I'm glad that guy isn't in my class

This summer I got the chance to go to an international medical conference. A bunch of us health professionals all having a good time together. I go with my family and I'm not great at socializing with strangers, especially those my age, so I didn't really talk to much to the other young people, preferring the company of my mom and cousin. I didn't really even notice many of the other people, just that there was a group of people who were maybe around my age that all hung out and that I didn't really feel any need to get to know. But there was one guy in particular that I took an immediate dislike to. Nothing really to do with him, my own biases were going crazy. Basically he was a good looking confident guy in his mid twenties, the kind of guy I love to hate, and by that I mean fall in love with and then manifest it as hatred towards them when they don't notice me. Which is a lot of information about myself, and I actually have a point to this story. About half way through the trip I found out he had just been accepted into medical school. I overheard him saying he was nervous, but in a confident, purposefully self deprecating way. He wants to be an orthopedic surgeon, and he fits the stereotype to a tee. Maybe that'll give you some insight as to why I wouldn't be his biggest fan. I listened to him say all the words I had felt going into medical school, about feeling inferior to those who had gone before me, worrying I wouldn't be any good, fearful it would be too hard and I wouldn't make it out. But his manner was so arrogant while he said it, and it left me reeling. I sat and chatted with another medical student who was heading into his second year. And I liked him ok, I was able to tell him my story and let him know he would make it through ok. I provided some comfort and confidence in him that he would get through it all like everyone else. I had no qualms with him. But ortho guy, I wasn't sure what to do with. Part of me felt it was important for me to go talk to him. I wanted to say "hey, I heard your concerns about medical school and I just wanted to let you know that it's going to be ok." I wanted to give him the address to the blog, or my contact information if he needed anything. But I didn't, and I'm still not sure why. I told myself that it was because my mom was always telling me to stop scaring people before they go into school. She said I'm too negative and I don't need to tell everyone it's going to suck before they even start. I'd heard that from the Dean at my school as well. I told myself I was sparing him unnecessary worry. Maybe he'd start school and excel and really love it. Why dampen his happiness at starting with my negativity at the process? But I don't think those are the real reasons. He's the kind of guy I wouldn't want to be in class with. The kind of guy who knows how to manage himself. He'd never let me see that he was struggling. He would be the kind of guy who makes me feel bad for feeling bad, always talking about how great he is doing and how much smarter he is than everyone else. He's my worst nightmare. That is what I saw when I stood around him or tried to talk to him. Oozing self confidence. So I didn't feel the need to offer him support because I didn't think he'd take it. And I knew he'd look down on me for offering it. In medical school I stood up in the class of first year students and told them how I'd struggled through the first two years and failed the boards but was surviving and if any of them needed me they could just call me any time. And mostly I got good reviews and some thank yous from that. But one guy came up to me a couple days later and said "you do know that you'll forever be known as that girl who failed the boards right?" And I just couldn't believe that he would say that to me. This ortho guy I met, that's how I felt about him. I felt like he would scoff at me and say "really? You failed the boards? That sucks. Sorry medical school was so hard, but I'm about to go rock it." He was the kind of guy that things came really easily to. He wasn't going to struggle in medical school, he was going to love every minute of it, still have a fun life, keep his sanity, and go on into the residency of his dreams. And I'm glad he isn't in my class, since I had my share of those and I don't need another. But he is going to be in class with one of you out there. Some poor struggling student is going to be in a small group with this guy, or someone just like him. Someone you know was popular in high school. Someone who drips with ego. Holds his head up high. And in the process of showing his self worth, brings you down even farther. We call them narcissists here in psychiatry. But their power is undeniable. And it's hard to break free of them. So while I can't stop him from going on and being amazing at medical school, I hopefully can save one of you from feeling crushed by his ego. Maybe I'm wrong about this guy. Maybe he's reading this blog right now thinking: "is she talking about me?! I am terrified! I hate medical school! It's kicking my ass!" If he is, I'm actually sorry. I'm sorry for judging you, and I'm sorry you aren't having such a good time at it. But you'll get through it. No matter how hard it gets, you'll get through. And at the other ends is the good life.

