Author: Amanda Xi

Day 260: Choices

Amanda Xi

Today’s inane image of the day:

Just 1 more month left of this…

In the last hour, I suddenly became overwhelmed with just how many choices we make in a day. We choose whether or not to wake up in the morning to drag ourselves to school [some might argue that this isn’t a choice… but let’s just go with it]. We choose what to eat when we’re hungry. We choose which lane to drive in. We choose how we spend our time [such as right now — I am actively choosing not to study]. In life, we make a lot of choices that we don’t think twice about because for the most part, they are trivial.

But if you really think about it, some everyday choices we make affect those around us. Something as simple as smiling at a stranger as you hold the door open could be the highlight of someone’s day. Cutting someone off as you merge into another lane could ruin the rest of that person’s day. Sometimes, I think we forget just how interconnected we all are; most of the time I think I am just minding my own business and living in my own little world, but there’s no such thing. We all end up influencing another human’s life at some point in time, whether we acknowledge it or not.

In medicine, our choices hold even more weight. This thought is exciting and chilling all at once; our choices can lead to bringing a new life into this world or ending one prematurely. Our words can tear a family apart or bring tears of joy to a patient. Our actions truly impact the life of our patient, whether we like it or not.

This is the path we chose. We want to help people. We want to heal people. But in the end, there is no escaping the reality that we won’t always be right. Most of the time, there is no such thing as black and white; there is just an expanse of gray that will only morph into clarity retrospectively.

Day 251: Where’s the “pause” button?!

Amanda Xi

Today’s series of inane images:

[To make up for the serial silence, I thought I’d post a series of images that represent what has been going on in my life…]

While in Miami, I had the opportunity to meet the Keynote Speaker: Gloria Steinem!
This was the view from our Sofitel Miami hotel room [except we didn’t spend any time outside…].

Dessert at the Anniversary Gala was amazing…

We’ve started our last block of the M1 year: Respiratory.

Last weekend I had the opportunity to attend the AMWA 97th Annual Meeting in Miami, FL — I had a wonderful time getting to know one of my classmates, meeting other AMWA members from across the country and listening to the insightful words of the session speakers. Dr. Remen‘s soft-spoken words from the Friday evening reception really stuck with me — she noted that many see the world as broken, as something that needs to be fixed… but suggested that we see the world is hidden and needs to be discovered. Additionally, another talk entitled “How to succeed in practice” started out with some basic advice: don’t burn out. The speaker then proceeded with minimalistic slides leading up to the main piece of advice: in order to succeed in practice, you have to love it. Although he essentially stated the obvious, the session was well-presented [i.e. comical and lighthearted] and I find that sometimes we just need to be reminded of what’s important to keep going when the going gets tough.

With the end of the M1 year quickly approaching, I keep wondering where I can find the “pause” button — I seem to need every moment of the day to attend lecture, complete assignments and keep up with extracurricular commitments. This essentially translates into our Respiratory material taking the backseat until [maybe] this weekend. Although I understand the need to test our competency with written assignments, sometimes I wonder about whether the timing of due dates was considered — we have a 4-5 page Literature Review paper due Monday and another 2-3 page Position Paper for PMH due on Wednesday. Sure, this doesn’t sound like much, but when I sat down and started to look into the assignments, I realized that they would take much more time than I seem to have.

The frequency of updates will be sparse in the upcoming weeks — we have 5 weeks left in the semester, but our block of 5-6 exams (depends on if you count the Anatomy Lab Practical) start in a little over 3 weeks. I’m sure that everything will magically work out and summer is right around the corner, but right now, in this moment, the future looks daunting.

Happily, I’m sure I’ll take some stress off tonight at our Med Ball — Social Committee has been working hard the last couple of months to make this a reality and I’m really excited to see all of their hard work pay off!

Until next time…

Day 242: Feeling overwhelmed

Amanda Xi

Today’s inane image of the day:

This salad was a wonderful surprise — adding fruit seems to make everything look and taste so much better!

