Wednesday, December 25, 2013

MERRY CHRISTMAS

HAPPY HOLIDAYS! MAY THE NEW YEAR PA OUT AS YOU WISH!

Tuesday, December 17, 2013

Ramblings of a medical student: The spar



The smell of sweat, permeating everything, hand wraps, cloths, the air. The smell of the gym and the backdrop of voices and grunts of hard working people. It all syncs and swells into oneness once your gloves are on, groin cup and shin pads. Its there but not there any more. Suddenly the first punch comes. Now theres a vacuum. All around you seems still. Its just you and your opponent. No extra tools, just your head/brain plus your 8 striking parts. Between advanced skilled individuals it becomes uncheoreographed synchronized dance, where a punch is met with a slip and a counter attack.

Tuesday, November 26, 2013

How to take advice like a medical student!



"I got a 240~" a resident I was speaking to let on. My eyes perked up, I need to know what books he used. I made him illuminate his studying method and his resources.  "I read through the book only once. blah blah blah." Wowww...! Hold up! "One time." This advice was not for me.

Advice is great. I am always willing to lend an ear to things that help me improve. However not all advice bears relevance to me or my situation. This is not to say that these same recommendations are nonsensical. It might have worked for the advisor and so is relevant to him.

I remember during pharmacology II during my basic science spiel on Sint Maarten. I created questions from the lecture slides and supplemented those with questions from Benji's website. (if you are considering AUC as your path in medicine make sure you check out his website. really insightful.) I used these questions as my sole studying material. Needless to say I did extremely well in that exam. A friend of mine that missed the exam asked me how to study for the exam. I gave her my list of questions (the same ones i used to study), a couple hundreds. She tried using them for a few days but soon after she gave up on that method. I'm not certain what method she used but I believe she did well too.

In that scenario, my method of studying worked for me but not for her. This is because we all have different strengths, weaknesses, preferences, different things that we consider tedious, and different ways we assimilate information. As a result some study methods  work well for others and might not work well for their friends.

Before you receive advice you have to know yourself. You have to know your strengths, your weaknesses, your preferences. For example if you know there is no way under this sun that you would wake up at 5 am in the morning starting your studies at 5 am in the morning would be equivalent to self deception.

Next find someone that has similar issues in assimilating information as you do, and seems to have similar strengths and weaknesses as you do and try following his advice and see if it works. If it does not ask someone else for help or try something else. 

Monday, November 18, 2013

What everyone/thing wants from a medical student...



There is one thing that you own that everyone wants; your family wants it, your girlfriend wants it, facebook (if you are so inclined) wants it, your friends want it, your email wants it, sleep wants it, extracurricular activities want it, studying wants it. If time was the first thing you thought of reading this you are right. There just does not seem to be enough time to do everything you want. As a medical student how do you find the time to do what is the most important for your time as a medical student.

As a medical student you will find that 24 hours a day does not seem sufficient. The semester starts, you sleep and wake up and already there is the first exam. After that exam, you blink and there is the next exam. Time just flies. There seems not to be enough time.

You studied really hard for your first block. Your results come back. Whew you survived. Now its time to relax. You take a week off from studying. You relax, sleep, talk to family, talk to your girlfriend, wife and spend time just doing whatever you want. The next week you say I will start tomorrow. That tomorrow turns into another week. Now you have two weeks to grind. You grab your books sit in your favorite spot and grind. You study hard but now you are spending time catching up. You need more time but oops now its 11pm and you need to call your girlfriend/family. Finally, blocks (exams) are tomorrow and you know you have to cram all night. This happens over and over again. Its a vicious cycle.

How do you deal with this? Haaaa. You on your own.

Just kidding. The best thing to do is to study  a little everyday. Yes. This is nothing new; its common knowledge. As such I'm sure you have tried to implement it at one time or another. Considering how much information you are able to assimilate on the day prior to your exams this should be a cinch. Suprisingly, it is not, you pull out your books/notes and read. For some reason you cover only a little bit of material you need to. If its even 45% (arbitrary number of the top of my head) of what you are able to cover on the day prior to the exam you are doing good. Unfortunately, more than likely it is not. Then you wake up and its already the eve of your examination and you still have to cram most of the material since you have not been able to keep up irregardless of the fact that you tried to study everyday. Why?



