Author: Amanda Xi

Words of wisdom for 1st year medical students

Amanda Xi

Today’s inane image of the day:

Don’t forget to get some fresh air this year. [Photo from my trip to San Fran]

Lately I’ve been getting numerous requests for advice about starting medical school – instead of re-inventing the wheel, I decided to post links to my personal words of wisdom and those of some of my favorite bloggers. Enjoy!

Advice from my first semester of medical school [from this blog]
Med School Insight [that’s me!] – Learning to study when starting medical school
Medical State of Mind – A Word With First Year
Medical Admissions – To the class of 2016: Observations from 2015
WayfaringMD – Advice to Medical Students, First Year Edition

As always, feel free to post specific questions as you start on your first year of medical training! Good luck – [not that you need it…!].

P.S. OUWB M1s – enjoy your first day of classes tomorrow. We’ll be right next door if you need anything. =)

All good things must come to an end

Amanda Xi

Today’s inane image of the day:

A nighttime view of a street in San Francisco. This was taken from the back of a trolley [one of the highlights of my visit to San Fran – they’re so fun to ride!].

The best part of vacation as a single [as in, unmarried], non-parent? Being able to completely remove yourself from your world – everything falls away when you leave your comfort zone and explore somewhere new. You can temporarily ignore all the things that plague you. You can tell strangers lies about your life. You can breathe, freely.

But, all good things must come to an end.

It’s not that I don’t want to go back to school, but I’d rather not feel stressed out 24/7. Nor do I enjoy feeling relentlessly overwhelmed with the material. Or feeling very lonely while studying [though, Mike has been great about keeping me company].

In so many ways, the pre-clinical years kind of suck.

Participating in the Cardiology internship was a reminder that there’s a point to all of this. There are individuals out there with heart-wrenching stories of courage, hope and determination that I want to hear. Things don’t always work out, but when they do, it means more life. More love. More memories.

—

One year ago, I was preparing to start a new chapter of my life. This year, we get an extra week of summer to enjoy before starting classes on Monday, August 13. Although the nerd in me is excited to put some new creases into my textbooks and break out a new set of highlighters/pens, another part of me is dreading our return. I am fully aware that in order to be a competent physician, I need to learn the material – but some part of me wonders if there’s a better way to do medical education.

Incoming M1s, please do relish in the excitement of this first week – it’s an exquisite feeling that cannot be replicated. You will learn all about our school and be greeted by an endless number of fresh, smiling faces. You will be interested in joining all of our organizations [come say “hi” to me at the Activities Fair – I’ll be at the AMWA table, of course], receive your laptops and lots of free food. You will bond with your classmates through group and evening activities. At the end of this week, you will be presented with your white coat by your PRISM mentor and have a million photos taken.

Then, you’ll be thrown headfirst into an ocean of material. Like I said, all good things must come to an end.

Hello from the West Coast

Amanda Xi

Today’s inane image of the day:

Hello from the West Coast! 

Just wanted to drop a line and let you know that my Cardiology internship did not eat me up – I’ve just been enjoying some time in California with my love. Being [mostly] unplugged and completely smitten with Mike for the last 5-ish days has been delightful. I feel light and happy, but a bit apprehensive to start a new semester in less than 2 weeks [August 13, to be exact]. Alas, there’s no point in worrying over the future when we’re living in the present.

I’ll be back in Michigan [and back to reality] in less than 24 hours. But until then… I’ll be enjoying my last few hours with Mike.

My first code

Amanda Xi

A real code deviates from what they depict in medical dramas like Grey’s Anatomy. Television chest compressions are usually too slow and superficial – they are nowhere near forceful enough to sustain blood flow throughout the body. There is no foreboding soundtrack to hint at what’s coming – only the numbers that appear on the monitor that suddenly dip in the wrong direction.

Although I understood the magnitude of the situation as it unraveled before me, the monitor deceived me into believing that our fluid and pharmacologic interventions were enough. I watched the numbers bounce around, then steady at a reasonable value. They sat there for a short stint, before starting a slow descent.

I felt the air in the room change.

Everything moved faster, except time. The seconds dragged on as I watched more people filter into the room. More supplies were requested. More fluids and drugs were administered. Everyone’s motions were hurried and purposeful as I stood at the end of the table with my hands together.

I remember watching everything but not really hearing it all. There were orders being called and more groups assembled to assist, but I processed it like a silent movie. Everything was surreal up until I saw that chest compressions had begun. The stoic, lighthearted facial expressions that the room started with had all faded into concerned, determined ones.