Never be ashamed of your shortcomings of failures. They make better inspirational movies

It's that time of year again. That dreaded time of year when a few of us open up our emails to a letter that says "FAIL" in big, capitol letters. Step one results are pouring in all over the country and some of you are finding out that you did not pass. You think your life is over, that your future is bleak, that your dreams will never come true. Some of you are thinking that you might as well pack your bags now and drop out. Others are worried they will have to take an entire year off from school to retake it. You're thinking about how you'll never match into a residency in your field of choice and you might as well sign up for Family Medicine, because they are the only ones who will take you. You feel hopeless and helpless and lost. And most of all, you don't want to study for and take that DAMNED test again. I feel you friends, I was there. And I'm here to say that you will survive this. You'll make it through. And you may even still get your dream job. For the past two years you have been fed a steady diet of "this test will determine the rest of your lives." That's really stressful, to say the least. You spend two years stressing out about one single test, placing all your hopes and dreams on your ability to pass and do well on this test. Nothing else is given the level of importance of step one. It determines everything, what residency you can get into, what job you can have in the future, how well other people will respect you, what kind of car you'll drive in the future, whether or not you'll live past 50. Whatever you want to do in life depends on your step one grade. It gets so blown out of proportion that you stake everything on your score. And this is the major failing of the medical school educational system. Because step one is a test. Nothing more. It tests your ability to remember random facts about a billion things that don't really matter. It supposedly standardizes you with the rest of your colleagues around the country going through the same education. It tests your ability to take a test. It does not determine what kind of doctor you are going to be. It is not the end all be all. The major failing of the medical school educational system is this fucking test. Testing me on the finest detail of how some system works does not indicate how good of a doctor I'm going to be. It emphasizes the details with a blatant disregard for the big picture. It has everything to do with science and very little to do with the actual practice of medicine. I don't know what the hell any of that stuff does. I would NEVER be able to pass that test again. And more importantly, neither would the attendings I respect and look up to. My uncle is an amazing surgeon, very well respected. Could he pass that? Hells to the no. Half the clinic instructors that you'll rotate with will admit they wouldn't be able to take that test again. Why do you think the first two years are taught by PhDs and MDs who work in labs and do research most of the time? Because that's what a high knowledge of step one material is good for. Yes, it's important to know the mechanisms of how things work. But step one doesn't really even test your knowledge. It's a mind trap. It's designed to be a puzzle that you have to figure out. It is full of patterns. And those people who excel at finding patterns are going to do better. For those of you who failed step one, I'm sorry. I'm mostly sorry because you have to take it again, and that is the really painful part. But your life is not over. Far from it. You're just beginning on your new quest. Any residency program is still open. You're options haven't disappeared. You just have to change to approach to things. The only real failure is giving up. Things are going to be hard, and you are going to have to work harder than your classmates, those lucky bastards who passed that damned test and get to move on with their lives. But you are going to be the stronger doctor because of this experience. Take time to figure out what went wrong and how to make it better. The important thing is to learn from this set back and keep on toughing it out. How do you get through this? The first step is to know you are not alone. Eleven people in my class failed. As far as I know we all got into residency. Some took another year to do it but that was their choice. Some (read: me) scrambled but now love their lives (being a psychiatrist is the greatest thing in the world). People in the class above me failed, people in the class below me failed. Someone else in YOUR class failed. I know a girl who failed four times before she finally passed it. There are many factors that went into us failing, but none of us are stupid or ill-equipted to be doctors. I failed for a multitude of reasons. My anxiety was probably the biggest factor. I could not focus, or study, or do much of anything other than cry. I was not in the right state of mind to pass a test. My poor studying techniques were another. I didn't do nearly enough practice questions. I was afraid to ask for help. My inability to take standardized tests was also high up on that list. I suck at them. I took the MCATs three times before getting a good score. I also let way too much drama into my life. Stupid ex-boyfriend and trying to make things right! I'll blame him forever! Think back to your