Moving On After Graduation (or: The Existential Terror Of The Void)

Before the ceremony, we were all supposed to line up in alphabetical order. But when our Dean called out our names in said order to make sure we all knew how to alphabet (spoiler alert: NOPE), I suddenly knew that she’d skip right over me. And that she’d then pause and look at me all concerned and say, “Oh, hey… you’re not on my list…” and then everyone would know I was a terrible, terrible fraud.

But she actually did read my name: both before the ceremony and (arguably more importantly) during it.

So I guess I’m a doctor now!

I probably need to stop finding this hilarious.

Anyway, in other news, I’m moving to Midwest Metropolis! On Tuesday! And I will be super excited about it just as soon as I’m assured that I won’t be living in a cardboard box.

(Not really joking. I legitimately will be living out of my rental car / cheap motels until I manage to sign a lease – and the rental car is expensive, so…)

This move entails:

1. Packing up everything I own.
2. Realizing I own way too much stuff to fit in a rental van.
3. Giving away half of my stuff.
4. Hoping that everything else fits, miraculously, into said rental van.
5. Driving 7 hours to Midwest Metropolis.
6. Charming some landlord into giving me a lease ASAP so I can turn in my rental van and stop paying $150 a day for it jesus christ that’s a lot of money
7. HYPOTHETICAL MOVING SUCCESS.

So far, I’ve gotten as far as Step #4: I’ve rented the van. I’ve packed my stuff. I’m ready and waiting.

I even looked up Craigslist apartment listings! I found one within walking distance of the hospital where a female grad student was looking for a “clean, mature, responsible female grad student or young professional”, and I was like “THAT’S ME. YOU’RE LOOKING FOR ME. HELLO, FUTURE BEST FRIEND.” and sent her a calmer, more subdued, casually disinterested version of that.

But it’s been 10 minutes and she hasn’t replied with an immediate offer so maybe I should diversify my options a little.

And finish packing.

And relearn all of pediatrics before someone accidentally expects me to know something useful.

And say goodbye to everyone in this town I’ve ever loved.

STAY TUNED.

Post-Match Paperwork: The 7 Stages of Grief

1. Denial. “WHOO! I MATCHED – I’M DONE!” 

The charming belief that because your CV, LORs, proof-of-identity, proof-of-USMLE scores, and photo were all uploaded into ERAS, your hospital employment will not make you find / beg for copies in order to upload them for its own pre-employment files.

Lasts up to 1 month.

2. Anger. “But they already HAVE all this stuff. It was all in ERAS.”

Yes, your residency program has your USMLE scores – but the hospital itself requires an official copy! Let’s hope you saved each individual score report, because the NBME ain’t Santa Claus – they want $75 per each “official transcript”.

Lasts up to ‘lingering resentment for the rest of your professional life’.

3. Bargaining. “Whatever, they won’t read it.”

They already hired you, didn’t they? The contract is signed. So you can probably get away with uploading screenshots for your USMLE scores, the draft of your Dean’s letter as a LOR, and your 3-years-out-of-date CV. There, you’ve helped your hospital check off some stupid boxes. Moving on.

4. Depression. “$300 to apply for a State Board of Medicine Training License? First and last month’s rent? No paycheck until July 31st?“

HAHAHAHAHA.

5. Acceptance. “Okay, private loans exist.”

Lasts until you discover that US law requires a 30-day “cooling off period” once you apply for one of these loans (to give you time to reconsider), so you aren’t getting your monopoly money anytime soon.

But hey – that’s okay, because you still have 3 weeks after you get your loan from when you need to move! Plenty of time to pack, buy a car, search for apartments, and – wait, hold on, check the calendar – oh god…

6. Graduation

… is poorly timed. You’ll have to stay in your current city so your proud relatives have somewhere to crash before they watch you walk across a crowded stage.

(Hope you remembered to order your comically colored robe and floppy hat! $800 to buy. You did remember to order them, right…?)

Okay, now you have 1 week to get your life in order before you need to move.

