Sometimes people ask me what my goals are in life, to which I answer, “To be happy.” I know it’s a cheap answer because it lets me avoid saying anything concrete and specific. The real truth is that I don’t know exactly what I want in life. I know I want to be happy, and I do have some ideas about what can get me there.

That being said, getting into medical school (May 15 2009) was possibly one of the happiest days of my life. I still remember the morning, almost one year ago, where heart pounding, I clicked on an email with a subject title of “University of Toronto – Co…”

May 7 2010

One year later, last Friday night, I was studying with one of my best buddies from class and we often study together on campus. Since the undergrad students were off school, no campus libraries were open past 6 pm on Fridays.

Unphased, we decide to set up shop at the Medical Sciences Building cafeteria for the night. To say the least, it turned out to be a funny but sad situation. Here were two burned out students, with huge coffees and highlighters sprawled over the table, studying a thick pile of neurology notes. To top it off, there was no one else there, save for occasional loud partygoers who walked through the building (and gave us stares) and the janitor who noisily cleaned around our feet. The thunderstorm flashed at us every so often, and, of course, we both had headaches. I chuckled every time that he sighed and said “This is so sad.”

The question now is – how did I get from extreme happiness one year ago to this?

Winning the lottery

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I sit here typing this relaxed and in a pretty darn good mood. Although my first semester of medical school actually finished last Thursday, I’ve been too busy/lazy to actually sit down and write anything.

I think this is the first Christmas break in a while where I haven’t really felt any stress or guilt whatsoever, and I guess most, if any of the stress, I’ve had previously was due to school. Even if not stress, just things like worries or concerns. In high school I would have untouched homework over the break and feel guilty afterwards. In university, although I almost never had homework, there were concerns about courses, marks, etc. being geared towards medical school.

Now it’s a bit different since everything in medical school is pass/fail. You could argue that there are still thoughts/concerns over things like working towards desired residency programs, but since the beginning of university, my priorities/values have changed and I’ve slowly began to care less and less about things like this. Not saying that I haven’t thought strategically at all about things like residency (because I obviously have), but what I can do now is pretty limited, and I’m more concerned with doing what I want and finding a residency that fits me than trying to mould myself to fit a residency program.

Group Studying

I have to say that I felt more comfortable with this anatomy exam than the first one. This exam focused on the head, neck, back, and limbs. Before I go into how the exam went, I wanted to talk a bit about group studying because of something I experienced and came to realize.

About a week before my exam, I went into the anatomy lab with four friends to go over some anatomy with the dissected cadavers and prosections. As expected, I was the least prepared person there. However, that doesn’t mean that I would not be able to learn anything or contribute to the learning experience of the others – the problems were that there were too many people and we were not all at the same level of preparedness .

Unless everyone in a group study period (assuming this is an active, discussion based study period and not a quiet one) is near the same level of preparedness, this experience will not be useful/fruitful for everyone. The whole group is not going to completely slow down just for you (okay yah this could happen, but it’s not going to happen in a high stress environment, for example).

I think it might help to explain this with an example. Imagine I went to the anatomy lab with just one other person, and that person was much more knowledgeable than I am. I can’t teach her anything, but she can teach me a lot. Nevertheless, we both gain from the studying. I gain because I learn new things, and she gains by solidifying hew knowledge through explaining it to me.

But imagine then a third person comes along who is more knowledgeable than both of us. The second most knowledgeable person is going to focus her attention on learning from the new person, since that is more beneficial for her. The rest of the roles remain the same. The point being that unless everyone is on the same page, the group studying/discussion is not going to be beneficial for absolutely everyone. Just to clarify, when I say that it would not be beneficial for everyone, I mean optimally beneficial – that is, while it’s true that I am learning something while there in such an environment, there are better group situations where I would learn more.

So the following week, I decided to go to the anatomy lab with just one other person, and found the experience much more beneficial (though I must add i was more prepared). For the things he didn’t know, I was able to teach him, and vice versa. It’s also much easier to look over specimens and test yourself with fewer people around. It’s harder to test your knowledge when many other people are also going over the same specimen as you in front of you. There’s also the thought of not wanting to slow other people down, which is something that definitely impacted me before.

My Last Exam: Gross Anatomy 2

So anyways, back to the exam itself. There were 61 stations in total (with I think 5 or 6 rest stations somewhere in there). During my last exam, countless times I found myself in a situation where I would have to use my entire minute and a half to decide what to put down – I rarely had situations where I knew the answer right away and could relax for an entire minute.

This time, I started somewhere in the middle of the head and neck stations, and was happy to finally experience what I didn’t before. I guess I knew head and neck pretty well because I had an answer for everything and got most of them pretty quickly.

Unfortunately I wish I could say the same for the back and limbs. Well, I think back I was probably okay with, and I don’t remember too many questions about that. My confidence was sky high from head and neck, but started to die a bit when I ran into some trouble with limbs – that was some hard stuff, and I found myself again wishing I spent even more time studying in the anatomy lab. It did boost my spirits to finish my exam back in head and neck where I felt most comfortable.