I notice the time – only minutes have passed.

Shocks were administered between bouts of compressions. Indeed, they do call out “All clear” prior to defibrillation [Grey’s got that right]. Abruptly, all the hands abandon the patient for a split second as the body receives a jolt. Everyone resumes their work immediately.

I study the compressions – they are exactly as we were taught: at least 100/minute with 2 inches of depth. There are three people switching off, but they look tired. To my left, someone asks, “Have you done compressions before?” I slowly nod my head and am nudged to assist.

The individual doing CPR looks relieved as I step forward. During the administration of a shock, we quickly switch positions. My heart raced and adrenaline coursed through my vessels as I stepped up toward the patient. At that moment, it was as if someone else took over my body – I felt myself approaching the patient, but then I saw myself rhythmically pumping the chest. Everyone continued to work around me, but all I really registered was the patient and my motions.

It seemed like I had been giving compressions for at least five minutes before someone else took over; in reality, it was only a minute or two. The motion really wipes you out – I stepped back breathing like I had just run my fastest mile. My second round of compressions was tough, but I pushed on.

The code continues to run. After what seems like hours, it comes to a close.

—

In medicine, we fight time and nature with tests, drugs and surgeries. Over the years, we have been successful in extending life, however, we haven’t discovered a magic formula to live forever. The reality is that sometimes we delay nature’s course, but there is no stopping the inevitable.

Every single day of life should be lived to the fullest – even if external forces put up road blocks, we need to realize that they are temporary and sometimes out of our control.

I have wasted a lot of time and generated a hefty amount of cortisol worrying about things that I cannot predict or change the course of. But this, and the events of the last week, have shown me the importance of letting go. Not to say that I’m going to forget this patient or the experience – they will undoubtedly stay with me forever – but there is a stark contrast between healthy reflection and incessant “what ifs.” I wasn’t responsible for this code, but someday I will run one and if I continue down the path that I’m on, I will never be able to move on from nit-picking at details for years on end or forgiving myself for things that I could not alter, nor foresee.

I need to change.

I don’t expect a sudden personality shift, but I’m working slowly toward peace – as corny as this sounds, I think it’ll do me [mind & body] a lot of good.

Wish me luck moving forward.

Expanding

Amanda Xi

Today’s inane image of the day:

Summertime is opportune travel-time. A couple weeks back, I made an impromptu trip to Milwaukee to celebrate my best friend’s birthday.

Remember that “exciting news” I had way back when? Well, now that things have finally settled, I can announce that I am expanding a bit and will also be writing blog entries for the Kaplan Medical blog, Med School Insight. With the exception of the first entry posted on the site, there shouldn’t be any repeat blog entries.

What does the new blog mean for this one? Well, the plan is to write more general medical school entries over there and stick to more personal narratives and OUWB-specific entries here. Hopefully it will all fall into place.

The surgical intensive care unit [SICU]

Amanda Xi

I open the heavy, wooden door to the unit. On my left are the patient rooms, equipped with minimal privacy; to my right are members of the healthcare team shuffling around. I continue toward my destination – a small room containing a couple desks and computers dedicated to mid-level providers – but cannot help but notice how eerie the unit is. Although there are at least fifty individuals within this space, it is relatively quiet, aside from the occasional blips emitting from the numerous machines all the patients seem to be hooked up to.

As I peer into a patient’s room, I notice infusion pumps, a ventilator and an endless spanse of tubing coming from all directions. A monitor displays various waveforms floats at the head of the bed. The bedding has a wallpaper-quality pattern on it that feels oddly comforting, despite the patient’s weak body sprawled upon it.

I watch the patient’s chest rise and fall in a rhythmic, forceful manner. There is a line straight down the center where the surgeon gained access to the heart. A wave of awe washes over me as I think back to the open-heart surgery I witnessed earlier that morning – it never ceases to amaze me how we can stop the heart completely and miraculously bring it back to full function.

Turning my attention to the bustling healthcare team, I see a group of nurses, physician assistants and physicians discussing patient care. …should this drip be stopped? …my patient is in a-fib, what’s our next course of action? …I think this patient is ready to be transferred up to the floor. Every workstation monitor is filled with the EMR [electronic medical record] software, with its plethora of tabs, buttons and drop down menus.

I walk into my target room and start to read up on the patients we will be rounding on. CABGs [coronary artery bypass grafts], AVRs [aortic valve replacements], MVRs [mitral valve replacements]… these open-heart surgeries have become a part of my knowledge. Although there are non-cardiac patients within the unit, they are outnumbered.

