Saturday, October 23, 2010

Finals Part II

This Tuesday I had my final for my Medical Interviewing class (if you remember, that is the first class in the two-year Physican's Core course which teaches us how to actually be a good doctor). The test is called an OSCE. Wikipedia recently told me that this stands for Objective Structured Clinical Examination. Yes, I just took this test on Tuesday, and I still had to look up what it stood for.

In Medical Interviewing, we learned how to ... wait for it ... interview a patient and take a history. There are a LOT of questions that you are supposed to ask a new patient (most of which I've never actually been asked at a doctor's appointment; usually you just fill it out on a form, butttt I guess it's sorta important that we at least know how to do it). Some of the topics of questions include taking a history of present illness, past medical history, family history, medications and allergies, current health behavior and risk factors, sexual history, and social history.

So the test. They have fake doctor's offices set up with one of those two-way mirrors and a hidden video camera (it probably wasn't very hidden, I just obviously didn't see it). Inside this fake exam room is an actor who is pretending to be a sick patient. You knock on the door, introduce yourself as a first year medical student, and ask all your questions. Then you ask if they have any questions for you or have anything to add, and then you say that you are going to talk to the attending physician who will be back to see them shortly. You do this three times in three fake rooms to three fake patients. And then they grade you.

You are not supposed to forget any questions. Luckily we were allowed to bring an index card with notes in with us... and guess what, I still forgot to ask a few questions. How? I really don't know, maybe nerves make me forget how to read. But rumor has it that if you have ever spoken to another human being in your life, you will pass. And in fact, I have spoken to many human beings throughout my life! So I'm not too worried. I was also in the first group to go (whatupppp backwards alphabetical order!) so I had the rest of Tuesday and Wednesday off while everyone else was still freaking out.

Level of Scariness: Terrifying. And I'm sort of a people person. Still terrifying.

Thursday, October 21, 2010

Finals: Some are Scarier than Others

Sorry for the long delay on posting, but I am officially finished with my first two classes of med school, and I am still alive! The finals for the two classes were completely different. Today you get to learn about the shelf exam, and tomorrow the OSCE. Spoiler alert: the OSCE was infinitely times scarier.

So, our MGM (aka biochem and genetics) final was last Friday. As many of you know, that was awesome timing because it allowed me to actually enjoy my birthday this weekend (thanks to those who were part of it!). Throughout the class, we had three non-cumulative tests, and then a cumulative final a mere ONE AND A HALF days after our third test. That sucked. The final was actually a national biochemstry test, scored and curved by a national board (aka our professors were too lazy to write and grade a final exam - I'm joking, they had good reasons, see below).

This national exam is called the "shelf." There is a shelf exam available for each course/topic in medical school, and it is a way of assessing your abilities in a subject in comparison to the rest of the country. This also means that based on how your class does as a whole, you can see how your med school ranks in comparison to others in specific subjects.

Here are my thoughts on taking the shelf exam instead of a final written by our own professors:

Con: The test doesn't necessarily follow what we focused on in class, so it seemed like the test was missing questions on topics we had covered really well, and vice versa - I definitely came across some (many?) questions on things that I am positive I had never seen before, and let me tell you, that is not a fun feeling during a test. But at least it's curved.

Pro: Getting used to these kinds of tests starts preparing us for the USMLE Step 1 which we take at the end of second year and is super important for getting into residencies. The Step 1 is also a national, standardized exam that will not be prepared by my professors.

a different kind of shelf

evel of scariness: Same as any scantron test. Even less scary because we were so tired and burnt out from studying for Wednesday's exam that by Friday we were all just ready to be done.

[fun fact: they are supposedly called shelf exams because they are "off-the-shelf," meaning ready-made as opposed to custom-made]

Tuesday, October 12, 2010

Funkmaster Flex and the Future of Medical Education

So I know you all have been thinking that I forgot about a very important milestone this year because I haven't mentioned it in the blog yet. No, it's not my parents' 30th anniversary (although that is a big one!) or my 24th birthday (also a big one!); keep guessing...

OK fine, I'll just tell you. This year is the 100th anniversary of the FLEXNER REPORT! That was your next guess, right? I know not everyone is quite as interested in science history as I am, so I don't want to bore you too much, but I had to talk about it in at least one blog post. Basically everything we do in medical school, the classes we take, the number of years it takes, the necessary science pre-requisites (I still vomit in my mouth a little every time I think of physics), are all because of this guy Abraham Flexner and the Council on Medical Education in 1910.

young Flex

Back in the good old days of the 'aughts (as I'm sure the first decade of the 19oo's was popularly called, similarly to the years 2000-2009), there were over 150 medical schools in the US and Canada, all with completely different curricula and requirements - some didn't even ask for a high school diploma for entry!

But Flexner's scathing report on the state of medical education and his recommendations that went with it brought about huge changes in the system, including the closure of many sub-par schools and the standardization of most aspects of training, causing an undisputed positive effect on the quality of doctors.

old Flex

There are a million things I could go into right now about how things have changed or stayed the same since Flexner's heyday and what is still relevant. But relax, I know this is already long, so I won't go into all one million of them.

One thing I do want to point out though is what seems to be a growing de-emphasis on science as the end-all be-all, and instead a focus on becoming a socially, economically, and politically-conscious physician. With the rising use of technology (like typing notes on laptops during patient interviews) and the increasing number of patients it seems like doctors, especially primary care doctors, have to take on each day to be cost-effective, the human element of being a physician looks like it is in danger of being lost.

funkmaster Flex

100 years ago, medical education was in dire need of an upheaval, and that need was met with more science. Today we get the science, but the so-called "pre-med syndrome" can get in the way of becoming a compassionate, informed doctor. As Flexner himself believed (I'm not assuming here; I totally know what all his personal thoughts were), continual self-assessment and making appropriate changes based on that assessment are essential. No major upheaval (in med school curricula, anyway) is needed, but I personally am a fan of the small changes many med schools have recently been making in the gradual evolution of the education system. BUT I was a humanities major, and I'm not a fan of biochem, so disclaimer: I'm biased.

still interested? check out this NEJM article on the Flexner report or this NYTimes article on humanities in medicine or this AMA article that actually has specifics on how medical education is evolving.

Thursday, October 7, 2010

study breaks

Sometimes it feels like the tests here come too quickly. It's not fun when you go out the night after a huge exam, and the very next day you are already stressed about having to catch up on work!

When tests are every two weeks, it is always the week before a test, the week of a test, or the first week of a new unit. There is always, always something I could be studying at any given moment of the day. The hardest thing I've found about med school so far is knowing when to stop, and what's important enough to be taking breaks for (#1: writing blog posts, duh).

There are a million and one excuses not to get involved or do things here (most of those reasons are some variation of "I have too much to study"). For me, the first activity to get cut when I have too much work to do is going to the gym. Of course, I also happen to hate going to the gym and things like 'my shoe is untied' or 'it's cloudy out' are usually enough for me to decide to skip it on any given day. On the opposite side of the spectrum, no matter how close it is to the test, I always seem to have time to stalk people on facebook; it's funny how that works...

So, recap. The hardest part of med school = finding the balance between studying and facebook. Wait, no, sorry. I mean finding the balance between studying and living. Because as much as I like to think that it will, life isn't going to stop and wait for me to finish school (but that would be nice, wouldn't it?).