A Plug, and My Break

I just have to make a plug for the best movie experience I’ve had in a while. You probably all know about it, but it’s so good, I’m going to plug it anyways:

If you haven’t seen Avatar yet, go see it. And if you see it, see it in 3D. The plot/acting/etc. isn’t amazing, but the visuals are stunning, especially in 3D. This movie is all about the experience, and it’s best experienced in 3D. My friends and I are considering going back to see it again in an IMAX theatre – it’s that good.

Christmas break has been great so far, and I’ve gotten to see a lot of people I don’t normally get to see. I’m not even counting down the days until school starts, it’s really not worth it – gotta just enjoy the moment.

Hope everyone has a great break – Merry Christmas! 🙂

As I mentioned previously, one of the courses I take in medical school is the Arts and Science of Clinical Medicine (ASCM I) where we learn basic clinical skills. So far this year we learned to take patient history, vital signs (heart/respiratory rate and blood pressure), and some physical exams (precordial, peripheral vascular). Next semester we will learn more physical exams like neurological, abdomen, etc.

For this first ASCM exam, we were evaluated on taking patient history and vital signs. The basic outline of the exam was that you would work with either a standardized or real patient – take their history for up to 35 minutes, and then have the final 10 minutes for the vital signs. While this was going on, a physician would quietly evaluate us.

My scheduled exam time was 8:00 am. By 8:15 am I was the last student still sitting in the waiting room, waiting for my physician to come get me, worried that I was forgotten about or something.

Finally my physician comes out and says, “oh there you are, we didn’t know we had to come get you – we were waiting for you inside the room!” I chuckle in reply “Haha I was waiting for you too!”

So I walk into the room and the patient is already sitting at a chair – the physician asks me to take a seat across from the patient and begin the exam. I quickly grab some hand sanitizer and rub my hands together as I introduce myself to the patient. She has chest pain, and so I spend a few minutes asking her more about it. I then go on and ask her about her family history, past medical history, medications, allergies, habits, and social history.

I realize that this is going really quickly and she doesn’t have much information for me – it makes me start questioning whether I actually missed a question or something. Once or twice, I pause for a few seconds, trying to think if I asked everything. I’m pretty sure I did, but I’m a bit paranoid because it seemed to have gone by way too fast. I’m not too surprised though because my brother said his lasted only like 15 minutes, but of course, when you’re in the moment, it’s easy to over think stuff.

After having summarized her situation twice (lol, paranoid much?), I move on to the vital signs part of the exam. Heart rate: 64 beats/min. Respiratory rate: 16 breaths/min.

Just before I start the blood pressure measurements, oops, I remember: “Oh yeah, the heart rate was regular” lol. (this means the heart rate had a regular rhythm).

I put the blood pressure cuffs on the patient, no problem. I start by measuring her systolic blood pressure by palpation (i.e. palpating the radial artery in the wrist and determining the pressure in the cuff that it returns). I try it once, and realize as I release the pressure in the cuff that I’ve lost her pulse. No problem I guess, I apologize to the patient and tell her I need to do it again.

This time, as I pump up the cuff, I realize the cord is knotted. I try a few times and it’s still knots even after I unknot it.

“Sorry, this doesn’t usually happen” (honestly, it doesn’t, so it’s a bit frustrating that it happens during an exam).

“Don’t worry, it’s just a technical difficulty” says my doctor evaluator. I’m really happy at this point that I have a super nice evaluator.

I finally seem to have gotten the cord straight, and I go ahead and obtain her systolic blood pressure by palpation: 95 mmHg.

I then go on to use my stethoscope as well, placing it over the brachial artery in her arm, and listening for her systolic and diastolic blood pressures. This time everything goes well, no problems: 104/65 mmHg. Don’t know if that’s right, but there you go!

I thank the patient for her time, and the physician and I leave the room for a few more words. She asks me about my general observations of the patient, and I tell her that the patient looked comfortable and rested, but that she appeared a bit hesitant, maybe because she was seeing me from the first time or maybe from her concerns about her chest pain. I also note that she wasn’t in distress and she looked about her stated age, maybe slightly less.

The physician examiner tells me she doesn’t know if she’s supposed to give me my feedback right now, but she smiles at me and says, “but don’t worry, you did great!”

Which made me feel great because I figure if she’s going to say that, there’s no way she is going to fail me – that would be just way too cruel.

I wish I could take a nap, but I’m heading to the anatomy lab this afternoon (followed by a business meeting tonight), so I need to do some last minute studying of head and neck!

Have a good weekend everyone!

…since I last wrote here?

It honestly hasn’t felt like it. I’ll be honest, it’s not like I completely forgot about the blog. Well, I do sort of forget about it during the week with all the medical school stuff going on (it really feels like a full time job, and that actually sort of doesn’t sit well with me to be honest). I do usually remember it on Fridays, and try to remind myself to write an end of the week reflection at the very least, but then I just make up an excuse or forget. Sometimes I’m just so ridiculously lazy. To make up for that, I hope to write a super long post today and be particularly candid about my thoughts (within reason obviously).