Rounds begin when the cardiac surgeon appears; most of the time it’s at 9AM, but it can vary. He reminds me of the “stereotypical-surgical-type” – confident and assertive. But over the course of my time in the SICU, I grow to appreciate his personality. Most importantly, the teaching is top-notch.

We assemble our team outside of the first patient’s room. One of the physician assistants presents the case and paints a numerical picture of the patient’s status [vitals, ABG, electrolytes]. The surgeon probes for more information – …why was this patient extubated? …what can we do about these pulmonary pressures? – until he is satisfied. Then, the group walks in.


“How are you feeling today?”

“Much better. When am I leaving this place? I want to take a shower!” We chuckle and assure the patient that a shower lies within the immediate future.

Non-invasive reading [i.e. echocardiograms]

Amanda Xi

Today’s inane image of the day:

The Heart & Vascular Services at Beaumont Royal Oak have been headquarters for my summer cardiology experience [“internship”]. I can actually find my way around at least a small part of the hospital now!

Nine of us elected to do a Cardiology “internship” [I’m hesitant to call it a true internship as most of what we’re doing is like “advanced shadowing” since it’s definitely more hands-on than shadowing prior to medical school and everything makes so much more sense, however, we still aren’t doing as much as if we were doing a clinical clerkship] [more appropriately, it is a summer Cardiology experience] – and I hope I’m speaking for my group when I say that it has been tons of fun. As with most things, there are definitely high points and mundane points, but overall I am extremely happy that I elected to spend six weeks hanging out with the Cardiologists/Cardiac Surgeons.

Our particular program is setup such that our weekly schedule mimics a Cardiology fellow’s monthly schedule – basically, each week we rotate through a different service [e.g. inpatient, SICU, Cath lab, etc]. We are expected to attend noon conferences [and there’s really no reason for us to skip this – they provide lunch everyday] and Cath conferences [early morning on Tuesdays]. Additionally, each of us spends at least one half-day in clinic following our mentor [each of us were assigned an attending]. Finally, we are also assigned a fellow to follow around each week [the only exception is the SICU/surgical week] – from my experience so far, the fellow generally dictates our schedule outside of the “required” activities.

My first week was spent in “non-invasive reading” which basically translates into performing and interpreting echocardiograms. Imaging is definitely one of my interests so I was pretty excited to start off with this service. The fellow I was assigned to had worked with our TBL group during clinical case studies so I was already somewhat acquainted with him.

The schedule for the week was pretty much performing ultrasounds in the morning [both transesophageal and transthoracic], noon conference, then reading/interpreting the images in the afternoon. Although this may seem somewhat slow-paced… I thought it was an extremely appropriate way to start off, plus I was able to get some experience doing the transthoracic ultrasounds [not that we saved any of the images I got, but hey, I could totally do a mean four-chamber apical view!]. Plus, I’m a big fan of dark rooms with images [this is, of course, assuming I have coffee] [this does not mean I’m going to become a radiologist].

I thought that the best part of my first week was probably picking the brains of the fellows – it’s great to hear their experience going through medical school, residency then finally this fellowship [two of them actually took a year to be a hospitalist prior to starting their Cardiology fellowships – I didn’t realize that this was so common]. Their advice was priceless and they were just a lot of fun to hang out with.

Anyway, I have to get up early to make it to Cath conference – I hope you’re enjoying your summer [I know I’m loving the sunny days!].

ACP leadership day

Amanda Xi

Today’s series of inane images:

Last week I had the opportunity to attend the American College of Physicians [ACP] Leadership Day on Capitol Hill.
Since it was my first visit to Washington D.C., I made sure to visit the National Mall. We started with the U.S. Capitol Building since it was right down the street from our hotel.
Sadly the Washington Monument is closed to visitors due to a past earthquake. 

The Lincoln Memorial was well worth the long trek across the National Mall.

A couple weeks ago I had the opportunity to attend the American College of Physicians [ACP] Leadership Day on Capitol Hill with two of my classmates, a Wayne State medical student, a Beaumont resident physician and three other ACP fellows practicing in Michigan [including one of our lecturers and the governor of the ACP Michigan Chapter, Dr. Carl Lauter]. Because I am not too well-versed in the area of legislation, I thought that this would be an optimal opportunity to catch myself up.