There are many reasons for this. They vary depending on individual. One common reason relevant to myself and a few others I spoken to appears to be pressure, ie the pressure you feel from the proximity of the exam.  The further away the exam is the less pressure you feel. With the pressure lifted  you feel you have more time to do other things. All of a sudden you have many things vying for your attention, things that you would not conceive on the day prior to exams. You dont push yourself to finish your alloted readings because you feel you have time to catch up. Catching up... ... (Now thats one dangerous phrase, but thats for another blog post. )  The exam comes around and you are cramming again. After this trial you return to your old habits.



Knowing what to do does not seem to be enough at times. So how do you handle studying with hard even when the exam is far off. You can approach it in two ways: 1) create your own pressure or 2) work without pressure. I can not speak for creating pressure because its not the route I took. Maybe reminding yourself constantly of the importance of the exams etc might help. Maybe... What I advocate is akin to nike's slogan, " just do it." Do not think, Do not rationalize... Just make a plan that you believe will help you spread your material over everyday (excluding weekends of you so please) and then blindly follow it like a robot. Just make blindly complete your daily goals.  In a week or two you can look back and see how your plan is working and tweak things.

This worked for me. And I hope it works for you.

Wednesday, November 6, 2013

Will she ditch her boyfriend for a Ferrari... lol.


A case during my allergy rotations...

With my stethoscope around my neck, wearing my short white coat, screaming medical student to anyone aware but apparently not so to patients, I called in my patient a recently born baby girl with possible allergies. At that time I was rotating at an allergy clinic in Bronx lebanon, a time I would describe as educative and fulfilling. I liked the level of responsibility that was permitted me. My attending took the time to review topics with me. It was great, he was great. I got to practice all the techniques I wanted and got to visualize many physical examination findings that I had read about but never seen prior. Also, being called doctor after I had previously informed them that I was a medical student made my head swell. But all of this is not what I wanted to talk about.

So there was a 3 month baby brought by her mother in for an evaluation of possible allergy. The story was right after receiving her 2 month old vaccinations she had an episode of syncope. As per mother patient started crying after being vaccinated and then syncopized. No rash, difficulty swallowing, dyspnea, or fever was present. She was kept for observation in the ER for a few hours and then allowed to go home. There was no recurrence of this syncope. The question i pose to you readers is what would be in your differential diagnoses for this patient???

answer next week.


Vine.

Tuesday, October 29, 2013

Of all the odd things...

... in this world a 4 yo mayor. Aiiii. A town in northern Minnesota elected a young child as its Mayor. Is this a prank was the first thought that passed through. Looking at the source it is quite unlikely to be. Is being the Mayor of that town so insignificant that anyone can do it even a child. hahaha. Ever heard of those jokes even my grandmother, my grandfather, my daughter or son can do it better. Well we have a prime example right here. Below is the link to the article for your viewing pleasure...



On a side note everyone has a friend that never offers to contribute gas money but always wants a ride. What if you did this.... hahaha i kid. 
http://www.youtube.com/watch?v=unShRhci-Iw

Tuesday, October 22, 2013

How to invest like a medical student: pearls of wisdom



Sitting, feeling sick. A slight fever with fatigue. Yes, I have had contact with an ill person, an answer to one of the questions I always pose my sick patients. Today, I will leave a quote I passed onto a good and old friend that continues to lose money in the markets. It imbues the mentality with which I approach the market. One does not have control over the direction in which a stock will move. Consequently one can simply not avoid making any losses altogether. However one can:
 

Minimize one's losses in stocks till one finds that one or two or three stocks that are moving in the desired direction.


Tuesday, October 15, 2013

Ramblings

Nothing much going on but its my resolve to post every tuesday so here is nothing. hahaha. Tried getting up around 5 today to do some ck studying. Quite ambitious. I woke up to my alarm blaring and instantly snoozed it and knocked right back out. There has to be a world record there somewhere. Finally woke up at 6 did some work and then headed to muay thai class. Its always great to get a good sweat on. Now I'm completely beat.


Wednesday, October 9, 2013

Thoughts on Step 2 cs


Like I said before I did not complete one of my notes, additionally I am not enthused with my performance overall. There a few more questions I could have asked, a few more physical exams that I could have performed. However, it is a focused exam with time limitations so I hope I did enough to pass. That said, the whole exam is organized to make things run smoothly. I can not divulge anything about the exact cases that I was tested on so I will not talk or answer questions about the actual cases I had.

I got to the center about thirty minutes early. We waited in the lobby for a few minutes. From there we were ushered upstairs and after confirming that we were scheduled for the day we were moved into a room with a locker for our things, a bunch of wooden desks and a tv. We watched the orientation video below; its the same one that is on the Step 2 cs website. After this we got to play with the tools that we would be using. Then it was down to business.

