the patients, we rounded as a team to each of the patients' rooms with the attending physician to further speak with the patients. It was a really amazing first day of rounding and I learned a TON. I thought I was going to absolutely hate internal medicine, but I've loved it so far! After rounding, we headed back to a lecture room and finished our last few hours of ECG work-shop (part 2).

Day 3: Today was crazy fast-paced. I got in a little earlier (6:55ish) to look up my patients, but quickly ran out of time. By the time morning report and a quick resident-given lecture about acute COPD exacerbation was complete, it was 9 AM and I had only 30 minutes to round on 3 patients! 3! This time yesterday, I spent 1.5 hours on 1 patient! So, obviously I freaked out and didn't do well, but hey I guess its my second day and its not that big of a deal. I have learned my lesson and will show up earlier tomorrow! After a morning of rounding, we headed again to a lecture; this time it was split into a Q&A session (basically answering board-type questions in my little group of 5) and 30 min mini-lecture on anemias. Overall, it was a pretty good day, but I know that I need to get my s*#& together when it comes to rounding on my patients earlier/quicker/more efficiently, but I think that will come with time.

Oh...and something else that happened today...................I FINALLY got my Step 1 score. You know, Step 1..The exam that I spent a month intensively studying for. The exam that determines where/when I can do residency. Yeah, that exam thats kind of a big deal. We were told that the exam scores would be released to MSU early this morning. If we had failed, the school was going to page us to come in and talk about when we could retake the exam/whether or not we had to stop the current clerkship we were on. If we didn't receive a call, our exam scores would be released via email by 11 AM. So, I had to use all of my self control not to frantically check my email/text messaging every 6 seconds. Thank goodness that I had a busy morning, otherwise I think I would have gone crazy. Well, all morning I waited and waited...convinced that I would get a page. Finally, a little after 11 AM I got a text from a friend to tell me scores were up. I took that as I sign that I had passed and let out a HUGGGEEE sigh of relief. I decided a while ago that I didn't want to check my score for a while, but with EVERYONE around me telling me to check it, I finally gave in at around 4 PM. I made my friend Michelle stand with me while I opened it, because I was so terrified that I would burst into tears. So, after a few seconds of calming myself down, I pushed "view results" and closed my eyes. When I finally mustered up enough courage, I opened my eyes and *sigh* I could finally breathe! I was so so happy with my score. It wasn't the highest score I had gotten on a practice test, but it was close. Its a score that puts me significantly above average for most medical specialties, especially those that I am actually interested in. Its a score that puts me in a position that (according to the latest residency charting outcomes) "almost always grants an interview" at the majority of residency programs. So, yes. I did it! Such a relief. Good riddens, Step 1! I'm so glad that is officially over with!

Third Year Orientation

Last week, I spent my first of many long days to come at Sparrow Hospital getting oriented to what my 3rd year would be like. To be honest, about 50% of it was common sense or things we have already learned (ex: dress code, professionalism, how to give an oral presentation), but the other 50% was pretty useful information. Most important of this information was getting trained on two different EMR systems, which are ridiculously confusing. Hopefully it doesn't take me too long to really understand the EMR during clerkships.

In addition to lots of talks about what to expect during third year, we finally got our finalized schedules. We had a one-on-one meeting with our clinical coordinator months ago, so we kind of knew what our schedules would look like, but only our first rotation was guaranteed. Overall, I got almost exactly what I wanted...so I'm happy. My schedule is as follows:

1) Internal Medicine (2 months)
2) Surgery (2 months)
3) Ob/Gyn (2 months)
*Winter Break*
4) Family Medicine (2 months)
5) Pediatrics (2 months)
6) Elective (1 month) [Not entirely sure what I'm going to do...maybe a research month? maybe anesthesia?]
7) Psych (1 month)

We were also given our swipey badges to have access to all over the hospital and to get out of the parking lot for free (woo!)... AND we were given our pagers! All of us immediately whipped out our iPhones to take pictures of our new pagers, 'cuz thats pretty cool. At least, it seemed cool until our Clinical Coordinator stated that "we must have these pagers on us 24/7 from now until you graduate." Then, my whole class collectively realized that maybe we shouldn't be as excited for something that we will surely get sick of very quickly!

