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.

A bump along the road to summer

Amanda Xi

Today’s inane image of the day:

Over Memorial Day weekend, Mike and I made our way to Western Michigan to South Haven for a quick day visit. Here’s the scene at the beach… even though it was rainy earlier and the water was chilly, there were still a number of dedicated beach-goers!

Although May 25th was our last official day of classes, sadly it wasn’t quite my last day. Our Art and Practice of Medicine [APM] course only had two graded items for the entire year — both of which were exams that took place during our last two weeks of classes. The requirement for passing was a 75% on our written exam and 85% on the OSCE — although I passed the written portion, the OSCE didn’t go as well. As with all of our other courses, I had to remediate the exam.

On the upside, of the six or so exams we had to take, this was the most predictable one — there is a set format and a very specific number of tests to memorize. Furthermore, I failed on two accounts: 1.) I didn’t ask enough open ended questions and 2.) I didn’t include enough detail in my write-up [honestly, I don’t know what I was thinking when I was doing it — looking back at how sparsely filled-in each section was, I guess I had temporary amnesia]. Basically, I had a pretty good idea of what I had to fix and could do them relatively easily.

On the downside, I was extremely disappointed in myself and went as far as to question my ability to become a physician [yes, I know that this was taking it too far, but hey try failing something like this and see how it makes you feel!]. All of the other courses require at least some rote memorization [something I really do not enjoy doing] and I could always blame insufficiencies on my laziness to memorize certain things. But this course is essentially the heart of medicine; we interview patients and perform physical examinations to lead us to reasonable differential diagnoses. Not doing well in this course could translate into not “being good at medicine.”

This discussion leads me to the question of whether certain skills and traits can really be taught through the medical curriculum. Can we be taught empathy and compassion? Can we be taught caring behavior? Or are we just shown what these things look like and through enough practice, we are expected to mimic it? Surely the admissions process disqualifies applicants who do not meet these criteria, but it’s not a perfect process so it makes sense that certain humanistic aspects of medicine need to be covered during medical training. These are interesting questions that I often ponder during our APM and Medical Humanities [MH] courses [with no definite conclusion].

Anyway… with all of this being said, I passed my exam [apparently with flying colors] and officially started summer as of Friday. Yay!

—

Look forward to a review of our Respiratory block, what I’m doing this summer and the exciting news I wanted to share with all of you!

Day 286: The last official day

Amanda Xi

Today’s inane image of the day:

I love the green summer foliage and clear blue skies — never fails to put a smile on my face.

Today we took our last examination of the M1 year. Today was our last official day of class. Today is the first day of summer.

I’ll be on a short hiatus until sometime late next week [look forward to some exciting news in the coming weeks and updates on my rather jam-packed summer].

Day 279: The long distance relationship [update]

Amanda Xi

Today’s inane image of the day:

One popular search phrase that lead people to my blog: “medical school books” — so I thought hey, why not post yet another image of medical school books?!  

It has been a little while since I touched upon the subject of long distance relationships [LDR]. As you might recall, I was struggling with my LDR back in October but by February, I doled out advice on maintaining [long distance] relationships. Tonight, as I was scrolling through my Google Reader feed [have you subscribed to my blog yet?], I noticed that the Thought Catalog had an entry entitled, “How to survive any long distance relationship.” After reading through it [and feeling rather unsatisfied with its content…] I decided to make this update about how things are going in my LDR.

Without a doubt, our relationship has taken a beating throughout the year. Mike has been exceedingly resilient [he’s totally smirking right now as he reads this] and supportive throughout all of my stressed out rants and panic attacks over exams. Sadly, I don’t feel like I’m reciprocating enough; because time is so limited and there’s always so much to do, I often catch myself taking our relationship for granted. [I’m slowly working on changing that.]

Maintaining a long distance relationship while in medical school is no easy feat. It requires a unique type of dedication, understanding and strength to pull through. I cannot claim to be an expert on the subject because it hasn’t even been a year since Mike left for California, but the first few months were the most difficult. There were a lot of factors to adjust to in those first few months: medical school, meeting new people, staying sane… adding an LDR only complicated things further. But then again, here we are more than nine months later.

In my earlier entry, I failed to mention how important it is to reach out to supportive friends. Admittedly, there were times when I thought the relationship wasn’t going to make it. Mike felt it, too. But then I called up one of my friends and she guided me toward a sound conclusion. Normally, it’s really hard for me to ask for help, but sometimes you just need to overcome your ego or whatever is preventing you from reaching out to someone because emotions tend to cloud logic — talking about it helps clear up the situation and leaves you open to ideas you probably would not have discovered on your own. I am so grateful for the wonderful individuals [yes, if you think I might be referencing you, I am] that have listened patiently to my redundant rants about this relationship. Thank you.

