Comic: OB exams are tricky

Kevin has too many med student pet peeves

I've noticed quite a few oddities in medical school that for some reason never really bothered me during my undergraduate studies. They’re not offensive but odd enough for me to take notice. I don’t think these people are unique to my particular medical school so maybe everyone can relate. Who knows, maybe you’re one of my pet peeves.  Here's my top %

5. Inappropriate questions
We have one particularly gross offender that can just fire off questions non-stop. Most students average maybe 1 question per week, if that. I think I can count on my hands the number of questions I’ve had to ask in class. But this guy is prolific in his question asking. Most of the time, the questions are only marginally relevant to the discussion and usually much too in-depth to be of benefit for anyone else. Instead, the rest of us are forced sit through his ego stroking barrage of questions while subtly shaking our heads.

4. Too many colored pens
I never really understood this but some people still insist on taking all their notes on paper even though everything is prepared on powerpoint slides. Environmental irresponsibility aside, I’ve noticed some people who really really love color coding their printed notes. I’m not really sure what color corresponds with what, only that these people have upwards of 8 pens of lovely pastels to help them remember conjugation is just a fancy word for bacteria sex.

3. Laptop on laptop sleeve
This really isn’t bad or annoying as much as it’s perplexing. I’ve noticed that some people like to place their laptop sleeves underneath their laptops while in use. I can only assume this is somehow meant to protect the machine from the ravages of our plastic table top. Such misguided attempts to protect their $1000+ investment is understandable but ultimately ironic. The most likely source of damage to laptops, and most computers, comes from improper venting and the accumulation of heat that damages CPUs, RAM, Hard Drives etc. And nothing builds heat more than placing a insulating foam pad on the bottom of the computer to effectively block any and all vent holes the engineers might have placed. Don’t believe me? Try using your computer by putting it on top of a pillow or bed and feel how hot it gets.

2. Taking too long to leave the classroom
At the end of every class I’m among the first to pack up and get ready to head out the door. However, I am always impeded by those who are just a bit slower, leaving me in the middle of a row twiddling my thumbs. This is quite frustrating since I dont actively rush through my packing, yet somehow I'm always among the first to be ready. Other people seem to take an endless amount of time packing and talking (never at the same time). Perhaps they love medical school so much, they subconsciously stall their packing ritual to milk ever last drop of medical schoolness before the day is over. Who knows.

1.  Jess
No explanation necessary.

David Discusses 5 Things He's Learned in Microbiology

One of the most important skills one acquires in medical school is the ability to synthesize endless amounts of information and develop useful frameworks with which to organize and understand seemingly disparate concepts. In Microbiology, we learn about myriad bacteria, viruses, fungi, and other baddies ad nauseum, and depend on a variety of such strategies in order to make sense of what sometimes feels like an insurmountable mountain of minutiae.

Looking for high-yield study tips? You've clearly come to the wrong place. Instead, here, in no particular order, are five important things I've learned in Micro so far:

5) Not all fungi are fun.

This pearl of wisdom is from Kevin. They can't all be winners...

4) It's time to page Dr. Robot.

So far, it seems like a computer would be as good or better at diagnosing all of the diseases we've studied. Sure, there are subtleties about each, but for the most part we're focusing on things that approximate a complicated checklist (Fever? Y/N. Burning while you pee? Y/N. Excessive play with turtles? Y/N).

Clearly, the next step is to invent Dr. Robot. One probe in the mouth, another down south, and a way to input the patient's responses to a series of questions that help the robot pinpoint the disease. You could even put a little white coat on him and give him some outstretched arms so people know he cares. (Alternatively, we could just find a human physician named Robot who's a whiz at ID. As long as someone's called Dr. Robot, I'm happy.)

3)Noah should have raised admissions requirements for the Ark.

After God told him to pack up the boat, perhaps Noah should have been a bit more selective about which animals made the cut. He really couldn't find two rabbits without Francisella or a couple flying squirrels that were disease free? He couldn't spare five minutes for a quick delousing effort? Pretty lazy, Noah, even for you.

If animal cleaning wasn't Noah's bag, at least he could've sealed the ship before the syph hopped on board. Nobody wins when genital lesions are involved.

2) There already is a Kevin* Disease (with a twist).

Apparently, a Kevin* Disease already exists. Yet instead of one that Kevin discovers and names after himself in order to watch his viral namesake wreak havoc across the third world, this is a bug seemingly tailor-made to infect Kevin. Perhaps we could call it Bizarro Kevin* Disease? BK*D is actually Bacillus cereus , a bacterium sometimes found in poorly heated fried rice. Tragically, his greatest friend has become his deadliest foe.