7. Magic.

[Presumably. I am not sure exactly what happens here but I am confident it involves a good story.]

Residency Interview Season 2013

The First Week After Submitting

Getting That First Interview Invite

… And That Program Earns A Special Place In Your Heart Forever.

Especially Since No Other Program Seems To Like You

… Until One Day…

 When You Get 17 Interview Offers….

… In 3 Hours.

And You Try To Fit All Their Restrictive Interview Date “Choices” Into Your Calendar

… But Mathematically, It Doesn’t Work.

QUICK: DECIDE YOUR LIFE PATH WITHOUT VISITING ANY OF THESE PLACES

And Now You Have To Write Horribly Complicated Emails Declining Those Precious Interviews

And You Still Aren’t Guaranteed To Match

… Welcome To ERAS 2013-2014.

I Wanted To But I Didn’t: Part 2

… Oh Wait No, I Totally Did

So yeah, you could say my research month is treating me pretty well.

Posts I Have Started Writing But Ultimately Abandoned (for One Reason or Another)

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.

Probably should’ve taken Ron Swanson’s advice on that myself.

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.

Theatrical data analysis in health policy: IT’S A THING.

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,

Pictured: The medical community’s diverse spectrum of opinion on Step 2 CS.

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.

 

The nerve of drinking coffee during morning rounds

Most med students are quick to catch onto the fact that “sipping coffee” is synonymous with “standing there, doing nothing” (or even – god forbid! – “taking it easy“). It’s one of the many little rules you’re expected to absorb from thin air on your first day of third year.

Sure, it depends a lot on your hospital and team – but broadly speaking, having a cup of coffee in one hand during rounds gives off a certain “devil may care” attitude that doesn’t bode well for your med student reputation.

(That said – I did it on surgery rounds because 1) I already knew I wasn’t getting honors, 2) there were no old-school attendings, 3) I deeply suspected the residents were too sleep-deprived to register the sight of me, let alone notice a small coffee mug, and 4) it was freaking surgery; I needed coffee.  I mean, screw it, I’m not a machine.)

But this is SUCH a good example of why medicine is insane: there is nothing intrinsically lazy, unethical, or dangerous about simply holding a cup of coffee outside a patient care area.

But dude, if you’re on the bottom of the totem-pole of medicine, it makes you look like you’ve forgotten your place, and we can’t have that now can we.

So, right: Reddit’s medicine section has been having a discussion about it:

I cannot believe how many non-medical people responded to this topic by raising hell about how inconsiderate it would be to drink coffee in the patient rooms.  YES, WE KNOW.

But honestly – even if the medical team taking care of you does dare to flout JCAHO rules by bringing closed containers of coffee into the room for the whopping 3 minutes they spend with you – unless you are NPO or on chemo, I can’t help but feel detecting a slight whiff of coffee in your room at Crack of Dawn O’Clock is not unreasonable.

But, right, the point here is that we are talking about drinking coffee in the hallway, not a patient care area.

… Yep, pretty much.

It’s such a dead-on example of why students leave med school hating medicine: “don’t drink coffee within sight of your superior” is – for better or worse – the sort of thing we end up internalizing as “professionalism”.

USMLE Week 5: Eh, Good Enough.

So after that mini-mental-breakdown of a practice test, I regrouped.  I montage-ed.  I set out to target my lowest-scoring subjects, grudgingly relearned them from scratch, ultimately spent more time alone in my room listening to morose music than I did during my last major break-up, and then proceeded to score, on two separate tests, just flat-out ridiculously higher.

… which – thanks in part to my newly-acquired Biostats knowledge (see: “lowest-scoring subjects” above) – I now know says more about just how poorly designed this test truly is than it does about how talented I may or may not be at short-term memorization.

(Okay, calling the USMLE “poorly designed” might sound a little harsh and high-minded – but when the NBME is purposefully distancing themselves from the notion that it’s an “achievement” test – in other words, that the exact scores mean anything – preferring instead to categorize it as “minimum competence”, and then still steadfastly reporting 3 significant figures?  At the steep end?  All while knowing that they’re handing out these career-determining judgements to the most self-absorbed, breakdown-prone students in the world?