Now that I'm done with orientation, I have realized that this is it. Tomorrow morning, I will be marching into Sparrow Hospital to start my very first day of third year with real doctors, real residents, and (most importantly) real patients. I am so nervous, so terrified, so excited, so eager...but I feel like this is normal for an incoming M3 that has absolutely no idea what to expect for the next 12 months. Wish me luck for my first day!

Step 1 - Complete!

I did it...I took step 1! I can't believe thats its over. It seems like a dream and that I am really going to have to wake up tomorrow morning and have to take it for real! Thank god thats not true.

Now, I have a LONGGGGG 3-4 weeks until I found out 1) if i passed and 2) what my score is. So, in one sense, I want these next few weeks to fly by...but on the other hand, I only have 2 weeks off until I start 3rd year and I want to make them last as long as possible...

My impression of the exam:
When I was taking it, I thought it was going okay. There were several that I knew right away. There were several that took me a while, but I eventually I came to the right answer. And then there were few that I was totally and completely clueless about. Nonetheless, walking out after the 322 questions, I felt fairly confident. I thought maybe I could possibly pass and maybe do possibly ok? Hopefully? But, naturally, I started freaking myself out by going on different med school forum websites entitled "failing step 1" and now I have convinced myself I failed.

I know the odds are in my favor. Our school gives us a breakdown of how students do with similar grades as us. For my Block I-Block II averages, the absolute lowest score someone has gotten over the past 5 years was a 214 (which is actually 25 points above passing). Also, I know that with my practice tests, I would have to drop 50 points to fail. So, I keep trying to logically convince myself to stop freaking out and enjoy my time off, instead of worrying about the unlikely possibility that I failed. Sigh.

At least I have something to look forward, tomorrow S and I are going to HAWAII!!!! It will be a short trip, only 5 days because S starts orientation for residency on Friday, but we will have a glorious 4 nights in Oahu. We have lots of fun things planned including SWIMMING WITH DOLPHINS (one thing on my bucket list), a hike up to a crater, and a luau! And of course, lots of time laying in the sand on the beach doing nothing. I'm so freaking excited.

Step 1

Tomorrow. 06/14/2013 at 8 AM,  I will walk into the Pro-metric Testing Center in East Lansing, Michigan to take the 8-hour long USMLE Step 1 exam. I can't believe its finally here and that tomorrow I am actually going to take the exam that I have spent the last 2 years preparing for.

For these last 4.5 weeks of my intensive study period, I have spent approximately 12-14 hours a day slaving away trying to learn as much as I possible can. I have done more than 5,100 practice questions.  I have read over 1,000 pages of review books and watched/listened to over 40 hours of review lectures.  And in just a short 24 hours, it will all be over. All of time time and preparation I have put in will be put to the test.

I am so nervous, but also feel (hopefully) well-prepared. Now, all thats left is to just sit back, relax, calm my nerves and mentally prepare for the long long day that is ahead of me. Wish me luck!

ISP, Week 3

Another week down. Only 13 days to go until the biggest test of my life.

This week was a little rough. I have finally hit a point in my studying that I have learned SO MUCH in such a short amount of time that I'm starting to make good connections, but I'm also starting to get everything jumbled. I feel like I am forgetting a lot that I learned the first few weeks, which is quite frustrating. But, I know it all has to be in my brain somewhere and I have almost two more weeks to get it all straight.

This week, I debated for a while whether or not to take an NBME. I knew that I should, but I just had such a bad feeling about it. I was not feeling well about studying and I was starting to feel depressed...but in the end I knew that I would regret not taking one. Last week, I had gone up 31 points from my start and was at a score that I would be legitimately happy to get on the real deal. So, I was hoping to simply maintaining that score. This week, I felt myself struggle when I was taking the exam and marked a ton of questions that I second guessed myself on, but I tried my best. And again, I surprised myself! I went up another 14 points (for a total of up 45 points from the start). I have beyond surpassed any score that I thought I was able to achieve when I first started my study period.