Despite my pragmatic and sometimes pessimistic view on life, I’m optimistic about making my long distance relationship work. After all, we’ve made it this far…

Are you in a long distance relationship? Are you considering one?

Day 278: Synthesis

Amanda Xi

Today’s inane image of the day:

I could go for another one of these Miami sunsets right about now… 

Mimi presented to the emergency room because of excruciating chest pain.

The seven of us delved deep into the case starting with the patient interview. We started with the generic, “Why are you here today?” and maneuvered our way toward the history of her present illness. She had been lifting boxes at home when the pain started. After probing for more details on her symptoms, she noted that “it felt like something tearing in my chest.”

We all had that keyword ingrained in our minds — it meant an aortic dissection.

After completing the rest of the pertinent medical history, we started a physical examination. We palpated the precordium and the abdominal area. We noted that the intensity of the point of maximum impulse was increased, suggesting a thickened left heart. Importantly, there was evidence of a dilated pulsatile mass in area of the abdominal aorta. It all made sense.

We wanted to visualize what we were working with, so we ordered a chest x-ray. The widened mediastinum and prominent descending thoracic aorta was more fuel for the fire. We ordered an echo to check on the heart and surrounding vessels. It confirmed our suspicion about the hypertrophic left heart and even revealed an intimal tear within the descending thoracic aorta. Everything fit together perfectly.

Following a few more labs and tests, we generated a problem list, submitted a diagnosis and suggested a management plan for Mimi. Then we joined the other six groups to debrief on the case.

[If you haven’t guessed yet, Mimi is a computer-simulated patient. This would be a blatant HIPAA violation if she wasn’t.]

This was our first case in our Synthesis course. I imagine this is what problem-based learning is like [if you have PBL at your school, do share about the experience!] and overall, I’m impressed by the modality. I like that we are working in a larger group than in TBL [we had 5 members for TBL, 7 now in Synthesis] because it is a better representation of a healthcare setting. I like that we are given the opportunity to work through all the nitty-gritty details of the case at our own leisurely pace. And I enjoyed the debriefing discussion [Dr. Misra led it — she’s wonderful!]. However, because we are forced to discuss and dissect every single detail, the session seemed to move slowly. I suppose it’s important to start slow and make sure you’ve covered all of your bases rather than delve straight into an algorithmic approach, but since there weren’t any huge curveballs thrown into the mix we knew the diagnosis within ten minutes due to her report of “tearing” chest pain.

Finally, the feedback portion of the program was valuable because it pointed out where we were on-track with our interview, physical exam and tests but also listed other important aspects that we missed. Although we had the diagnosis from extremely early on, we still missed a couple of smaller steps that would have been important to report. Regardless of the things we missed, I’d say that our group did a relatively good job investigating our first patient.

We have our OSCE tomorrow so I should rest up for it… hm, I guess it’s a bit late for that now.

Day 276: The non-cognitive evaluation

Amanda Xi

Today’s inane image of the day:

A couple of weeks ago, we received sealed envelopes with our “Non-Cognitive Evaluations”

Prior to receiving my non-cognitive evaluation, I completely forgot that this was one aspect of our medical education. Although I kind of knew what to expect when I received my second round of TBL peer feedback, it still stung to read those comments. I don’t think anyone takes constructive criticism well because it is inherently personal in nature and draws attention to our flaws, whether we are willing to admit them or not. Regardless, it’s important to always strive for improvement and my non-cognitive performance doesn’t escape this scrutiny.

We only received evaluation forms back from our Neuroscience and Medical Humanities courses. Once again, I wasn’t particularly surprised by the marks. The forms were set up with specific “areas” such as “Explain things clearly to others” or “Sense and respond to others’ feelings” and a set of ratings and comments that included the options: Below Average, Average, Above Average and Not Observed.

Even though there weren’t a ton of comments provided, the few that were reminded me of how important it is to establish relationships with everyone within the field. In the end, our faculty and staff are our team members — I will rely on them for my education and recommendations and someday, I’ll be able to give back. These non-cognitive evaluations won’t end up in my permanent file, but they are a good way to remind us that there’s more to success in medicine than just academic performance.