… if that’s not poorly-designed, it’s at the very least disturbingly cold-hearted.)

And while I’m relieved as hell about scoring better, the relief is transient and the tiredness is a slow burn.  I’m forgetting more and more while caring less and less.

The result of adding this kind of burn-out to the general theme of my Step 1 study plan (which, FYI, would be most appropriately titled “Ways In Which I Helpfully Verified Common Wisdom By Ignoring It Entirely” – subtitle, “Somehow, It Went Poorly”) is a schedule for the last three days that looks something like “do stuff, but not too much or too little”.

I guess I will probably go through my flashcards again.  Or my notes?  Or re-listen to the recording I made of me reading First Aid.  Or learn to juggle.

I DON’T KNOW.  THERE ARE OPTIONS.  It’ll work out – and someday, as a commenter recently reminded me, there will be happiness again.  (Seriously, thanks for reading/tolerating self-absorbed posts like this, you guys.  Thursday can’t come soon enough.)

Meanwhile, Here Are Some Awesome Step 1 Resources Buried Deep In The Depths of The Internet: 

• – Compiled USMLE Step 1 Mnemonics
• – Protein Synthesis Inhibitors: Never Mix Them Up Again!
• – Virology Cheat Sheet – pretty great starting point, and well-designed to boot.
• – The Ultimate Guide to Gastrointestinal Hormones – Dude, seriously, this guy can make a table.
• – Confidence Intervals vs P-Value 
• – Everything I Need To Know I Learned From USMLEWorld – Where has this blog been all my life?
• – Goljan Flashcards (or here, a more selective set strictly from the Goljan High Yield document everyone raves about but never links to.)

USMLE Week 4: A Light Update

… So that happened.

For my more visually-challenged readers, that disturbing sound you just heard was the sound of an NBME practice test exploding me into tiny bits of sub-par, clearly less-than-average, horrifyingly-close-to-my-pre-studying score self.

IT’S LIKE THE NBME DOESN’T EVEN CARE THAT UWORLD THINKS I’M SMART.

IT’S ALMOST LIKE THEY’RE RUN BY TWO SEPARATE COMPANIES OR SOMETHING.

(Yeah, I know statistical variation is a thing.. but I’m not willing to attribute a difference of almost 40 points to it.)

Luckily, even though I’m studying in the middle of Abandoned Rural America, I had a friend who was willing to listen to my hysterical panic attack and help point me towards a rational plan for the next few days.

So instead of following my regularly-scheduled Gut Instinct of Crazy (crying, staying awake for 120 hours straight, emailing the dean, and then pushing back my test date) I will instead follow her advice and spend the next few days addressing specific areas of weakness in a logical order.

Like a smart person would.

All of this to say: This blog will be taking a minor “crisis-mode” break until the 21st.

Turning This Sad Ship Around To Face The 230+ Iceburg Head-On

Today I put in 10 solid hours of pharm and cardiovascular pathophysiology.  Not even kidding, I haven’t been this productive since I first got into med school.  THE FIRE OF INADEQUACY IS KINDLING A FLAME OF RIGHTEOUS CAFFEINATION, which is in turn fueling focus, goddamnit.

… so you might say to yourself, “Gee, that’s nice, Action Potential – but why are still awake and writing on your blog at 4am?”

And to that, I would argue, “because… goddamnit.”

I don’t know.  I’ve been awake since 2pm yesterday.  EVERYTHING WAS GOING SO WELL until I realized how I had mutilated my sleep schedule.  It’s been a vicious cycle of caffeination that would fit really well in a G-rated adaptation of Trainspotting.

Definitely two Italian Roasts too many.  I think it’s caffeine’s fault.  I know blaming chemicals throws up a few red flags, but surely we can all agree caffeine is undermining my efforts, here.

I think I just need to drink 4 Italian Roasts tomorrow; just to show my plasma adenosine concentration who’s boss.