studying. What was going wrong? What could you have done better? Ask for help. That's probably the hardest thing for a medical student to do. We all need help, we all refuse to ask for it. Don't get tied up in what someone else says is what you should do. The student affairs office has some advice but it's generally cookie cutter advice, and it might not work for you. Going to the FALCON program in Texas might be awesome, but it might not be right for you. Take the test again when you are ready, not when someone else tells you to take it. Don't take more time off rotations than you need to. The most important thing to remember (I'll probably say that at least twelve times. Everything is important. Determine for yourself what is most important to you) is that you are the only person who needs to know you failed. Sure, whoever was on rotation with you probably figured it out when the scores came in and you ran home crying. And the attending you were working with that day may need to know why you ran home crying. Student affairs will know. And residency directors/interviewers will know. The attending on your next rotation doesn't have to know. Your best friend doesn't have to know. Your future colleagues won't ever find out. So if you are a secretive kind of person you don't have to tell anyone. I am not a secretive person (obviously) and felt it necessary to wear it as a badge of honor. "Yeah bitches, I failed step 1. But my patients like me better." I told who I wanted to. Which definitely was not everyone. I was more willing to share it after I had finished and taken it and passed it. But when I first found out I texted a bunch of my friends to let them know. Mostly for the sympathy, but also so they would know why I continued to be a crazy bitch. And that way when a couple of my friends failed they could tell me and we could commiserate together. And for those who didn't pass it they could bring me candy and feel sorry for me. I've been getting comments on my blogs from all kind of people struggling in medical school. Some failed tests, some failed classes, some failed rotations. But everyone keeps working through it. And I'm proud of all of you, because you aren't giving up. No matter how bad it gets, we are survivors. And when I go out there and look for a job I'm going to be able to sell myself so much better than someone who never struggled, because I know more about myself because of how much I had to struggle. And I'm an inspiration for others. Think about your favorite movie. Did the protagonist have an easy time of anything? No, because that movie would suck. There would be no point in watching it. So those classmates of our who go through life with everything coming easy aren't going to get to be the plot of a movie. Their movie sucks. Our movie is awesome. I want Emma Stone to play me. She's got spunk, and she's super cute. She'd make a great me. And my story is better than other people's. I had an easier time writing my personal statement, because I have something to talk about. Most importantly (there it is again!) I am a kick ass doctor. I'm in my second year of residency in psychiatry. Even though I scrambled into my program I'm one of the best residents in my class. Everyone who find out I was one of the scramblers is surprised. I teach medical students and get rave reviews. I just got an evaluation from my internal medicine attending saying I worked at or above the level of a medicine intern (I was an intern when I did this rotation). My six month reviews have consistently passed me with no concerns. My attending love me. And my patients swear by me. I'm officially done tooting my own horn, because really all I was trying to point out is that step 1 (or 2 or 3 for that matter) does not determine your ability to be a good doctor. People will continue telling you that to help you feel better, but I'm living proof that it is true. So study hard friends. Keep calm and carry on. Be proud of yourself for continuing on this crazy journey towards medicine. And remember that if you aren't struggling you aren't really living! I love you all, and wish you the best in your endeavours. Even if I don't know how to spell it :-)

If you don't want to teach, don't work at a teaching hospital

So as a psychiatry intern I have to do six months of horrible time "off service" as part of a national requirement. I have two months of medicine, two of neuro, one of emergency and one of pediatrics. I have spent the last four months working on this off service requirement waiting for the blessed moment in which I will become a second year psychiatrist and move back to my home, the psych ward. In the meantime I'm constantly reminded of the crap I went through as a medical student, mostly because many of the services treat me like a glorified medical student. And while I have plenty of crap to say on the matter, I'll just focus this blog on the title, attending who don't enjoy teaching. When I was in medical school during one of our small group gab sessions one of my classmates brought up a good point. He was talking about residents who don't teach well and how there should be some kind of system in which residents could be separated out on services by whether or not they had any interest in teaching residents. Because we all know that every rotation is based on who your upper levels and attending are. Unfortunately we all train in