Similar to the end of the Fall semester, the end of this semester is jam-packed with exams, assessments and assignments. I wish I could say that my many years of experience with this end-of-the-term-phenomenon prepared me to tackle this last month and a half with poise — but the reality of medicine is that you cannot really predict how things will be until they are. Being someone who likes to feel in control of any and all situations… this is a terrifying position to be in.

Alas, I have adapted over the course of the year. Medical school seems to send you into a perpetual state of feeling overwhelmed — it feels like you increase your threshold for stress and studying exponentially as you spend more time in medicine. Even though I’m used to this, school is still challenging. At times, it feels like being dropped off at Mt. Everest and told that you have to make it to the top; although we’re inexperienced amateur, we were selected because a committee decided that we are capable of scaling this challenge called medical education.

Being conditioned to handle stress doesn’t mean that I don’t have moments of doubt. Often, the following questions creep up in my mind: How will I memorize all of this material? How will I have enough time for all of my extracurricular commitments? Will I have the strength to get through this all? And then I reflect upon the trials and tribulations of the last academic year, and I feel accomplished. Our class has made it this far — we will make it through the last month and a half!

In the meantime, the only way to really address feeling overwhelmed is to actually do stuff [nothing compares to the satisfaction and relief of seeing the checkmarks next to a bunch of completed tasks!]. At this point, we have PMH and Capstone assignments due in the coming weeks in addition to keeping up with Respiratory lecture material. Then there’s that whole trying not to gain 20 lbs from eating junk food [Sweet Onion Kettle chips for the win], coffee beverages [if that warm weather would just come back for a visit I could start drinking Frappuccinos again…mmm], consuming inordinate amounts of energy drinks [I’ll be honest — Red Bull is my drink of choice; 5 hour energy = flushing, Monster = too much liquid] and Lunch and Learn food [yeah, uhh cheesy pizza and oily mac and cheese are not conducive to maintaining a healthy weight]. Additionally, I seem to have taken on a number of extracurricular commitments that require some serious time management on my part to maintain [e.g. AMWA elections are around the corner — eek!].

Anyway, look forward to future entries on trying to stay healthy, commuting, stress relief and anything else that pops into my mind!

Day 237: Block 2 – Cardiovascular

Amanda Xi

Today’s inane image of the day:

Lilly’s Pathophysiology of Heart Disease was the textbook most, if not all of us used for the Cardiovascular block. I personally thought that this was one of the best textbooks I have ever read [and likely one of the only textbooks I truly read from cover to cover].

Block 1 [Neuroscience] was somewhat of a disappointment, so it seemed that it could only get better from there. And it did with our Cardiovascular system block.

Preface
I want to preface this post by noting that even if Neuroscience went relatively well, I believe that I would have still written a positive review of Cardio — lectures and assessments were as organized as they could be for a first run-through and every lecturer has been enthusiastic and extremely approachable. Not to say that there weren’t bumps in the road, but looking back, they were all minor and overshadowed by how smoothly everything else went.

How the block was organized
We had ~6 very packed weeks of lectures then an Anatomy practical and final NBME exam to wrap things up. Each week featured a “theme” — for example, one week we discussed acute coronary syndromes and everything related to them [i.e. atherosclerosis, hypertension, heart attacks, pharmacology, etc] then ended most weeks with a Clinical Case Study [more on this later]. We only had one TBL during the block, but I definitely preferred the Case Studies as the main form of active learning. Finally, each weekend a 10-question quiz opened up on our online course management site that was worth a couple of points [we had unlimited tries and the grade was whatever our highest scored quiz was].

As with previous courses, we still had Anatomy lab each week and in lieu of Radiology lectures we had Cardiac Imaging labs. Basically they were similar to what a Radiology lecture would be like, but since much of cardiac imaging can be done by Cardiologists now, it makes sense that they would teach us the material.