Back to studying…

Day 275: 2 down, 4 to go

Amanda Xi

Today’s inane image of the day:

Have you had these Bolthouse Farms smoothies? I grabbed this one thinking that it would be slightly less sugar-laden than all the rest of them… but the “Green Goodness” part was misleading. Alas, it was a yummy dessert to go with my weekend pre-exam pizza!

The best part of having NBME exams is that the questions are inherently more fair than an in-house-generated examination. When various individuals write questions, the variability in semantics, difficulty level and understandability [oh, you meant that?!] sometimes get called into question. And when you’re sitting in limbo between passing and failing because of a couple of measly points… you can bet that you’ll be sitting in the exam review session contesting every single question.

Despite the fact that the exam is more fair … most of us have no idea how we performed. The exam was 115 questions, so when I finally hit the submit button on my exam, my brain was fried [and the caffeine-rush had already worn off] so I was ready to book it out of that uncomfortable O’Dowd lecture hall seat. Plus, we had an Anatomy Practical just a few hours afterwards that I needed to study for.

Either way, what’s done is done and I just have to keep looking forward and studying for the next thing. I feel calmer now that we don’t have class from 8AM-5PM [only 8AM-11AM for Synthesis] and we don’t have anymore days jammed with 2 exams. Plus, there are a number of fun end-of-the-year lunches/dinners scheduled for the upcoming week and end of next week — lots of little things to look forward to [and one huge thing: summer!]. I cannot believe that we are down to our last 9 days of the first year… the year went by in a haze of studying, O’Dowd, getting to know my classmates and adjusting to being in a long distance relationship. I’ll definitely be reflecting more on the year in the coming weeks.

If you’re off enjoying summer please soak up some sun and adventure for me. If you’re still in the midst of finals, good luck. If you don’t fit into either of these broad school-based categories, then please enjoy this present chapter of your life — I’m quickly realizing that time is fleeting and we only live in each individual moment once.

Day 272: May 4, 2011 @ 11:17AM

Amanda Xi

Today’s inane image of the day:

Sample of my written notes… here, I am trying to remind myself of the distinctions between the two main categories of lung cancer: small cell and non-small cell.

May 4, 2011 @ 11:17AM will always hold a special place in my heart — it was the moment that I received my first medical school acceptance. It was a redeeming, beautiful, overwhelming moment; finally, all of the years of preparation and hard work opened the door to the next chapter of my life. It was the day that I realized I would someday be a doctor.

Time get back to the lung…

Day 271: Response to reader Qs

Amanda Xi

Today’s inane image of the day:

Skimming through the Respiratory chapter of Rapid Review Pathology.

A reader left me a set of questions to answer on my FAQs page [prior to my template switch — comments apparently cannot be left on pages anymore with the new layout — BUT, I still love getting questions so comment on a post or feel free to email me!], and as promised, here is an entry with my responses:

1. One thing I like most about medical school.

It is really hard to narrow it down to just one thing that I like most about medical school — I love almost everything about medicine [except maybe for the stress…]. But since you asked for one thing I’m going to have to go with the fact that every single day, I learn something new and fascinating about the human body. From an engineering perspective, the human body really has some incredible checks and balances that we try to mimic imperfectly. For example, although we have had the ability to stop the heart and place a patient on a heart-lung machine, it still isn’t an optimized device — emboli can be introduced occluding blood flow in a vessel and red blood cells are damaged as they run through the tubing of the machine [a reality that I became really familiar with while working at Terumo Cardiovascular Systems]. So yeah, medical school [and being in this profession, period] is awesome because everyday when I learn something new, I am reminded of how awesome our bodies really are!

2. Extracurricular activities/leadership roles I had prior to medical school.

I posted an abridged version of my CV on the blog to try to answer this question. But if I had to highlight a couple of them, I’d say that my involvement in the Society of Women Engineers [SWE] and planning/facilitating the Ypsilanti Middle School Engineering Club really stand out in my mind. Keep in mind that I transferred from Bard College at Simon’s Rock to the University of Michigan after 2 years, so while I participated in a number of extracurriculars at Bard College, I don’t usually mention them since they were so long ago.

SWE was a huge part of my life since I joined prior to starting at Michigan and jumped right into an officer position after 1 semester. The organization gave me the opportunity to organize and run a summer camp with one other person, network with corporate recruiters, build my interviewing and resume-writing skills as well as assume a leadership role as part of the Executive Board. Because SWE at Michigan is one of the largest engineering organizations on-campus, there was a lot of work to do to keep it running [we had 50 officers and 200+ members during my last year] — but it was well worth it because the position taught me a lot about being a leader and working with a leadership team. Plus, I met and became close with some incredible people along the way!