There were two scheduled breaks. During the first break they served some food. Nothing too extravagant but good enough to provide the fuel needed for the rest of the day. So if you were like me and only showed up with a pack of gum you were all set. Hey at least some of that exorbitant fee for taking this exam went towards food.


I was allowed to use my long coat. thank goodness.

The staff was helpful and did not do anything to distract us from the task at hand. The patients played their roles well. We played our roles. Now I just sit and wait for THREE MONTHS. This is so long. They have to change this lengthy waiting period.

This brings my posts of Step 2 cs to a close. Hope you enjoyed it.  

Update:
I failed!!! I was devastated. How could I fail the CS exam?? Thinking back there main reason was that I did not prepare myself adequately.

On my second attempt, I made sure to devote sufficient time and as well as practice to the exam; I made sure that I understood what they were looking for in grading the exam. I passed, but man that blemish will be on my record forever.

This is now about two years after the exam and I have tutored others to make sure they do not fall where I fell.

My advice to you, if you are reading this, is to not take this exam lightly. Study appropriately with knowledgeable partners and you will pass. Any questions let me know.

Good luck.

Tuesday, October 8, 2013

So whats next?


Currently in bed with a headache. Step 2 cs is done. It was long in the beginning but then it just breezed by. The only thing that worries me is that I did not complete one of the notes. For now its wait and see. Three months is a long time.



Countdown to step 2 cs: Its D Day:


Woke up at 5. snoozed the alarm and woke up again at 6. Showered, did a few push ups and now i'm having breakfast. See you after the exam! Wish me luck!

Countdown to step 2 cs: 1 days left:


Did some practice cases in the morning. Then went shopping for a shirt and white coat. I found found easily. But guess what when I got home and opened the wrapping for the white coat it was a full length attendings coat and not the short medical school version. My goodness. I tried it on in the store all the lady had to do was retrieve the same coat. I told her I was a medical student. Aaaa. well.... thats water under a bridge now. It will be handled, all that is left is to focus on my exam tomorrow. Later that evening i practiced my cases.

Monday, October 7, 2013

Countdown to step 2 cs: 2 days left


I woke up, practiced my full physical examination and then focused on my neurological examination. Around 4 pm I drove off to showdown site, and checked into the sheraton a block away from the test center.
 At this point I have already gone through all the cases in first aid, and have reviewed the mini cases multiple times. In the evening, i reviewed a full length case and noticed i had tunnel vision because i knew what was coming and what answers were expected in the case. The solution for this is to  treat every case like new, like its the first time you are seeing it, ask open ended questions, and figure out solution from scratch.

Finally, I am meeting my time deadline of 15 minutes per case. For this to happen I changed my approach to being more focused both in the amount of questions and in the physical exam. Now I do not ask every question under the topic instead i get chief complaint, the associated problems and get descriptions of all problems (quality, duration, location etc.)

Later while lounging in my nice hotel room, I noticed I left my white coat and shirts at home in my haste. Not to worry, there's macy's close by. Tomorrow I will do some shopping. This is why you always give yourself some time leeway. Good thing I arrived a two days prior.

Tomorrow is my last free day before D day. Will iron out a few details and just practice to make sure I have the overall routine to approaching the patient down.

Vine: That moment you see you are in the same class as someone you know.

youtube link: http://www.youtube.com/watch?v=KxG035tQJ8c

Sunday, October 6, 2013

Count down to Step 2 cs: 3 days left


In the afternoon, I completed all the other cases with my buddy. After this we went over performing a full physical exam to make sure I was doing my physical exams correctly. In the evening, after practicing , I packed my bags and headed to my girlfriends house. I will go through the physical exam a few more times and also review some of the cases i found difficult. Then around 2 pm tomorrow, Sunday, I will head of to philly.

I have a splitting headache. Most likely a tension headache, quite possibly caused by the lurking exam.



Count down to Step 2 cs: 4 days left


I practiced 5 cases with a medical school buddy. He pointed out a few things i could tweak here and there. The pressure of the exam being so close is beginning to hit me.

edit: this post is from two days ago. 


Friday, October 4, 2013

Countdown to step 2cs: 5 days



I made a lot of progress. I now have only nine cases to go through, meaning I will have seen all the cases at least once ahead of the planned time, saturday. This leaves saturday to do some revision.

Today, I went through 13 cases: 9 back to back in the afternoon, and 4 back to back in the evening. This time i spent ten minutes after every case writing my notes. My head felt really stuffed and heavy after about the 6th case but i pushed on.