What I loved
The textbook. For most of the year, I have been learning primarily from lectures and Powerpoint slides and only referencing the textbook when I felt like something wasn’t clear. This seemed to be the most efficient way to study because most of our textbooks are really quite monstrous in size and some tend to have convoluted explanations. But when one of my classmates pointed out how clear and concise Lilly was, I decided to try it out… and was pleasantly surprised. There are a bunch of extremely helpful figures and tables nestled into each chapter and the text is really very readable. Furthermore, it’s compact… so it’s manageable to read and portable [I took it with me to California over Spring Break without breaking my back!].

Clinical Case Studies. I wasn’t sure what to expect from these, but was very satisfied with how they turned out. Basically, we are given a short Powerpoint file with a history of present illness, past medical history and pertinent information from the physical exam and are expected to come to the session with a problem list, differential diagnosis and an idea of where to go from there [i.e. what labs/tests/imaging studies to order]. During every session, there were a ton of Cardiology fellows around [so many that each group had one!] to guide us through the process. We would start with discussing what we prepared and our thoughts then the fellow leading the case would ask the whole group what to order next. The complete Powerpoint file for each case contains links to the results of various tests [or to a slide that says a test isn’t indicated] as well as further information. Finally, every case had some sort of twist so we had to try to put the clinical picture together and determine what might have gone wrong [we’re basically pretending to be doctors on a case in slow motion]. Overall, I definitely learned a lot from these sessions — passive listening to lectures can only get you so far [and that’s not very far when you’re sleep deprived] so this form of active learning was definitely welcome.

The organization. I really cannot stress the importance of this enough. The week’s lectures were opened up ~1 week in advance. Only minor modifications were made [for the most part — there were maybe a few lecturers that made significant changes to the presentation, but that’s bound to happen]. The schedule did not suddenly change on us. For the most part, we knew what to expect and how to prepare for it.

The weekly quizzes. Since we had as many tries as we wanted and only the highest grade counted… this was an extremely low-stress way to force us to review material. Even if I didn’t want to take my notes, it forced me to at least think about the material, even if I was guessing on some. [I think I racked up something like 20 tries on one quiz because I refused to flip through my notes…heh!]

Weekly lunch/review. At the end of each week the lecturers came in to answer any of our questions from past material and also brought pizza/salad with them. Even though it felt kind of wrong eating cheesy, buttery goodness while discussing atherosclerosis… well… everything in moderation, I guess.

Final exam. Although things were different this time around, in retrospect, I loved the changes. Not only did we get an NBME exam that was taken using their USMLE examination interface [that’s right! we’re getting experience now with that rather minimalist interface! I’ve become a computer-strikeout-answer pro — yes, it actually takes skill to learn how to strike an answer out…], but we also have the whole weekend off. Yes. All 2.5ish days of the weekend are free! Woohoo! So, although I have no idea if I passed this exam… at least the weight of it has been lifted and I have a glorious weekend of decompressing ahead!

What could be improved
Lack of suggested reading assignments. [This is a minor point.] For the most part, Lilly’s chapters correlated with the week materials [e.g. during our valvular week, I read the valvular heart disease chapter], but sometimes I wished the lecturers would point out important pages to preview or review. Not all of the professors used images from the textbook, but for the ones that did, it would have been easier to keep up earlier on [I figured it out within a couple of weeks, but still…].

Communication. Everyone working in a group setting could work on this [myself included!] and I think that you can always fall back on this as an area of improvement. Specifically, I thought that although I really enjoyed hearing certain things over and over again, that sometimes the redundancy was a bit too much. For the most part, each lecturer knew what the other lecturers discussed, but there were still some times when I heard the same concept repeated almost the same way and I didn’t think it really helped much. This is most likely a preference thing, though.

Consistency in quality of lecture slides. As with any academic institution, some Powerpoint presentations are formed better than others. Truly, I think it’s an art — being able to cram a ton of important information into slides and keep it interesting? Well, that’s quite difficult and I don’t claim to know the secret to doing this well, but with how many slides I’ve seen in my years… I have an idea of what I like. For example, placing images on a slide without labels doesn’t really help us when we go back to review the slide: Is that little black thing the problem? Or is it that white stuff? Or maybe that growing thing off the side? Wait, is that normal? Or, putting a couple of words on a slide: Mitral valve, stenosis, regurgitation. So I just used up 1/6 of my page to print 4 words? I’m trying to be environmentally-friendly here! 