a teaching environment so residents have to teach. In fact, most programs are doing more to try to teach residents how to be better teachers. But a resident who doesn't take time to teach you on a rotation, you feel worthless and like you are wasting your time. Many residents take the "I was treated like shit as a student so that must be the best way to teach" approach, which can be very frustrating. And some really try. Others just want to survive their residencies so they can go on to work in some private practice in which they won't have to do any teaching at all. Either way, all residents are basically forced into a teaching position, so if some of them aren't any good at it, it's not completely their fault. Attendings, on the other hand, have the choice of where they work. So why the fuck do you choose to work in a teaching hospital if you don't enjoy teaching? If you just want to go into work every day and see your patients and go home, that's fine, but don't work in an academic setting! It really is that simple. Many University hospitals and VA hospitals have positions available for people who don't want to teach, take one of those. But when you put on your white coat and walk in the door for your week as a teaching attending, don't be a jackass about teaching. You're the one who signed up for it. Jeez. The service I'm on right now (which is not surgery) is full of high and mighty attendings who seem to think that not only are they smarter than every other doctor in the whole world but that they are supposed to constantly put down the residents and make them feel like total shit while at the same time completely ignoring medical students because they don't actually matter. I've heard the attendings tell the residents that they don't "trust" the resident's ability to read the MRI. So to me that seems like a failure of the teacher if the student can't read an MRI. Should you, as the teaching attending, sit down and TEACH the resident what you want them to be able to read. Especially since this resident one day will be the teacher? Also, no attending should look at an intern at the end of the week and be surprised that they aren't a student. Dear Lord man, pay attention to the people around you. And being a good teacher doesn't involve making students cry. So if you are too high and mighty to teach people, or just really hate being around other people, get another job jackass. The world is changing, medicine is changing, and the way people learn is changing. So there is no need to resort to the "old ways" of teaching residents. Remember, we are going to your co-workers one day, so if you want us to know something you should teach us that something. Also remember you were all students one day, someone had to teach you, you weren't always that smart (or as smart as you think you are)so don't play all high and mighty. We all go through this, lets spend some time not making it so horrible for everyone else. If school teachers taught your children the way you were treating your residents you would be FURIOUS and probably get them fired. And your kids wouldn't be learning anything. Ok, that's the end of this rant. Stay strong friends. And know at least that if you ever come across me, you'll be in the hands of a really great teacher.

What they don't tell you about survivng your clerkships

Walking into a new clerkship can be completely terrifying. What makes it more terrifying is the fear that is instilled in you before you walk in the door. Horror stories about how you will have to spend every waking hour running around doing work, seeing patients, getting coffee for your attendings, being demeaned by the residents and doctors, not knowing any of the answers, waking up at three AM to get to work and not getting home until 10pm at the earliest. Having no life outside of your clerkships. But I think the worst part of all of this is going into it thinking "and so goes the rest of my life." Because if you work that hard as a student you must be working that hard as a resident right? Well let me debunk some of the myths. Yes, the above can be your life for the remainder of your third year, fourth year, and possibly even your residency. But you don't have to let it. Because clerkships, and residency, really aren't as bad as you think they are going to be. In fact, for most people medical school gets MUCH better once the clinical years start. I still hated my life, just not nearly as much. You just have to know a few things. Here is what I learned going through my rotations to make life a bit easier: You can go to the bathroom. There is time to take a small break and run off to the rest room to relieve your poor bladder. I was convinced I was going to have to hold my tiny bladder forever, was getting ready to buy depends pull ups just in case, when I realized that no one would really miss me for the five minutes it takes to use the rest room. Of course there are some exceptions. You can't run off in the middle of a code to go potty, even if you are just standing on the side watching. Leaving the OR to potty is also a bad idea. But go before the next case starts. Leaving rounds to go to the bathroom is permissible but frowned upon. So try not to make a habit of it. Take a break for lunch. Really, as a medical student you are not so important that you need to work through your lunch break. There is always downtime to go get some