Or maybe not.  Maybe that’s a stupid plan.  It’s hard to tell given the extraordinarily low standards I currently have for the intellectual viability of any given “plan”, given that my current one relies on throwing all advice to the wind and just learning shit for the sake of maybe remembering it later.

Goals for Today/Tomorrow/Oh God What Day Is It:  200 UWorld questions and 5 solid hours of Pathoma!  THIS IS HAPPENING.

FULL SPEED AHEAD.

USMLE: Week 2

After multiple half-hearted attempts at writing this update, it looks like I’m kidding myself if I think it’s going to be coherent   I give up.  Just consider the lack of editing a testament to what studying is doing to me, please.  I am bleary-eyed and anergic to caffeine.

1.  My Step 2 CK score came in!  And I got my goal score: 200-and-Not-Outrightly-Memorable-In-A-Bad-Way points.

Seriously, I was dead-average and thrilled about it.  (Though – to be fair – I originally thought ~220 was average, which is why I was probably so thrilled to see that I got a 237.  Took me a second to parse that 237 was written twice because it was also the current Step 2 average.)

(By the way, did I just make up the “220 = roughly average” thing?  Was it ever true?  Is it something a med student told me years ago that I just internalized as the gospel truth?  Or are med students getting smarter?)

But, okay, DONE.  Nothing more to say on the subject.  No more speculation.  Back to Step 1.

2.  “The best step 1 prep is to study hard for the pre-clinical tests.”  I can’t believe this saying actually turned out to be true.  I mean, sure, it makes sense, but I still thought it was mostly just a clever way for M3s and M4s to sound haughty when asked for advice.

All I know is that as an M1, I literally studied myself into an injury during Microbiology – probably the hardest I’ve ever studied in my life – and.. holy crap, I retained that information!  Even though it was all just random association.  It was amazing.

And I’m not saying that having a near-mental-and-physical-breakdown was “worth it”, exactly, but –  I scheduled myself 48 hours to review micro and only had to use 6.  So, time-wise, I guess overstudying for M1 Microbiology was as “worth it” as a near-breakdown is ever gonna get.

I just wish I could say that about the rest of the Step 1 subjects. Looking at my QBank breakdowns, it’s patently obvious that I barely passed M1 Embryology.  At the time, I just didn’t feel motivated to learn, and now I’m paying for it.

Actually, not only did I not feel motivated to study Embryo, but I distinctly remember explaining to someone that “You know what?  It doesn’t matter.  The only people who need to learn Embryology are future pediatricians.”  (Yeah, you tell them, M1 Action Potential!  … those.. future.. pediatricians…)

NO. BAD. Stop that RIGHT NOW, Former Me.  I am from the future and I am here to tell you are wrong.

But, too bad, I don’t have the time machine necessary to knock on my former self’s door and forcibly cancel her Netflix subscription, so instead I’m bitterly studying embryology 4-5 hours a day just to break even.

(Yes, I know it’s not “high-yield” for Step 1, but if I don’t learn about the embryonic origin of cleft palate anomalies now, when will I?  I made my bed and now I have to lie in it, etc.)  (Besides – for all I know, Future Pediatric Resident Me does have access to a time machine – and I really don’t want her to knock down my door to cancel my Netflix subscription.)

3.  Immunology: is, however, still stupid. 

4.  Stuff That Doesn’t Fit Anywhere Else:

• First Aid 2013 is a huge improvement from 2012.
• USMLERx “Flash Facts” has, by far, the worst interface and programming of anything I’ve ever regretted paid money for.
• That said, the USMLERx QBank is actually shockingly good – memorization-wise, it’s unbelievably helpful to have a picture from First Aid and page number for every answer explanation.
• I bought an extremely comfortable pillow and it was a major time-management mistake.
• Picmonic is new and brilliant.  I bet it’ll catch on as fast as Pathoma did.
• I am forcing myself to limit my prep books to 2 per subject, and it’s a daily battle.  This had better be good for me.
• I should have quit caffeine 3 weeks ago.