For the most part, this wasn’t a problem, but hey, it doesn’t hurt to mention it.

Time in lecture. Being the person in charge of turning on the recording equipment and assisting the lecturers with their education technology needs [i.e. where did my Powerpoint file go? how do I go back? why did the screen go black!? *throws hands in the air*], I need to be at every lecture. Of course, I could have someone cover for me… but I’m pretty proud to be one of the few ridiculously dedicated lecture-attending-students [you know who you are!]. Anyway, we spend a lot of time in lecture and sometimes I find that it is more detrimental than helpful to sit in our rather uncomfortable lecture hall chairs [future classes, you are so lucky]. There are definitely some places that could be shaved down as to reduce a couple of hours each week of lecture-time, but I understand that with the first run-through that everything has to be as complete as possible.

Final thoughts
Dr. Goldstein and Dr. Augustyniak [I couldn’t find a link for him anywhere…] really did a wonderful job with this course and overall, I’m extremely satisfied. Our Respiratory block is starting off strong on Monday… but it’s Friday now so I’ll worry about that stuff come Sunday evening.

Have a wonderful, relaxing weekend everyone!

Day 234: Ready, set, Cardio!

Amanda Xi

Today’s inane image of the day:

This was the view from Starbucks when I was in California… definitely was a fan of the palm trees and mountainous horizon!

Not quite sure if my title makes much sense, but hey, let’s just go along with it. Alas, the last week+ has been filled with EKGs, pharmacology and trying to determine what I don’t know. One of the hardest things to adjust to [at least for me] has been the fact that I can never really know what to expect. With this exam being an NBME one, at least I know these are standardized questions that are unlikely to test minutiae that appeared in one slide and diseases that only affect 1 in 1,000,000,000,000 individuals [just kidding — our exams have never been that bad] [plus, I think the Boards actually like those diseases because they’re more readily identifiable and thus, testable].

We have our Anatomy Practical Examination today and our Final Exam on Friday. Hopefully, all goes well!

On another note, a popular topic around the blogosphere has been about maintaining an online presence as a medical student. I hope to expand on my own views in the near-ish future [don’t expect this website to be taken down anytime soon!], but I’ll leave you with “5 Reasons Mind on Med Won’t Disappear for Interviews,” “My Social Media Manifesto,” and one of my favorites, “Pioneering Unchartered Territory.”

Happy Tuesday!

Day 224: Unseasonal

Amanda Xi

Today’s inane image of the day:

I went to San Diego for an evening during Spring Break to avoid this scene of gloomy, overcast skies. At least there were palm trees and was a gorgeous body of water outside of our window! 

I have so many ideas for future entries, but have been out and about enjoying the beautiful weather [70s all week and sunny!] and mingling with some awesome admitted students [last week was Second Look Experience] that I haven’t really had a moment to sit down at my computer and write.

Our Cardiovascular final exam is creeping up so it’s time for me to ramp up the studying. There are a number of factors that are different for this exam: 1) it’s our first cumulative final exam; 2) the questions are written by the NBME [they also write the USMLE]; 3) it’s on the computer [since they are NBME questions, they can only be accessed through their online system…very much like the boards!]; 4) it’s on a Friday [historically, our class has used the 3 day weekend before an exam to cram… now, that option is no longer available].

Anyway, back to the pharmacology [did you know that one side effect of ACE inhibitors that some patients may not tolerate is a cough?].

Day 216: Breaking the cycle

Amanda Xi

Today’s inane image of the day:

I always tell myself that I’m going to cut back on the Starbucks… and what better time than Spring Break? Well… then the problem of productivity arises and I end up sipping my favorite coffee beverage over my lecture notes. 