food. It is ok to ask to go grab some lunch. Again, use your common sense. A code is not the appropriate time. Always bring snacks in case lunch should get delayed for some reason. Bring a book or study material. There is always down time. And you won't always have a computer during that down time. Do not show up at 4am (again, except maybe for surgery). There is no reason to be there that early. And on most rotations, except when on call, you will likely be out between 5-6pm. Afterwards, you can sit and watch tv for awhile. Or catch dinner with friends. Do not make medicine your entire life, or you will go crazy. Study while you are on the wards during down time and then take some evenings off. If there is an upper level on the team, do not let the intern boss you around. Interns have little power. I've had a couple of interns who felt it was in their job description to boss me around and tell me all the mistakes I made and make me feel as small as possible. They are douchebags. Your intern looks good when you look good. Yes, they should tell you when you are doing something wrong, but in a helpful, we all make mistakes kind of way. And they do get to assign you tasks, but they are not your boss. The upper level is. Do not let anyone make you feel inferior. Remember, everyone is there to learn, and we all learn a different way. Your main job as a medical student is to learn. Occasionally you will have to do scut work, we all did. But that is not your main job. And you don't need to make a huge show out of learning, but do make an effort to demonstrate your ability to learn. For instance, if you don't know something and the attending asks you to go read about it, the next day do bring up that you took the time to learn about it, and ask if you are understanding it correctly. Do not make a huge show of the twenty different articles you read about it. You don't have to be a gunner, but you do have to show interest and some initiative. It is okay to not know things. No one knows everything. If you don't know something, DO NOT lie about it. Never say you did something that you didn't do. Because it may come back to bite you. Remember that we all make stupid mistakes. On one of my clerkships I was evaluating a guy with stomach pain and completely forgot to do the physical exam. When asked about the exam I just said "wow, I am an idiot, I didn't do one, let me go do it and I'll come back and finish this presentation." It was no big deal. I got teased, but not ruthlessly beaten down by it. If someone is making a big show of how amazing they are at your expense, it means THEY feel insecure and need to take it out on you. Don't let them get to you. Just do your best. This is all about survival, get through it and move on to the next one. Some of the rotations you will LOVE. they will be super exciting, you'll look forward to going, you'll enjoy the work. Others are so boring you want to poke your eyes out. And sometimes the one you love is the one others hate. Who cares, it's about what you like. For the ones you don't like, put on your happy face and remember it is only a month (or eighth weeks tops). And let yourself enjoy things. I even enjoyed some of my surgery rotation, and I hate surgery. But when I liked something I went with it. I actually hated very little of my rotations. I was surprised by the ones I liked. Go home when someone tells you to. Just do it. Offer to help one last time, then if told to go home again, just go. Pay attention to the lifestyle of the residents, their stress level, the work load, and the hours. Because these are things that help you decide what you want to do with your life. You can absolutely love surgery but hate the lifestyle. So then pay attention to things you enjoy that have procedures, because there are other jobs that involve procedures that you may be able to do without the hectic life of a surgeon. I, for instance, hate procedures and am so excited to finish my off service months so I can go back to the comfort of psychiatry where the only thing I have to do is talk and listen. And give drugs. Ah, the life. Also, don't feel bad about what it is you like. I know I felt like if I went into psychiatry I would not be a real doctor and why go through all of medical school to just go into psychiatry, and so I decided to go into peds instead, andthank goodness I didn't get in because being a "real doctor" is totally over rated. I would have hated being a pediatrician! I LOVE psychiatry. And I don't care who doesn't. Because it is my life, not theirs. So do what you love. Last bit of advice. You are still a human being with things that cannot always be taken care of on your one sunday a week off. So sometimes you have to schedule an appointment of some kind into the afternoon. It is okay. Don't take everyday of the week off. But go see your doctor. Take your car in. I once left work early to pay a parking ticket. It was embarrassing to ask for the time to do it, but it couldn't wait any longer. I also would sometimes leave work early for therapy if I couldn't get a later appointment in the evening. It is ok to do every once in awhile. And that's all I can think of right now. I'm back to feeling like a medical student now that I'm on internal medicine again haha. Except when we round I don't have to go into every patient's room, and when we are done with my patients I can go back to work haha.