While I am really happy with how my Step 1 studying is going so far, I know that I need to stop second guessing myself and have more confidence. I know that I am capable of doing well, but I seem to always shoot myself down. I think this is common for medical students, especially those that are studying for Step 1. Its so easy to compare yourself to other people who are studying other things or using different methods and think that you are doing every thing wrong. Its easy to compare yourself to students who seem to have it all together. Its easy to start to feel depressed or feel inadequate when you are surrounded by other students that for some reason seem to know everything that you don't.

I know that I need to just put my blinders on for the next two weeks and keep doing what I'm doing. I am improving. I am doing well. There is no reason to feel inadequate. I just have to get through the next two weeks...

ISP, Week 2

2 weeks down! 3 weeks to go!

Step 1 ISP is seriously the most I have ever studied in my entire life! It is really exhausting, sometimes tedious, but also very very interesting. I really do love about 90% of the stuff we are learning. This is so so different/better than studying for the MCAT.

This week, I slacked a little in the exercise department, slept in a few more days, but still got a ton of good studying in!  I focused on the Respiratory System and Cardiovascular System, along with trying to fit in some Pharmacology and Biochemistry/Immunology review. I am a little bit behind schedule on where I wanted to be, but not much. It definitely could be worse!

I just took my weekly NBME exam. If you remember last week, I said I had an (unrealistic) goal of improving 10 points each week. I was ecstatic last week after bumping up my score by a whole 14 points. This week, I definitely wasn't expecting any crazy score jump, but was hoping for about 5 more points. So, you can imagine my surprise when I finally pushed "view results" to see that I had jumped 17 points!!!! Thats right, folks...I'm up 31 points in just 2 weeks!! I am actually less than 5 points away from my ultimate goal score! Its such an encouraging feeling. I hope that I maintain this excitement throughout my studying for the next week, because I think I'm starting to get a tiny bit burnt out.

3 weeks and I will be done with Step 1 (hopefully forever) and laying on a beach in Hawaii with S. That sounds like bliss.

ISP, Week 1

Greetings, from ISP land! I am officially done with my first week of my "Intensive Study Period" for Step 1 studying! Overall, its been going pretty well. Its pretty insane how much I have learned/re-learned in just 6 days, but its also a really cool experience finding out just how much I have actually been taught over these last 2 years of medical school.

I have gotten into a pretty good routine this week that I really hope I stick to! My schedule is as follows:
8:30-9:00           Wake up/hit snooze/wake up again
9:00-11:00         92 UWorld Q Bank practice questions
11:00-12:00       Gym/Listen to audio lectures
12:00-1:00         Shower/Cook Lunch/Eat Lunch
1:00-5:00           Review Uworld Qbank questions/make flash cards
5:00-6:00           Dinner break
6:00-12:00         Read First Aid/Goljan RR books
12:00-1:00         Go home/do flash cards in bed until I fall asleep

This week, my "Reading FA" time was devoted to my 3 worst subjects: Biochemistry, Immunology, and Microbiology. I am definitely happy that I started with these to a) get them out of the way, and b) give myself a good base for when I start reviewing organ systems tomorrow.

Today, I took my second NBME practice exam (first one was sponsored by my school - [NBME]). The last exam I took, I was very excited to have passed, but knew I still needed a lot of work to do to get my score up to somewhere I would be really happy about. My big goal was to improve 10 points each week, but my realistic goal was to improve 5 points each week. Well, I am happy to report that I improved a whole 14 POINTS from my first practice exam!!! I'm sure I wont make that big of a jump again, but it was such a great feeling to have my hard work validated.

Since I took my NBME practice exam today, I get an easy day for the rest of the afternoon. I get to watch some TV and take a few hours off and relax. Then, tonight, I will review my incorrect answers from the NBME and review the chapters that I learned this week.

Also, since I'm on my break, I should tell all of you blog readers some exciting things have happened over the past 2 weeks. First, I turned 25 and now can rent a car ....woop! and 2) S graduated from medical school!!!!! Thats right, blog world, I am officially dating a real doctor! Im such a proud girlfriend.