Issues:
1) still struggling with time. My best time was 10 -11 min but that was a pediatric case that involved no physical exam. My best time with adult cases was 15 min. My slowest time was 22 min.
2) Enuresis, rape,  mva, and pregnancy cases

Solution:
1) time: stick as closely to pneumonic as possible and then after ask extra questions.
2) make a list of cases that I need to focus including the ddx, diag wkup, and questions and review them daily





















Side note: its thanks to my sister and girlfriend that I have progressed so quickly!

Thursday, October 3, 2013

Count down to Step 2 cs: 6 days left


I followed my normal morning routine so there's nothing to write about there. In the afternoon I did 3-4 cases with my sister and then 8-9 cases  back to back in the evening with my girlfriend. I was inconsistent in asking about the job, stds, drugs. At times I would ask at other times I would be so caught up in the case that I would forget. Also, I need to work on my DM and HTN follow up visits, and to work on being more observant of the patient, what they are doing and their environment. I might have missed things because I was exhausted but exhaustion is can not and will not be used as an excuse. I have to be on point always. Will review what i missed tomorrow morning in addition to the usual.

Today my best time for completing the patient section was 16 minutes.

modifications:
1)for chronic cases always screen for depresion
2)for each new complaint get a description ( if in ros there is pain somewhere else rewrite SIQORAAA, if there is another complaint rewrite DOCPAAA, and if there is vomitus get descriptions and ask if blood or mucous and ask to descrip.
3)for social history use pneumonic to remember alcohol use and drug use work etc.
4)for sexual history use pneumonic to remember std, protection, types of partners, counsel
5)counsel as you go along 
6)focus focus focus and pay attention to details around you.

Wednesday, October 2, 2013

Countdown to Step 2CS: 7 days left


Day 1 of step 2cs studying was fine. I took it a little easy to ease myself back into the groove of going hard, and to let my sister get used to the format. By easy I mean I did only four to five cases back to back. Tomorrow, I will do 6-7 cases back to back. I will now detail how I organized my day and what i have learned.

In the morning, whilst in my car  for an hour and a half awaiting the end of alternate side parking,  I reviewed/memorized the blue sheet structure and mnemonics outlined in laura's video. (check out my earlier post) When i got home i looked over some mini cases mainly to review differential diagnoses as well as the possible lab tests to run. I also read through the special scenario section, which details how to handle difficult patients, questions, ethics etc. Then i relaxed.

At 2 pm, I practiced 4 cases, with my sister being the standardized patient. Then we took a break till 8pm at which time we did the remaining 5 cases. I did not write up any patient notes today. The longest time I took to complete a patient encounter including the physical exam was about 22 minutes, with my best time being 18min (technically it was 12 minutes but that was for a short pediatric case so i'm not counting that.)

I noticed that I occasionally missed a few things: asking permission to start physical examination; counseling about smoking or sex (this was at the end so maybe i was tired); and for pediatric cases hearing, vision, vaccination, and last check up. I will make a list of the things that i keep forgetting to do and just review it everyday, especially on the morning of the exam. To make sure I dont neglect to counsel patients with bad habits i will place a big star beside the desired section (smoking, drugs etc) the moment i write down the information.

Tuesday, October 1, 2013

Neymar vs Celtic Away HD



Neymar was trully jostled, kicked, pulled elbowed  throughout the whole match against celtics today. If he can toughen up like messi  and grow from these rough matches he is bound to become a versatile weapon for barcelona. As a skilled striker a lot of teams will be using rough tactics to try and disrupt his momentum. Will he grow above that and still shine? That is yet to be seen. I will follow his games hoping upon hope that his true potential shines through. (side note: I'm not saying he sucks. He is a way above average player as he is now. But he can get even closer to messi/ronaldo status and thats what i want to see.)

Monday, September 30, 2013

How am I studying for the Step 2 CS

My CS is scheduled for October 8th, 2013. Thats right around the corner; about 7 days to D day. Luckily for me, I just finished my pediatric allergy rotation in the bronx ( a rotation I really enjoyed so will write a blurp about it later). Since, the exam is right around the corner everyday from today is going to be crucial and as a consequence must be structured.

I will be using two resources: First Aid for the USMLE Step 2 CS and laura Miranda's youtube video. The essential sections of first aid that i will use are mini case section (to review ddx and appropriate lab tests) and the full length practice cases which i will go through with my sister. Laura Miranda's youtube details how she structured her approach to each patient. I will follow her approach since time is short and it makes no sense to reinvent the wheel. I am already comfortable when it comes to performing interviews but since the step is timed a structured approach is needed, this is where laura's video comes into play. See below for a link to her video.
I watched laura's video today and jotted down the structure she used for her step 2 CS. Thats it with the video.