Now, every time Kevin uses the microwave, he's walking a tightrope walk of death, through a ring of fire, over a pool of sharks with laser beams mounted to their heads and dogs on their backs that shoot bees out of their mouths with each bark. His life has devolved into a terrifying game of Chopstick Roulette.

1) The vagina is an extremely dangerous place.

Contrary to popular belief, what may seem like a bed of daisies and kittens can actually be a raging cesspool of microbiological evil. Every bug and its brother kicks it in the vagina. Want more evidence? Look at all the bad times that befall neonates. What more would you expect from something that has to bust through this danger zone to make it to freedom?

Kevin Warns You About Perineal Silicosis

Disease:
Perineal Silicosis aka Sand in your Crotch

Symptoms:
Perineal Silicosis is characterized by silicon dioxide deposition in the perineal region.  However, PS has a characteristic neurological component that is the basis of clinical diagnosis.  Patients with PS are irritable, adversarial, sarcastic and annoying during social situations. Behavior can best be described as "bitchy," complaining endlessly over trivial matters that no one else cares about. PS patients are prone to overreactions and endless whining. The rants generated by a patient with PS are frequently vitreolic, overly emotional, and most unfortunately, completely devoid of humor.

Etiology and Epidemiology:
The cause of perineal silicosis is currently unknown but recent studies suggest a heavy genetic influence, with certain populations more prone to infection than others. Rates of occurence tend to increase during times of stress, perhaps hinting at a hormonal component. Though this is an acquired affliction, the source is undetermined and it is not believed to be communicable with human to human contact. It is believed to strike men and women at equal rates but more accurately diagnosed, and treated, among men.

Treatment:
There is no established treatment protocol for PS but common practices usually include social isolation and/or mockery of the patient. With extreme cases, blunt force trauma across the patient's face using either the metacarpal or dorsum of one's hand may be necessary.  Treatments should be applied PRN by classmates, co-workers, friends or any other volunteer nearby.

Kevin wishes these classes were real

Top 5 rejected class proposals

MED 451: Healthcare for the Overserved/Majority Communities
This course is designed to give graduate students in health sciences an introduction to the issues faced by overserved populations related to health and obtaining too much health care. Course will focus on proper treatment of ailments such as twisted ankles, tennis elbow, liposuction as well as breast augmentation. Students will be taught to overdiagnose ADD and dyslexia as well as overprescribing Ritalin and Prozac.

MED 454: Advanced Infectious Diseases. Pre-req: Infectious Diseases
This course prepares health profession students for work in an Infectious Disease specialty through first-hand experience. All registered students are infected with an infectious disease drawn at random. They have until the end of the quarter to identify the infectious agent and design a successful course of treatment.* Course is Pass/Fail. *No credit given posthumously.

MED 696: Medicine and future relationships
This course prepares physicians on leveraging their degrees in social situations for maximum benefit. Male students are taught subtle but useful tricks in a variety of situations to pick up unsuspecting ladies (and gentlemen if that's your style). Examples include casually saying "I'm sorry I can't do another shot, I have heart surgery tomorrow morning" at a bar and "I just love saving all those children" anywhere else. Women are taught to downplay their significantly above-average education as to not scare away insecure, but otherwise eligible males. Techniques include asking obvious questions you already know the answer to, twirling your hair and stressing your desire to practice only part-time. Final is a practical test of learned skills at the local college bar.

MED $$$: Advanced Selling Out. Sponsored by Pfizer (R)
This course prepares health profession students for work in private practice, specificially in surburbia. Curriculum will focus on the importance of prescribing commercial brand pharmaceuticals over the obviously inferior generics. Small group sections involve role-play situations in which students will learn to turn away the majority of medicare and medicaid patients and strictly adhere to a cash-only policy. However, students also learn the nuances of such a policy such as taking on flashy charity cases for publicity and dealing with medical errors through rapid and effective out-of-court settlements and non-disclosure agreements.

MED 000: Alternate career paths
This course prepares health profession students for work in fields other than medicine. Given the state of the healthcare system today, it is important to educate medical students on other career pathways that could make use of their skill set. The class will focus on three major alternative paths: 1. Medical TV show authenticity consultant, 2. Weightloss commercial spokesperson 3. Medical School professor.

David realizes things finally matter now

At this stage in our education, there has finally come the point where what we are learning will have an immediate, signficant, maybe even life-alterating effect on others in the relatively near future. For me, this marked shift from previous educational experiences seems like a big, perhaps too often glossed-over transition. That is not to say I didn't see this coming long ago - soothsaying and double-negatives are two of my hobbies - but I still think the distinction warrants mentioning.