Second Year Complete!!

I officially finished my second year of medical school yesterday! We had out last domain exam (Digestive/GI) from 8-10, which was actually really difficult...so we all waited anxiously for our exam results to be released at noon to make sure we passed. When 12 PM hit, I finally got to celebrate...I had passed the exam and was officially done with my pre-clinical coursework!

To celebrate, my friend Michelle and I went to the beach in Sleepy Hollow State Park! It was so amazing to have a completely free afternoon to lay out in the sun, have a few drinks (spiked 7/11 slurpies...yummm), and play with M's new pup Kuma!

Kuma

Spiked Slurpies

Beach Day

After playing at the park/beach for a few hours, we headed back to East Lansing and started to celebrate with our whole class...it has been so long since I have gone out to a bar in E.L, especially with most of my classmates. It was a great night and I'm so happy everyone came out to celebrate!

Couldn't have made it through the first 2 years without these girls! 

Story: This bar has all the tiles in the bathroom
covered with gravity...I did this one on my first night out in EL
and I found it when I went to the bar last night!

Today was my first day of ISP (intensive study period) for Step 1! Although I didn't do much intensive studying (only 3 hours of QBANK today), it still was a very productive day. I woke up late (11:30) with a pretty bad headache thanks to high doses of acetylaldehyde, but luckily that didn't last long. When I finally got up, I caught up on a few TV shows, picked up S's cap/gown for his upcoming graduation, signed my lease for next year, planned my ISP study schedule, went to my go-to study spot (Grand Traverse Pie Company) to study for 3 hours, went to the gym and am now finally catching up on blogging! It feels so great to have a day to do normal people stuff, because usually about 14 hours of my day is spent on school/studying.

Tomorrow, I'm going to really buckle down and put in my first 12 hour study day of ISP! I'm actually kind of excited to get started...wish me luck!

Boards Studying/NBME Practice Test

Hello blog world! Have you missed me? I know I have been MIA..but I have been rediculously busy. I promise to update everything from these last 7 weeks very soon, but for now here's whats been happening to me lately...

I am currently in my LAST week of pre-clinicals! Crazy! We are done with lectures, finishing up our last PBL case and have our last domain exam (GI) coming up on Monday. After that, its time to REALLY start intensifying my studies for 6 weeks before I take (arguably the most important exam of my career) the USMLE Step 1 exam! *cue scary music*

This week, a lot of things are coming to a close. I found out I passed my Clinical Skills Gateway/Exit Exam (which is a half-day testing that involves doing different clinical skills exams/interviews...kind of like Step 2CS for all of you medical students out there). I finished our last Clinical Skills experience (Phlebotomy). I turned in my last paper for Medical Humanities. We are currently working on our last PBL patient case. AND... we took our first NBME Step 1 practice test! I actually just got my score back about 10 minutes ago....the verdict: I actually passed! I didn't do great...but I passed! I'm so happy. Now, I can spend the next 6-7 weeks getting my score up to a place I want. I am not sure how many points students usually jump during their intensive study period...but I'm hoping the fact that I was able to pass without any real prep is a good sign. *crosses fingers*

Well thats all for now... Many new blogs to come, including my spring break trip to NYC, a research conference in Galveston, Texas, and all of the match day/4th year adventures S has been a part of over the last few months! But, now its time for me to get back to the books and learn all things G.I.

Phlebotomy lab! 

Spirometry Lab

This may be the nerdiest post I have ever written on this blog, but hey... this is who I have become!

I am currently in my Pulmonary Domain, so last week we participated in a Spirometry Lab practical. The lab wasn't required, but was "highly encouraged", since it would help to solidify concepts we have been learning over the last few weeks. So, I thought I would go. While it definitely did help solidify my understanding, I was not anticipating how fun/entertaining the lab would be.