Basically we spent an entire day learning about the ACP Key Priorities which were:

  1. Eliminate Medicare’s Sustainable Growth Rate [SGR] and Transition to Better Payment SYstems
  2. Ensure Full Funding for Essential Health Programs [e.g. National Health Service Corps, National Institutes of Health (NIH), etc]
  3. Enact Meaningful Medical Liability Reforms; Authorize and Fund a National Pilot of No-Fault Health Courts
  4. Fully Fund Graduate Medical Education; Re-align the Program with the National’s Workforce Needs
You can read more about these topics and ACP’s stance here [I actually thought that this PDF was a really quick and easy read that helped me understand what the current structure is and where the ACP wants to take it]. After getting to know these issues, the following day we went to speak to Representative McCotter and Levin as well as Senator Levin to advocate for ACP’s policy statements. Although we only briefly saw Congressman Levin and spoke to the staffers for McCotter and Senator Levin, it was still a great way to practice advocacy.

Anyway, I’m not an extremely politically-oriented individual, but I thought that the experience was a wonderful way to learn about current health policy [and a perfect excuse to explore the D.C. area with my wonderful classmates!].

—
In other news, I’m starting my Cardiology Internship tomorrow! Should be a fun time [plus, I’ve missed seeing my classmates – it seems so weird going for such a long time without seeing them!].

OUWB – A flawed curriculum?

Amanda Xi

Today’s inane image of the day:

Hey Class of 2016, here are the USB flash drives you’ll be receiving in August with your laptops – I had to box each and every one of them for you…



I received the following comment from an Anonymous poster on my entry, “A bump along the road to summer“:


Hi Amanda, Great blog! You are obviously a really bright student. I know you’ve had to do some re-mediation of course work at OU. Do you feel there is a flaw with the curriculum at OU? You seem way too smart to have to re-mediate any work, especially a clinical diagnosis type write up. Does OU “fail” a certain amount of students per block? Thanks for the input! Hope you are enjoying the summer.


Since I thought that this posed an interesting set of questions, I decided my response warranted an entire blog entry. 


First, OUWB does not have a quota of students that it needs to fail for each course. This ultimately works in our favor since it fosters an environment of collaboration and teamwork. If we all do well, we all pass [I do believe there was an Anatomy practical exam where the entire class passed]. However, because the bar to pass is set relatively high [usually 70%], this isn’t necessarily an easy feat and there tend to be a couple of students who just barely miss the mark. That is where exam remediation comes into play.


I’ve noted this before, but I’ll repeat it once again – exam remediation does not equal course remediation. It does not appear on your permanent record or your transcript. Essentially, it acts like a second chance to prove that you know the material. The only thing setting it apart from the first pass is that even if you score within the “Honors” range in your remediated exam, you cannot receive that grade since you failed the exam the first time around.


Keep in mind that I have only needed to remediate exams, not courses. 


Second, I had my concerns about the curriculum when the academic year had just started – it seemed harsh that students who had earned enough points to pass a course had to re-take an entire examination if they just barely failed. However, the reality is that most things only make sense when considered retrospectively; making every exam high-stakes prepares us for the concept that every assessment counts and ensures that whatever weaknesses we might have had are addressed immediately. My experience failing and remediating an exam in BFCP forced me to review the subjects that I was weak in [e.g. Microbiology, Anatomy, Immunology] and made sure that I was truly competent. And looking back, I definitely remember the microbes I reviewed for that exam.


Did failing a couple exams send me spiraling down a path of self-doubt? Yes. Did they seem to add stress to an already stressful situation? Yes. But did it help me feel more confident in the material? Absolutely. 


Third, if the question was more along the lines of, Do you think that you weren’t taught the material well enough and that’s why you failed? Well, this is a difficult question to answer. We haven’t had an exam where the majority of the class failed, and most of our averages have been relatively high. This leads me to believe that most of the class is learning the material somehow.


So what happened in my personal case?


The short answer: a lot of things. I tend to procrastinate on studying by dedicating time to extracurriculars [e.g. this blog, AMWA, etc]. I am also lazy when it comes to memorizing things. This combination, along with the fact that I attended every single lecture during the M1 year [i.e. I didn’t have as much white space to study as those of my peers that may have missed some class] didn’t quite set me up for success. However, I’ve learned over the course of the year how to prioritize, memorize and utilize my time in class. Overall, I feel like I’ve come a pretty long way since last August.