The Engineering Club sticks out in my mind because I had to do a lot of preparation to plan each session for the students. Ypsilanti Middle School is a high-need school, so that means at least 50% of the students qualify for free or reduced lunch [while I was there, it was close to 90% of the students]. This posed a number of challenges for me — recruitment, trying to accomodate for a range of learning styles and levels and building a relationship with my students were all hurdles I had to scale. In the end, I got a lot out of the experience and believe that at least a couple of my students did, too [one of my favorite memories of the club was when I asked who was interested in engineering and most of my students raised their hands — this was huge for me since many of my students weren’t huge fans of science or didn’t know what engineering was].

3. How long I spent studying for the MCAT.

I wish I could remember exactly how long I spent studying for the MCAT… but I think it was at least a couple of months. I took it in January of 2010 during my Senior year so it was kind of tough to juggle a Senior Design project, classes and studying for the MCAT. The only resources I used to study were the ExamKrackers series, sometimes the Kaplan Comprehensive review book [there seemed to be a number of errata in this text so I don’t think I used it much] and the official AAMC practice tests. I completed almost all of the prerequisites for the exam over 2 years prior to actually taking the test so the material wasn’t too fresh in my mind, but I got through it.

I’m interested to see how the new MCAT plays out… but I guess it’ll be a while before the AAMC starts administering it. I’m skeptical of it being a “better” test, but I do believe that the exam needed an overhaul of some sort so I think they’re moving in the right direction.

Hopefully this answers your questions and as always, feel free to leave more for me in the comments section below!


Day 269: I am not a doctor

Amanda Xi

Today’s inane image of the day:

Have you tried the new Mocha Cookie Crumble Frappuccino yet? It’s like blended cookies and happiness all in a cup. Plus, you can get them for half off between 3-5PM from now until May 13. [Today’s entry actually pertains to Starbucks…]

This morning started off like any other. I parked my car, walked into Starbucks and pulled up my iPhone app while waiting in line. The usual suspects were already there — the elderly fellow that always flirts with the baristas, the business man with his freshly pressed suit and the tired-looking mother. As I approached the counter, I ordered my usual summer morning beverage and went through the motions to pay.

As I meandered toward the pick up counter, one of the baristas grabbed my attention: “Hey, Amanda! You’re in medical school, right?”

I stopped in my tracks and turned my attention toward him. Immediately, I braced myself for the worst; in our Medical Humanities course, the professors warned us that upon entering the profession, family and friends would suddenly start turning to us with their medical questions. We were cautioned that because there would be no escaping the situation, we needed establish an appropriate response to the request. But never did I imagine that as a first year medical student, an acquaintance would turn to me for advice.

“Yes, but…”

He cut me off. “I have lower back pain that radiates down my leg…”

The gears in my head started turning. I thought back to my latest clinical experience — one of our patients described a similar chief complaint and during our discussion with the preceptor, we discussed differential diagnoses for that particular symptom. I tried to clear the cobwebs clouding my knowledge of Anatomy and Neuroscience and considered the nerves that could be affected. I wondered if there was an inciting event that precipitated the pain. But in the end, although these thoughts raced through my mind, I never had any intention of sharing them.

“…and I was wondering…”

As I stood there listening to him, it struck me how entering medicine was almost synonymous with being entrusted with a stranger’s thoughts, feelings and ultimately, their life. We are taught how to ask open-ended questions and how to probe for the whole story. We are told to trust our instincts if something just doesn’t feel right. But for the most part, patients come prepared to talk about what is bothering them because it is embedded into our culture to have an unspoken confidence in physicians.

As medical students, we reside in a paradoxical limbo. In order to become competent physicians, we need to interview patients and suggest diagnoses. We need to try procedures or practice them to obtain perfection. However, because we have little to no experience, patients tend to shy away from our [supervised] care. Additionally, at this early stage of training, most of us do not feel confident in our knowledge to provide even basic explanations of diseases.

When he continued with, “…what kind of doctor should I go see?” I let out of a sigh of relief and directed him toward his internist. This time, I was posed with a question that I could answer. But the situation gave me an opportunity to consider how I would respond to future questions that I am not qualified to answer. In class, our professors explained that when faced with a medical question outside of the hospital, they defer to the patient’s internist because they do not know the details of their medical history. Today, had I been faced with that situation, I would have responded the same way but with the added note that I am just a medical student; I am not a doctor.