We started off, by assembling our Spirometers. This is a device that is used to test breathing flow/volume. As you inhale and exhale, a computer program will map out exactly how much volume of air you take in or out, and how quickly or slowly you do it. After we assembled the device, we conducted our first phase of our lab. We used the spirometer to measure our normal airflow. We then had the computer make a Flow-Volume Loop graph with this information. Next, we used a straw connected to the spirometer and did the whole thing over again. This was to imitate someone with COPD. Sure enough, the Flow-Volume Loop that we constructed mimicked exactly what we thought would occur with someone with an obstructive condition. FINALLY, we conducted one more round, by tying each other up with scarves so that your chest wall doesn't have much movement. This round was to represent a restrictive disease, like Pulmonary Fibrosis. Sure enough, our lab results again predicted exactly what we thought would occur. Its great when that actually happens haha.

"Pulmonary Fibrosis"

Recording our results

"Normal" Flow-Volume Loop

COPD/"Obstructive" Flow-Volume Loop

 This was a really nice change from book studying. To understand the concepts we are learning in a practical manner and to be able to physically see the results from different changes to the lung, I think that I have developed a good understanding of these pulmonary concepts. Plus, we had lots of laughs and a nice study break!

But now, I have less than 1 week left before my pulmonary final..so I I have got to be getting back to the books!

Finals Week

Another semester down! Only 1 more semester until 1) I am done with pre-clinicals and 2) I have to take boards. Its absolutely crazy how quickly this last semester went and I know that next semester will be the same, if not even faster!

This last round of final exams was much different than those of M1 for a few reasons. First, the M2 year is based on block exams (meaning we have a final exam every 2-4 weeks) and we only have 1 main class at a time. So, while all of our grades are based on a 100% final exam for each block, we at least have the opportunity to focus the majority of our time on studying for these domains. Second, I feel like I finally have a scientific background on subjects that allow me to dive right in to the material, instead of having to spend half the class understanding the basics. While I loved my major at UCLA, I think that coming from a non-science heavy major kind of put me at a disadvantage last year...fortunately, I think that having my M1 year under my belt, this disadvantage is over and the playing field is now even. Thirdly, the three final exams that we did have all happened to be some of my favorite courses: Clinical Skills, Epidemiology, and Psychology. So, while finals are always a little stressful...I felt more comfortable with these subjects than others that we have had in the past. Finally, our school put on an AMAZING and supportive finals week that was full of relaxing activities to help us poor med school students out. These activities included pet therapy (an afternoon playing with puppies), art therapy (art supplies out for a quick relaxing break of exercising our creativity), free chair massages (clearly amazing...I don't think this really needs an explanation), and lots and lots of free snacks/coffee.

Pet therapy! 

This semester ended wonderfully. My overall final average for the semester is my highest yet and I feel like I am finally getting the hang of this whole medical school thing. Lets just hope this confidence continues into next semester and into my board studying!

Animal Procedures Lab

Two weeks ago, I got the opportunity to participate in a really unique learning experience! Every 6 months, the Emergency Medicine residency program at Sparrow Hospital puts on a workshop for their residents to practice some skills that are rare in the emergency room. These procedures are done on anesthetized pigs and include Chest Tube Thoracotomies, Transvenous Pacemaker Insertions, Surgical Cricothryotomies, and Resuscitative Thoracotomies. For these workshops, 8 medical students are invited to come and participate. Because its such a small number of spots for the 200 first and second year medical students at CHM, the opportunity to sign up for a spot goes QUICK...as in, as fast as the Spice Girl's Reunion tour tickets selling out...as in seconds after the email goes out! So, although I really wanted to go, I knew that the chance would be slim. Miraculously, I got one of the 8 spots available during this semester! And...

IT. WAS. AWESOME.

Seriously. Such an amazing experience. For any CHMers that read my blog, you MUST try to go to the next workshop. It was really amazing working 1-on-1 with residents and learning how to conduct these procedures first hand. From lots and lots of suturing practice, to holding a live-beating heart in my hand, to putting my first chest tube in (and having my glove rip while my bare finger was inside the pig's thoracic cavity), it was truly an experience I will never forget!

Suture Clinic

Last week, I went to a skills lab offered by the Emergency Medicine Interest Group to learn how to suture! Even though I don't really think I will be going in to Emergency Medicine, every doctor needs to know how to suture... So, I was really excited to learn this skill.