By the winter of each academic year, I find myself losing my motivation to be in school. When November rolls around, I just want to make it to break so I can replace academia with [fun] reading, catching up with old friends and quiet time to myself. Yet, midway through winter break, I am antsy to get back into the grind of school; I start to feel the excitement of starting a new semester of material, places and faces. Once classes start up, the feeling quickly wears off along with the treads of my shoes as I trudge through the snow to class. Novelty morphs into mundane and by February, the cycle starts all over again.

Throughout college, I was under the impression that medical school would break this cycle. I thought that by making it to this point, I would love learning about everything and thus the motivation to study would never be an issue. Surely, medical school would be different!

Well, I wasn’t entirely wrong — instead of breaking the cycle, I seem to be settling into a new one. I didn’t lose my motivation last November, despite my difficulty with exams [sort of]. My drive to keep studying even stuck around through most of January. But somewhere between then and now… it dissipated. I suspect that the stress of Neuroscience never had a chance to resolve because we took our final then dived right into our Cardiovascular block. Either way, ruminating over why I feel this way doesn’t really help me with the issue at hand now: I am tired and unmotivated.

My spring break has been filled with a lot of sleep and minimal studying, yet the thought of returning to school on Monday for the home stretch really frightens me. I am well-aware of the fact that the rest of my life will be filled with work — this is medicine! But everything following M1/M2 is a different kind of work. Instead of reading about the cases, I’ll see them. Instead of spending endless hours at Starbucks, I’ll be at the hospital [heh, except there’s a Starbucks in the hospital so I may still spend endless hours at Starbucks]. I am excited for clerkships… but a lot of books, lecture notes, exams and the Boards stand in the way [with good reason, of course].

Regardless, I know I’ll conjure up the motivation to get through this, but I think it’s important to document these moments to look back upon someday.

Do you have a cycle? Have you found a way to break free from it?

[Happy Match Day!]

Day 209: The digital world is a huge distraction

Amanda Xi

Today’s inane image of the day:

If only this photo could show just how worn down my keyboard is… 

The problem: internet/technology is a huge distraction and time warp
More and more, I’m finding that the urge to check my phone or computer for the latest updates on Facebook, Twitter or my favorite blogs is impossible to overcome. I always tell myself that I’m going to close my laptop and switch my phone to silent while I study, but when the inevitable need to look up an unfamiliar term or find a better explanation for a concept comes up, so does my laptop cover. At that point, I decide that it can’t hurt to check up on at least one of my favorite sites for updates… only to find that an hour has been wasted on the latest from my Facebook news feed or refreshing my Google Reader for new updates from Wayfaringmd or Dr. Grumpy.

This is what our generation grew up with
When my family got our first computer, I remember spending every evening tinkering around the settings, instant messaging my friends that I had seen only an hour prior, or discovering the infinite depths of the internet. The world was literally at our finger tips… all we had to do was apply pressure to a specific pattern of keystrokes and we could get the latest news, relearn how to knit, or even figure out how others were getting into medical school. Anyway, the point is that as I matured, so did the internet and the technology that can be used to access it… making it something that our generation grew up with.

A semi-recent study shows that the current generation would rather text rather than talk — admittedly, I fall into this category because many times it’s more convenient to do so [imagine sitting in the silent reference room of a library and you have to ask someone you’re studying with a question — definitely more appropriate to use instant messaging/text] or the question is so small that it wouldn’t warrant a full-blown conversation [are you wearing business casual for tomorrow’s event?]. But in the end, yes, I am more comfortable sending a text rather than chatting over the phone.

An interesting NYT piece, “Growing up digital, wired for distraction” really delves into the issue I’m facing now: “…computers and cell phones, and the constant stream of stimuli they offer, pose a profound new challenge to focusing and learning.” This. Exactly. The scariest part of all of this is that medical school doesn’t really forgive these kind of distractions — in order to keep up, we need to find fail-safes to avoid being sucked into the time warp. If we do not overcome this challenge, then we may find ourselves facing more bumps in the road.

