Post Idea #1: Advice for New M3s, via Quotes:
This one sort of worked. Easy and topical! I’d argue that you can learn a lot about how to function on the wards from people like Anton Chekov (“Any idiot can face a crisis – it’s the day-to-day living that gets you down”), Will Rogers (“Never miss a good opportunity to shut up”), and Ron Swanson.
But I didn’t post it because after a 3 month absence, something this trite seemed like a weird re-entrance to blogging (“Okay.. an entry composed of nothing but quotes. So.. you’re not dead?”) – so instead I’ve just been letting it languish in my Drafts folder until I find something better to post first.
Post Idea #2: Hey Guys, I’m Back!
I didn’t actually write it, but I thought about it.
And then I remembered that “Hey! I’m back! I’m SO sorry for the hiatus – been super busy!” posts always seem to be 1) boring as hell, 2) the death knell of blogging (once you see one apology post, you can bet good money it’ll be immediately followed by another, even longer absence) and 3) really self-involved. Even by blogging standards.
So I didn’t post this one because it’s a terrible idea. (Though I’m clearly writing a goofy, “self-aware”, meta version of it instead! Which is probably worse! Oh well.)
Post Idea #3: Links to fascinating articles about medical education.
This month I’ve been finishing up a lit review for a research project, and since the next step after “literature review” is “actually just submit the damned IRB protocol already” – I’ve… spent some extra time on that lit review.
Seriously, I’ve become completely obsessed with journals like Academic Medicine (the journal of the AAMC, where you can find out a lot of unexpected things about USMLE grading), Medical Education, and just generally link-diving into the PubMed abyss.
In related news, I’m… very easily side-tracked.
I didn’t post this one because all the cool articles I’d want to link are behind equally uncool paywalls. And while I could say some snarky things about a couple of very poorly done studies, at least they actually finished theirs instead of just being stuck on the IRB proposal itself for an entire month. Glass houses, thrown stones, etc.
Post Idea #4: Step 2 CS Is The Dumbest Exam On Earth. So! Besides “research”, the other thing I’ve done this month is the CS exam – which isn’t news. Neither is the fact that the exam is widely considered to be worthless,
But the point I kept trying to make while writing this was that it is beyond absurd for a Clinical Skills exam to not actually test Clinical Skills. It is about whether you can go through the motions while speaking English and not alienating your patients.
… and also that any journalist could easily write an article exposing the US public’s misconception that their physicians are – at any point in their training – ever tested for their ability to actually notice findings during a physical exam.
Think about that for a second. The one thing a doctor is most trusted to do, and it’s never tested. People just assume that an “everything looks/sounds good!” after their yearly physical means something besides “well, you have no chief complaint and I went through the motions, so you’re set!” because, hey, doctors have to pass tests, right? And one of them must be on doctor skills, right?
Wrong. Sure, after all that clinical experience, your doctor can probably be trusted to notice a murmur. But isn’t it interesting that American doctors are tested on their ability to understand the phrase “abdominal bruit” or “cotton-wool spots bilaterally” – but never actually tested on their ability to actually recognize either one?
Personally, I have some mild hearing loss (otosclerosis) and have always been a little self-conscious about the professional implications. So I use an amplified stethoscope and have like to think I’ve actually gotten pretty darned good at discerning soft murmurs – but, still: isn’t it sort of an uncomfortable truth that no one’s ever tested me on it? That no one ever will?
That Step 2 CS wouldn’t let me use my electronic stethoscope – but it was totally okay because there weren’t any murmurs to find anyway?
Since the NBME already went to all the trouble of setting up the national Clinical Skills Centers – and several European countries appear to have already figured out the logistics of netting Standardized Patients with real diseases and physical findings – why not just go the extra step? Actually test clinical skills?
Or at least give me back my $1,500.
I didn’t publish this one because it sounded really defensive, almost angry. Besides, it was both way too long and somehow still over-simplified. It’s probably a better topic for a book than a blog post.
Post Idea #5: Just posting bits from all the entries I started and why I ultimately decided against them. This one’s been languishing in my ‘drafts’ folder for the last week because it’s incredibly long – too long. I bet you just skimmed the last 5 paragraphs. (A safe bet, since that’s what I did while trying to edit it.)
I actually DID finally post this one because a commenter on the last post (Hi, Barney!) asked whether I had changed careers. Which… is both a reasonable assumption (given how depressing that last entry was), and a good indication I should suck it up and just hit “publish” on something.
So – here I am! Still alive, definitely still in medicine, definitely still over-thinking things as simple as “is this really worth posting?” – but here, all the same.
Well, I liked it. 😉
Aaaaaah I have my fifth year CS exam tomorrow. And I’m sitting here reading the list of things to remember: greet the patient. Wash your hands. Get consent. Local. Now suture this piece of sponge and pretend you can suture a grizzly human wound.
P.S: welcome back. I like the quote post idea, and have tried it myself, and came to the same conclusion. Just make pretty quote pictures and add them to other posts. Or something.
Welcome back. And I enjoyed the deconstructed/meta-welcome back post.
… What are you applying in? Long time follower (but with a bad memory). You started out interested in psych. Then peds? Also, I would be really interested in the links to all those medical education studies if you get a chance to share them. Student followers like myself at least can probably access most of them through our university library accounts. (And I suspect the topic of medical education is mostly interesting to students in medical school … And probably a small sub-set of those.)
I was actually pretty entertained by this. And the same thing is kind of going on with my blog haha. Glad to hear from you!
A+ on not making your return post boring or excruciating! 😀
Speaking from veterinary school here, but the physical exam bit is SO TRUE. Apparently it’s just assumed you’ll become competent in detecting any and all physical exam findings by the end of fourth year, but no one actually confirms that in any substantial way. The best practice I had was on an externship with a GP vet who did very very very thorough exams and would send me off with an apparently healthy animal and say, “Don’t come back until you’ve found six things wrong with the dog.”
Life happens. Good post 🙂