The doctor is out, part 3

May 28, 2007 at 9:03 pm (1st and 2nd year)

For crying out! I spent the last two years busting my ass to get through med school and now all I’ve got is a consistent series of mediocre performances on practice tests. Christ, I’ve never worked so hard to be average. All of that time spent in Physician Training made me realize what a raw deal I’ve gotten with respect to medical school. Instead of teaching us valuable things like vascular abnormalities and biochemistry, my school wanted us to write reaction papers to television shows and practice PowerPoint presentations via PBL. Lot of good those exercises are doing now.

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Quick post: extracurricular activities for an application

May 24, 2007 at 9:06 pm (Applying to med school)

Lots of pre-meds want to make their applications stand out by getting involved with extracurricular activities. The most popular things to do involve shadowing a physician, volunteering, clinical work experience, and research. Here’s my take on the issue of EC’s. The big thing is that your activities need to be meaningful. Most pre-meds don’t grasp that concept and somehow think that the application is a series of check boxes for them to join a dozen campus organizations without any real contribution.

Shadowing is pretty worthless. Most people do it to get a sense of what medical practice is like, but few applicants spend any significant time working with a physician. What’s worse is when students try to use these attendings for rec letters. If someone can’t immediately list ten positive traits about you with stories to backup each claim, move on to another letter writer.

Volunteering is good for an application as it shows altruism. However, you should only volunteer in a field that is meaningful to you and the people you’re serving. Pushing wheelchairs is not something I would regard as substantial volunteering.

Clinical experience is also good because you’ll get a taste of medicine. Again, hospital volunteering doesn’t count unless you actually worked with patients. One applicant wrote a personal statement in which he detailed watching doctors work in an emergency department. My take on his essay was that he hadn’t ever worked with patients and was clueless as to how a hospital functions. Some of the more common routes for clinical experience are CNA, EMT, and surgical tech.

Your “research” doesn’t count if it was for a class. If you want research, find a lab and start working with the graduate students. You’ll need at least a year—preferably two—to get into the scientific mindset. Bonus points for publications. Again, what was your contribution?

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The doctor is out, part 2

May 22, 2007 at 11:37 pm (Uncategorized)

I’ve been hitting the books pretty hard over the past two weeks. If you’ve ever seen the movie Groundhog Day, you’ll recognize that everyday I wake up at the same time, study for about 10-12 hours, and then go back to bed. Nothing’s worse than testing my current level of knowledge by taking a practice test and only getting half of the questions right. Then I remind myself—doctors are only half right most of the time anyway.

Just remember: Huntington’s disease = methylation of histones = silencing of genes = (somehow) dance-like movements. Oh, and tri-nucleotide repeats have anticipation.

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Is it too late to go back to graduate school?

May 19, 2007 at 8:52 pm (Life before med school)

I mentioned earlier that before coming to medical school I used to be in a graduate student in engineering. I went to a highly ranked school and worked in one of its top labs. When I was interviewing for a research position with this group, one of the associate directors told me that they were among the best in the world in their field. Naturally, I was excited about joining a group that pulled in nearly $5 million a year in funding. Unfortunately, I realized soon after arriving that everything was not as it seemed.

We had so much money because so many professors were lumped together in this group. We had multiple labs where anyone—from undergrad to post-doc to janitor—was free to come and go as wanted. We ran into several problems with this mentality. The first was that we had no accountability. A person could make a mess in a lab and then leave because the support staff (i.e., me!) never knew who the culprits were. I got tired of baby sitting 30-year-olds who would mix acids and organic solvents together not knowing that they were creating bombs. I’m all for building weapons and blowing stuff up. But if you don’t know that putting multiple chemicals together is a safety hazard, you shouldn’t be let out of high school.

The next major issue was the director of our research center. He did some pretty big research in the past and earned a spot on the National Academy of Engineering. Unfortunately, there seemed to be an inverse relationship between his people skills and his laboratory skills. For example, when I arrived, he had been director for 10 years and was currently on his 11th secretary. If that doesn’t scream, “Run!” then I don’t know what does.

During meetings he routinely insulted students, called their research “crap”—seriously, from a 50-year-old man—and constantly yelled at us to work more. I felt like the horse in Animal Farm: I will work harder. By the end of my first year, I was putting in 60 hours of work each week, even though I was originally hired to work 30.

Our director had everyone scared. People furiously scrambled to get as much done during the week as the could. Many of us came in on weekends to run experiments. Every week, each student was expected to give a presentation on the progress of his experiment. Therefore, I had to spend one afternoon a week creating a PowerPoint presentation when I could have been working in the lab. Therefore, I had to spend additional time at work so I could finish everything.