Taking Control of my Education

Anyways, the gist of it is that unless I really want to prioritize my ego, marks don’t really matter (as long as I pass). So I’ve come to the realization that, if my marks don’t matter, why let that control my life (and specifically, my overall education)? I feel like I’d rather expend my energy doing things more productive or fun than studying more than I really need to.

So in terms of my medical education, for me that means spending more time exploring various specialties and trying to get a better grasp on what I’d like to be doing in the long term. While things could of course change, at this point in time, I’m not interested in any of the surgical specialties. I’m just not interested in working with my hands for hours on end, and the lifestyle (i.e. longer hours) just don’t suited the type of life I want. So that leaves medicine (this might be confusing, but apparently, medicine just often means anything non-surgical). Right now internal medicine and neurology are at the top of my interest list, but I’m leaning back towards neurology (after sort of writing it off earlier this semester for reasons I don’t really want to mention now).

I’ve found some neurologists whose work really interests me, so I’m going to try and connect with them in the next week, maybe set up some observerships and possibly get involved in some side research work so I feel like I’m actually being productive. An interest in neurology (and its associated disorders and illnesses) is what got me into medicine in the first place, and if I’m being completely honest, nothing else has excited my yet. I figure this is the right place to start.

Wait, so Am I a Leader or Not?

As part of our U of T Medical School curriculum, we tackle more than areas like anatomy, physiology, histology, embryology, etc. I have already mentioned that we look at Determinants of Community Health and the Arts and Science of Clinical Medicine.

What I haven’t mentioned yet is that we also explore other perhaps less obvious aspects of medicine, and one that we will visit several times a year over the next four years is the theme of management. As part of exploring the concept of physicians as managers, we spent one afternoon a few weeks ago learning about different leadership styles. A particularly interesting concept came up recently that I think would be good to share, especially since I think growing up, students have such a huge misconception about it.

One question that was brought up (and one that I think many individuals think about) goes something like:

We say being leaders is a good thing, but if everyone in a group is a leader, won’t the group be dysfunctional? Don’t we need some people to be followers?

I think the first thing that needs to be addressed is the concept of being a leader. Especially in today’s school and work settings, we are bombarded with the idea that we need to become leaders. Leaders are important of course, and we often praise leaders in the media. However, it’s important to keep in mind that leaders are individuals who lead in a specific setting – that is, leaders exist only in the context of the activity they are leading.

For example, when we say Barack Obama is a leader, what we’re really saying is that he is the “leader” of the United States of America. Put him in another context, say the local pick up basketball team he plays with (I’m just making this up as an example), and he may certainly not be a leader. Of course his leadership skills are always there should he need to rely on them, but it would be wrong to say he is a leader in the absolute sense – because he isn’t.

What we’re really trying to do in today’s world is cultivate leadership skills in young people, so that they may be leaders of tomorrow, but in a variety of contexts and not necessarily in everything that they do. So while you may end up with a group full of individuals with strong leadership skills, not all of them will end up being the identified leader of the group. Most commonly, the individual with the skill set and background most relevant to the group will end up being the leader. For instance, if a group regarding promoting science to young people formed, I am more likely to be the leader, whereas if a golf club was forming, I most definitely would not try to be the leader because I would just be wasting everyone’s time.

Furthermore, it’s important to realize that an important aspect of being a good leader is recognizing strengths/weaknesses of your teammates, as well as knowing when to lead and when to follow. It’s a mistake to think a good leader is always in the leadership role. A good leader recognizes achieving the goals of the group is most important, and that can sometimes be best done when someone else is in charge.

Contrary to intuition, dysfunctionality within a group full of strong minded individuals is actually a sign of poor leadership skills because good leaders would have come to a peaceful consensus on who is most adept to lead the group. Anyways I think that’s sort of a cool concept that we tend to misunderstand, and I hope some people find that helpful, especially if you’re struggling within a group setting.

Real Patient Contact

As I mentioned before, I had been practicing interview sills on standardized patients (i.e. actors). Two weeks ago, I began practicing my interview skills on actual patients. Without a doubt, real patients are more difficult for a variety of reasons (one obvious one being that you can’t “time out” and ask your tutor for advice!). Whereas standardized patients will answer your questions directly, real patients can sometimes be all over the place, and it’s up to you to try and keep the interview focused. That being said, there is something rewarding about working with real patients, I guess for the very reason that it’s actually real.

I also finally got my stethoscope, blood pressure cuffs, and other pieces of equipment. I think we’re going to start learning to use those soon, and I think that starts with real patients this Friday, so that should be cool.

Coming Up…

I have my first Anatomy exam coming up (bellringers…), so I think my writing here will be sporadic again (but hopefully not, we’ll see).

Sorry to everyone who wrote a comment or sent me an email in the past month – I am way behind on those things, I apologize. I will try to get back to everyone soon, but I really don’t know.

Hope everyone is doing well!