We worked 3:1 (3 students:1 emergency medicine resident) on our suturing skills and learned several different types of knots. These sutures included a simple knot, a two-layer suture, a horizontal mattress, a vertical mattress, and a running stitch!

My first suture: Simple Stitch

Horizontal Matress and Vertical Mattress

2-layer suture (used dissolvable layer underneath)

Running Suture

I had a really great time and learned a lot...Suturing was definitely not as hard as I thought it would be, but I guess thats because I was suturing on a pig's foot and not a little kid thats moving around while I'm trying to sew...

Hem/Onc

Welp! I haven't blogged in a WHOLE MONTH, because I have just survived the hardest domain of my second year curriculum- Hematology/Oncology. I was warned about this class from 4th and 3rd years basically since I entered medical school...so I was prepared to put myself in hibernation and learn the heck out of the subject for the month.

After many long hours sitting in our underground silent cubicle study area, referred to from students as the "nerd cave", after gaining about 10 lbs because there was no time to exercise/grocery shop/cook healthy, and after many nights of under-sleep, Monday morning was FINALLY here and it was finally the moment of truth -- exam time. Our exam started at 7:30, which meant doors opened at 7 AM...wayyyyy too early to think critically, but hey, there was not really any other option! The exam was 120 questions, which was also a challenge. This was the longest exam we have had up to date. The second longest exam thus far was only 90 questions, so this also was an added stress of this exam. Nonetheless, by 9:00 AM, I had finished the 120 questions, double-checked a few unsure answers and fearfully hit "submit". I then collected my belongings and left. From calculating the number of questions I knew I had definitely gotten correct, I was fairly confident that I had at least passed the exam (a 75%), but wanted the official grade report just to make sure.

The official grades arrive every exam day at 12:00 noon...This is directly after our first PBL group of our next domain. So, usually my fellow students are fairly brain-dead from a morning exam and constantly re-freshing their emails until grade reports are sent out. This was definitely the case for me during this particular Monday.

So, when 11:55 arrived and my last re-fresh of my inbox finally showed an update, I fearfully opened up my grade report and let out a huge sigh of relief. Not only did I pass, but I did pretty well! What a relief.

After getting our grade reports back, it was time to celebrate. For lunch, a group of us went to an Indian restaurant for a delicious lunch buffet. Michelle, Caela and I then (finally) went to watch the last Twilight! [side note: I have been to almost all of the Twilight midnight premiers, so I was pretty sad that I had to miss the last premier to study Hem/Onc...finally getting to see this movie was the BEST post-exam gift.] After the movie, we went to forever 21 to costume shop for 90s costumes. Our class was having a 90s-themed post-exam party that night and the G-Phi in me (who LOVEEEESS costume parties) was all about finding the perfect costume. Caela and I decided that we were going to buy matching outfits and be Tia & Tamara Mawry from Sister-Sister!

Roomie love. 

Now that I'm done with Hem-Onc, I feel much more confident about myself in medical school. This was always one of the big humps that I never thought I would overcome, and now that I have....I'm even more excited about the rest of the year. We will see how long this lasts as boards approach haha.

Step 1

So, this happened today:

Yes. This is my registering for my board exams. I can't believe I am already getting to this point in my medical education....crazy.

For my non-medical student readers, the USMLE (United States Medical Licensing Exams) are broken up into 3 parts. The first part is taken after your second year of medical school and tests all of the basic-science knowledge. The second part is during your fourth year of medical school and the third part is during residency. So, I know I am only starting in my long string of licensing exams, but its still pretty crazy that I am already at the point of Step 1!

Besides registering for my Step 1, I also had a final exam today! So, far I have completed 4 classes; 1 ethics class and 3 blocks: Neurology, Infectious Disease, and Musculoskeletal. So, although I have not been blogging as much as I would like to... I sure have been a busy bee in all of my classes.

This year is going by RIDICULOUSLY fast.... I am officially more than 50% done with this semester. Only one more domain until Thanksgiving break (Hematology/Oncology) and one additional domain  (Psychiatry) until Christmas! :)