Do I think OUWB has a flawed curriculum? No. Do I think that we still need to work out some of the kinks like essentially every other medical school? Yes. In the end, there will always be aspects of a school that could be improved, but if the LCME put its stamp of approval on a school, then I trust that it will graduate competent physicians.


Anyway, I hope this answered your question. As always, please feel free to post a follow-up if I didn’t quite hit the spot!


[And I am indeed enjoying my summer! I hope all of you are, too!]



Block 3 – Respiratory

Amanda Xi

Today’s inane image of the day:

Yes, yes, I know I’m recycling images since this originally appeared in an earlier entry,  however, I think it’s the most appropriate photo to depict our Respiratory block so I’m sticking to it!

As with our last two blocks (Neuroscience and Cardiovascular), I thought it might be helpful to write about how things went during our last block of the M1 year: Respiratory. Now that we’ve completed a couple of these organ system courses, I realize that I need to go into each new block with an open mind about how it will run — there are definitely some uniformity between each system [e.g. Anatomy, NBME exams], however due to the fact that each course is organized and run by a different faculty member in addition to the inherent differences in the subject matter, there are bound to be differences. This being said, Respiratory had it’s pros and cons but overall I thought it put up a pretty good fight.

Course Overview
This block was 6 weeks like the Cardiovascular one. Each week we had a graded Moodle quiz that consisted of 20 questions that opened on Friday and was due by the end of the day Sunday. As always, we had TBLs, Anatomy labs and lectures. Additionally, we had a couple of Microbiology labs and a ventilator one. There were no clinical case studies. Our grades were determined by performance on the weekly quizzes, TBLs, Anatomy practical and final exam.

What I loved
Microbiology lab. Since the Respiratory system is so open to the environment we live in, it makes sense that there would be an emphasis on microbes. This being said, one of my favorite faculty members, Dr. Harriott, made sure that we really understood all the clinically significant information in lecture and through two fun, hands-on, laboratory exercises. We cultured our own throats and went through various stations associated with clinical vignettes to determine the causative agent. Through these stations, we performed catalase tests and tried to identify gram positives/negatives through the microscope [and more… I’m just drawing a blank now]. Basically, she did a wonderful job making Respiratory Microbiology fun and easier to remember.

Ventilator lab. I was a bit skeptical about this lab, but it ended up being a really interesting experience. The gist of it was to learn about the different settings that ventilators can be set to [e.g. volume vs pressure control] and experiencing how it feels to breathe on one. I was definitely apprehensive about trying out a ventilator, but it helped me understand why it can be such an unpleasant experience for patients. Furthermore, we got to play with the controls and become familiar with the device which will undoubtedly come in handy later on.

More study time. Dr. Rodenbaugh [our faculty course director] really pushed for carving out more white space for us and I really appreciated it. Although we still had a ton of lecture, just a couple hours each week really made a huge difference in being able to digest the material being thrown at us.

Final exam. As with the Cardiovascular block, our final exam was an NBME one, which made it more fair and straightforward.

What could be improved
Textbooks/course pack. The course required two textbooks by Dr. John B. West [one of which is featured in the photo above]. I really tried to give these books a chance, but I was not a fan of them. Additionally, Dr. Rodenbaugh compiled an iBook course pack [it was also available in PDF for the students without an iPad] that followed his lectures really closely. Although I thought the iBook had a lot of potential for making learning the material more interactive, I didn’t find it very helpful [keep in mind that I used the PDF version]. Maybe if I had used the iPad version I would have found more utility. Regardless, any textbook in its first edition is bound to have some flaws and I’m sure that Dr. Rodenbaugh will be integrating our feedback into improving the resource for future classes.

Quizzes. Although I found the quizzes to be helpful in the Cardiovascular course, this was not the case for Respiratory. I attribute this primarily to the fact that they were just too long… 10 questions is pretty reasonable to work at during the weekend, but 20 made it more of a burden than a learning tool. I just remember spending hours trying to bump my score above the 70% mark and feeling frustrated by the questions [they were a mixture of professor-generated and USMLEasy ones].

TBLs. I personally liked the Clinical Case Studies in Cardiovascular… however, I still maintain that the team-based learning exercise has the potential to be a great learning and assessment tool if it is designed to be more clinically-oriented. For some reason, the Respiratory TBLs didn’t quite meet my expectations — I thought that the background reading and the assessment questions needed some improvement.

Final thoughts
Overall, I thought the course was above average but that it could use some work to bump it up to exceptional. Dr. Rodenbaugh worked really hard with what he had and I applaud him for his dedication to making the course as successful as possible.