The moment he went out of town, we all took a sigh of relief and many people went on vacation. In fact, our director went out of town quite a bit throughout the year. He was gone so much to various conferences that he eventually lost track of what was happening in the labs. Although we gave him progress updates via our PowerPoint presentations, he hadn’t actually stepped foot in a lab in nearly three years. He ran no experiments of his own, yet by virtue of being the director, his name appeared on every paper that the center published. In fact, he was a co-author on several papers that he never even heard of. He taught me a very simple rule: he who works the least, gets the most notoriety.

Coupled with his ignorance of experiments was his arrogance that he didn’t actually know things outside of his field. For some strange reason, he one day decided that we should move into bio. Before that, I had been modeling the oxidation of gold surfaces. Now, I needed to run animal experiments.

The result was a disaster. We were laughed out of every conference we attended. I didn’t know what apoptosis was until I got to medical school, yet we somehow mentioned “apoptosis” in every presentation and poster we gave. We tried forming ties with researchers in the medical community to give credibility to our work. Unfortunately, our director treated the Ph.D.’s in the medical community much the same he treated students. Before long, almost every outsider dropped off of our project. We were left in the same position we had started almost a year prior—no results and no clue of where to go next.

During the spring of 2005 I graduated with my masters and immediately fled the university. I was gone never to return. When I was offered a chance to stay on for a Ph.D., I balked and said that I would never come back.

I mention this story because even though grad school was hell for me, I think that I was treated with more respect there than I have been in medical school. When I went through my M.S. program, I met students in other labs who were happy with their advisers. To date, I have never met anyone who hasn’t been treated like a child by medical schools. Sometimes I wonder: is it too late to go back to graduate school?

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Quick post: application numbers are rising

May 18, 2007 at 5:47 pm (Applying to med school)

During the past week, I’ve seen two medical blogs say that applications to medical schools are decreasing yet again this year. I want to set the records straight before this rumor spreads farther. Look at the graph below:

Applications vs matriculants

The AAMC recently released this study showing the number of applicants and matriculants each year since 1982. You’ll notice that the numbers have been increasing steadily each year since 2002. You’ll also notice that applications to medical school seem to follow a cyclical behavior. The AAMC does not try to explain this behavior, but I think that it’s due to the economy. When the economy is going great, people feel that they can make money in other fields and abandon medicine. When the economy turns south, college students flee back to medicine. Now look at the graph below:

Quarterly change in GDP, 1977-2006

Here, I show the quarterly change in GDP since 1977. Notice that whenever the economy is growing quickly, the number of applications to medical school drops five years later. Once the economy slows or enters a recession, application numbers rapidly rise. The lag is due to the time required to fulfill all of the pre-med requirements and to make the commitment to enter medicine. I touched on this issue in an earlier post. Now, the AAMC has released more data points further giving evidence towards my claim.

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The doctor is out

May 16, 2007 at 11:16 pm (Uncategorized)

I’m currently studying for Step I.  I hope to have some new posts in the near future.  I’ve got several ideas floating around in my head—I just need some time to write them. For right now, ponder this thought: If Purell joined forces with KY Jelly, they could create a formula called “Safe Sex.”

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Home school/med school

May 14, 2007 at 3:10 pm (Uncategorized)

One of the most popular changes to medical education is the video taping of classes. The idea is that students can re-watch videos later for review or, in the event they have to miss class, they can watch the videos to stay up to speed with their classmates. Administrators will warn students by saying, “These videos are not a substitution for going to class. They are there for a supplement.” At my university, many students try the home school method of med school. They stay home and watch lectures, only coming in for physicianship training and PBL. Their methods seem to catch on with others.

Just think, you can have class when you want, where you want. If you miss something during a live lecture, you’ll have to raise your hand and hope that the professor will repeat whatever he said. With the videos, you just press rewind and keep on. Further, several software programs such as 2xAV can speed up the videos, meaning that a 50-minute lecture now takes half and hour to watch.

At my school, several students routinely take vacations after every exam and then use the videos to play catch-up during the week before the next test. The administration has tried to do away with this kind of behavior by threatening to remove the videos or institute download delays. Their threats have been empty. Just this past semester, several classes featured as few as 15 students in regular attendance.

I’ve begun wondering what would happen if for-profit universities caught-on to the video phenomenon. In particular, I wonder what would happen if the University of Phoenix started its own home school/med school. I could see it now: I’ll get an email saying, “Need a medical degree now!?” Next, I’ll click on the link to see ACCREDITED stamped all over a website touting an MD for $50,000 a year—a good price for working professionals. By interacting with my classmates via online forums, I can participate in anatomy by ordering my very own cadaver.

The Department of Education might be a little annoyed. The New York Times may even hold an investigation. The end result will be the same. I can earn my medical degree in my spare time by reading Robbins and watching the video lectures.

Some of my readers may be laughing at this part. The truth is that many medical schools already do follow a similar plan. Ok, so I didn’t get any emails from American universities, but many students are using the home school/med school method. I know quite a few people with jobs, families, or other obligations that keep them from coming to class. Over the course of the first two years they would show up when necessary, watch the videos during their spare time, and then beat the class average on all of the exams.