For the next five days I will eat breath and sleep CS. Every morning, I will review the structure that i will be using (check laura's video), review my physical exam plan, and review the mini cases in first aid. For the rest of the day I will go over full length cases with my sister, 9 in total for the day and if i can i will do more.  As with all studying plans, i will change and focus on specific things as time moves on, but this is the overall plan of attack I will use. Pray for me. haha.

Resources:
1) Laura Miranda's video:



2) First Aid for step 2 cs


Monday, September 23, 2013

How to succeed in medical school: Medical School is hard

            For some students medical school is a breeze but it is not for the majority. For most of us medical school is quite hard. I have to work really hard to do well, to succeed. Even then there are stumbling blocks. You might feel you are not good enough, you might  fail an exam or even fail a class. However so long as you stand back up, put your head back in the books you will succeed. Make a plan on how you'll study and follow it. Get help if you need to, get help from counselors, friends, the internet; dont be too proud. And the most important thing I would say is test yourself. Always test yourself by doing sample questions, sample practical exams sample everything to see where you lie. Enjoy this motivational video and listen to the words of Gary Raser in the back ground. It is not about medical school per se but principles of success are universally applicable.





Monday, September 16, 2013

Medical School Board Examinations: steps 1, 2 cs and ck, and 3

All major board exam are daunting, however for exams with a huge impact on whether or not you will have access to multiple residency spots they are especially more so. An example of the latter for medical students are the United States Medical Licensing Examination Board Step exams (Step 1, Step 2 Cs, step 2 Ck and step 3) For medical students these exams are vital and even more so for Caribbean students as it tests everyone (whether you attended a foreign or US medical school) for a standardized level of aptitude and knowledge.

 
The step 1 exam tests your knowledge of basic sciences. Step 2 exams test application of clinical and medical knowledge in supervised patient care. It is split into a practical portion, the step 2cs, as well as a multiple choice portion, the step 2ck. The Step 3 exam is basically like the step 2 exam but it tests the knowledge needed for unsupervised medical care.

 
Doing well on these exams can open or close doors. Some residency programs use Step scores cut offs to filter applicants. The type of score that is acceptable depends on the specialty you are interested in. In 2011 students aiming for family medicine that matched had an average of 213 and those who did not match had an average of 201. For dermatology the average score for applicants that matched was 244 and for those would did not match it was 227. Now 227 is not a bad score its actually pretty good. However, it becomes more difficult to get into specialties like dermatology. However a score of 240 will have a lot of programs at least consider your application. Thats why it is important to work as hard as possible to get as good a score as you can.

 
For AUC students we take the step 1 exam before commencing clinical rotations because that is a requirement. The Step 2 exams are usually taken in at the end of third year but this is not an iron clad rule; there are exceptions of course. For example in AUC if you are want to take the Step 2 ck exam before completing your core rotations you have to take and pass a comprehensive exam before you can take it you can take it. If you're not taking the exam early you dont have to worry about the comprehensive exam.

 
Another thing to consider when scheduling your step exam is the time it takes for your score to be reported. It takes about 2 months to get the results for the Step 2cs exam so some students take this at least 2 months prior to Residency application program opens so that they have the results by the time they send out their applications. Others take it after the the application program oppens and thats fine too. However, I feel that it is best to have everything ie your scores, resume, recommendations etc in early. (Does not mean its the only timing you can follow.)

I took my Step 1 exam following the aforementioned schedule. I studied to exhaustion and got a result I am satisfied with. Next up on my plate is the Step 2cs which I will be taking in October. After that in December I will take my 2ck exam. I am aiming for the match in 2015 so I have a bit of time. Wish me luck!!

 
In the near future, I might write about how I studied for the step 1 exam and how I am studying for these exams.

Tuesday, September 10, 2013

Not everyday...

Its not everyday that you see a child crying as he is leaving a hospital/clinic. My last patient today started balling when it was time to head out. He reached for my hand and wanted to stay. So i told him everyone that stays gets a needle. haha. thats a joke. I said we're here and we'll see him some other time. 3 years old imitating taking lung sounds with my stethoscope. Everyone in the room became his patient. The joys of childhood...

Saturday, September 7, 2013

Missed me??

I missed you too. It has been quite a while since my last post. I'll try to post more. In other news GHANA qualified for the worldcup, Brazil 2014.