What has been done
I’ve considered trying to unplug from everything as one of my favorite physician bloggers, Wendy Sue Swanson [Seattle Mama Doc] did during her online sabbatical, but it isn’t the most realistic thing for me to do at this point [Facebook has been an important medium for our class to exchange important information, alert each other of upcoming deadlines, etc]. Furthermore, I am just starting to discover and gain traction in healthcare social media communities, so leaving would feel a lot like taking two steps backward.

Another way to address the issue is by blocking specific websites for a period of time. One tool I found just by Googling “block sites for studying” is an add-on called “LeechBlock” for the Firefox browser. I don’t use Firefox, so this wouldn’t really help me. On the other hand, the site “Hack my study” contains a browser-specific tutorial for blocking sites. This seems like something I will probably have to use in the future.

Where to go from here?
One of my favorite non-medical blogs, A Cup of Jo [she’s a Michigan native, too!], recently posted this article asking readers if we really are as busy as we think. The idea is that we actually exaggerate how busy we truly are [claiming to work 80 hours, but in reality it’s actually less than 60; claiming to sleep only 6-7 hours/night but really sleeping more than 8, etc] and don’t realize what we are really doing with the 168 hours we have each week. The way to resolve this issue is by keeping a time log — similar to a food log for those of us on diets. From there, it becomes glaringly obvious that a lot of our time isn’t spent on high priority tasks.

Right now, I am not in such a terrible position that I cannot buckle down and study when I need to [yes, I can study for hours without checking my laptop], so I don’t plan on doing a complete online hiatus. On the other hand, I will probably turn to these drastic measures come this time next year when the Boards will be looming. But I do think it might be telling to start a time log [I’m start by trying this program] and assessing where I could optimize my activity. Even if it doesn’t lead to a drastic improvement in time-management, at least it’ll be one way to see how I’m spending my weekly 168 hours. I’ll keep you updated on the numbers.

Do you feel like the digital world is a distraction? What do you do to alleviate the problem?

Day 208: International Women’s Day

Amanda Xi

Today’s inane image of the day:

This year’s theme: Connecting Girls, Inspiring Futures

I don’t remember exactly how I stumbled across this, but I saw it and thought it would be interesting to try something new. Gender Across Borders and CARE are hosting this online event — I encourage you to check out their websites.

Anyway, the question I’ll be musing over is: How can we, as a culture and as members of the global community, involve, educate, and inspire girls in a positive way?

Here are a couple of my [rather jumbled] thoughts:

I attribute much of my success to always having strong role models and mentors to look up to — my parents, teachers and professors have all contributed tremendously. Thus, I believe that by connecting young women at an early age to an invested mentor, we can make a positive impact on young women. Furthermore, I think it’s imperative that we expose girls at an early age to women who are successful in STEM [Science, Technology, Engineering and Mathematics] fields — I have written before about how few women pursue science-based careers and I will say it again: it’s maddening that there are so few women in science. Anyway, I digress.

A huge issue that young women face is that of body image. We all went through it at some point in our lives and many women still struggle with it today. I personally remember how tough it was to be a pre-teen or teenager at the mall — left and right there are images of women who have been airbrushed and cropped to a size that is either underweight or right on the bottom border of a healthy BMI. Or even just watching television — everyone always looks glamorous with perfect make-up and exotic hair styles! How can we try to address this? Well, how about by reinforcing what healthy really means (eating right, staying physically fit) and discussing how beauty is in the eye of the beholder? Maybe by having these dialogues early on, we can veer young women away from eating disorders and other damaging behaviors.

I also believe that acceptance is key — exposing young women to non-judgmental individuals allows them to grow and discover things they are passionate about. When I’m expressing my thoughts to someone, I am always searching for a reaction, and if my words are met with a disgusted or disappointed expression, I tend to take it personally. When I was younger, many of my actions were directed by these responses, which leads me to believe that it’s vital for girls to be surrounded by other open-minded individuals that can guide them.

Ultimately, girls need supportive, devoted mentors that are invested in their success and that’s where we fit in as members of the global community. All it takes is a couple hours a week to connect with  a young woman — in the end this small investment will probably make a huge positive impact on her future.