I know that the idea of your doctor getting through medical school in his pajamas may sound scary, but trust us, we know what we’re doing—we’re professionals.

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Letter to my PBL facilitator

May 11, 2007 at 5:36 pm (1st and 2nd year)

You presided over a group of motivated medical students and managed to crush their will to the point of learned helplessness. In the beginning, our presentations were good enough to study from. But by the end of the semester, I spent less than an hour on my PowerPoint presentations. My classmates similarly had a steady decline in quality.

Whenever a student tried to contribute to the differential diagnosis, you didn’t just lead him away from erroneous thinking, your typical response was, “Think before you speak. Why would you even say such a thing?” You successfully management to keep us all from ever trying to add to the discussion. Surely you didn’t realize something was wrong when you kept asking at the end of the course, “Why is everyone so quiet?”

I know you went to an Ivy League school. You couldn’t help yourself in reminding us every week that you attended Harvard and know all about the PBL process. I wonder: did Harvard also teach you to be rude to everyone? Was one of the learning issues about crushing people’s will?

We had multiple guests drop by to see how PBL works. You demonstrated the opposite of what the school was hoping for. I think you even scared away two professors who could have done a lot for our university.

Your evaluation of me was the lowest eval I’ve ever received. While most of my peers gave me perfect scores and noted that I give great presentations, you wrote that I need to stop throwing out ideas without thinking of the mechanism of disease. I was only doing what I had been taught by earlier instructors. As I recall, formulating a differential diagnosis involves listing every possible disease, even the zebras.

You convinced me that I want to go back to lectures, where I could at least stay home if I didn’t like a particular speaker.

The worst example of your arrogance and inability to look introspectively came when you decided to give us advice about third year. Included in your talk were don’t be arrogant and acknowledge your shortcomings.

In summary, I hope that future generations of students don’t have to put up with your non-sense. You are a shining example of the physician that I hope that I never become.

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Quick rant: drug companies

May 10, 2007 at 8:27 pm (1st and 2nd year)

As doctors, you’ll notice corporate sponsors everywhere. It can be pretty simple, from a pen that says “Seroquil” to a stethoscope that says “Bayer aspirin.” I’m just waiting for boxer shorts that say “Correctol laxative.” And just look at drug companies. Life is hard. If you want to be thin, you have to exercise and diet appropriately. But drug companies take the work out of life. Don’t feel like exercising? No problem! Just take Lipitor to bring down your cholesterol. And we’ve got Viagra and Cialis. Boner pills for men who’ve given up on back massages, foreplay, and deep, meaningful, metaphysical conversation. All we need now is a pill that causes orgasms and we’re set. I can imagine some of the women reading this blog are nodding their heads in agreement. “Uh huh! Sign me up for that clinical trial.”

The drug companies run amazing commercials to convince people to buy medicine. Most of them feature a field of grass and make it seem if I take their pill, I’ll get a beautiful wife and a puppy. I want that disease! The commercials have me convinced. I go to my doctor to ask about the latest drug I need. He says, “You don’t have this disease.” I say, “What do you mean I don’t have… restless leg syndrome? This is my life we’re talking about!”

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The type of people you meet in medical school 2

May 8, 2007 at 10:15 pm (1st and 2nd year)

I’m following up on the previous post with some more characters you should avoid in med school.

My Parents are Doctors, so I Guess I Should be One, Too = this person doesn’t really have a defined reason of why he/she is in medical school. Usually, the rationale is rather vague until you hear, “Well, I wanted to become a chef, but my mother told me to go into medicine instead.” Ironically, even though this person has grown up around medicine, she will have the worst physician skills in your class.

Patient Killer = this person will be the first person in your class to kill a patient—usually during orientation. This person will be so inept, that he will not know that he lacks skills. Having this person on your team is a true nightmare because he will not know the basic tenants of medicine such as how to take a blood pressure. The hospital’s nursing assistants will constantly follow behind this person, carefully keeping the patients out of death’s grip.

The Giver = this person will bemoan everyday that passes without Socialized medicine. He will cry out for patients all across America, saying that every person deserves access to free care, that the Republicans are out to kill poor people, and that he will flee to Canada after graduation because the Canadians have it figured out. Hypocritically, this person will never volunteer his time while in med school.

Hypochondriac = every week this person will suspect that he has a new disease. If a lecturer gives a presentation on Lupus, this person will demand an ANA test, even though he does not have a rash. If you’re studying thyroid disease, he will want to be tested for both hypo and hyperthyroidism. Eventually, a random laboratory study will confirm that this student has pernicious anemia.

New Specialty Each Week = similar to the hypochondriac, this person gets more out of lecture than just notes. If an ear, nose, and throat doctor gives a talk, this person needs to become an otolaryngologist. When the radiation oncologist shows up, this person immediately starts talking about dosages of radiation. He will become a pediatrician.

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