In high school, some people may undergo fundamental intellectual changes, as they begin to think more abstractly and independently without necessarily allowing teachers or other authority figures to dictate their conclusions. Yet despite all this wonderful personal and intellectual growth, the main scholastic endgame is a golden ticket to the highly-coveted next round: college, and hopefully a good or great one at that. For a lot of students, the academic part of the high school years is less about truly learning and more about getting the grades and SAT/ACT/SATII/ACT3/PSAT9 scores to climb the ladder of undergraduate tiers and get as high up as possible. Though obviously not the only, or even most important, measure of success, getting into a good college still remains a landmark achievement that many identify as the primary educational goal of their upperclass years.

Once you reach Eden University, with its manicured lawns, red-brick quads, flowing fountains, and more libraries than one could ever imagine, then what? Do you learn for learning's sake and explore a whole new intellectual world whose vivacity tickles you deep within your knowledge loins? Maybe you do (or even should). Or maybe you, like countless overs have before, find yourself in the next race, working towards another weighty, seemingly nebulous yet arguably life-changing achievement four more years down the road - med school. That'll be a profound, baby-saving party that won't quit, right? Actually, yeah, it very well could be all that and a bag a Fritos.

Yet because reaching that goal can be challenging, your college time might be spent working towards similar grade/score ambitions that might occasionally force actual learning to the back-burner out of sheer practicality. This isn't necessarily bad. It's hard to do well enough in college to get into medical school, and sometimes, where learning best and improving a grade aren't 100% compatible, it makes sense to favor the latter for the time being. For many, paving the road to the next step is more important than appreciating or learning from every noteworthy stop along the way. Besides, there will be time to catch up on things that were missed or glossed over, and even what's been well-internalized will require quite a bit of brushing up in 1-2 years. So, even if one isn't completely sacrificing learning at the alter of the almighty 'A', a bit of a compromise is sometimes made en route to the ultimate goal.

BUT, once in med school, things actually matter. Sure, grades and scores remain important, but skating through important material with only a mind for H/P/F/whatever may leave students unprepared for the clinical applications that are fast approaching. In college, one could feasily put off O-chem and only do enough to get by in the class. Even the BS MCAT section doesn't require any particularly in-depth O-chem knowledge. In med school, we can't just ignore microbiology and expect it never to pop up in the future. Sure, one might pass the class without knowing all the important details, but the difference is that, sooner rather than later, this stuff is going to be of practical, unavoidable importance. Perhaps this is no big revelation for most people, but I'd argue it represents a fundamental difference in the educational endgame and significantly changes the required approach to the curriculum. This is simultaneously awesome ("Hey, this stuff actually means something now") and maybe even a bit daunting ("Hm, if I don't learn this, there will be real consequences for other people"). Or, perhaps, everyone knows and takes this concept for granted, and I'm just slow enough to find it worth discussing.

Hopefully, this is food for thought. As long as it's not Moroccan food. Excuse me, can I get a fork...

David discusses the 15-15-1 Theory

In my glorious two-plus decades on this planet, I have been many things: scholar, playwright and, most recently, emo-blogger extraordinaire. Today, I add intellectual revolutionary to that storied list as I unveil a strategy that will forever alter the landscape of medical school admissions.

Just kidding. The following is more of a thought experiment. Nonetheless, ladies, gentleman, our #1 fan (that’s you, Julia), maybe even Kevin (but probably not Kevin), I present to you the 15-15-1 Theory:

As many of you know, the journey to medical school is filled with hurdles. One must do well in school and have a decent complement of extracurricular activities and/or research experiences to make the cut at many schools. On top of all that is the MCAT, perhaps the greatest, most-feared obstacle of all. The MCAT, in a nutshell, is comprised of three main multiple-choice sections – Biological Sciences, Physical Sciences, and Verbal Reasoning – each scored on a 15-point scale. There is also a short essay section that students generally believe carries less weight in admissions decisions. According to the American Association of Medical Colleges (AAMC), the group that administers the exam, the national average for applicants in 2007 was 27.8, while the average for matriculating students was 30.8.

According to conventional wisdom, a strong applicant has both a high MCAT score and a reasonably even distribution of scores among each subsection. A student with a 9-9-9 breakdown, ceteris paribus, is probably more desirable than one with a 15-6-6, as the former score may indicate a more well-rounded student. This rationale makes perfect sense; a strong medical student should be less a genius in only one subject and more a jack-of-all trades who is competent across the board. We’re not doing hardcore physics or PhD-level biochem here.

Yet how would you choose between a 15-15-1 and 10-10-11, again assuming all other primary characteristics are roughly the same? Here, the choice may not be so clear-cut. Let’s assume for a moment the school has no minimum subsection requirement – which may be highly unlikely, but potentially true in extreme circumstances such as this – and thus does not immediately exclude the 15-15-1. In this scenario, which student is likely to become the more competent physician?

Well, the lopsided genius (LG) is probably a lot more intellectually gifted than the jack of all trades (JT). Two perfect scores indicate LG is very bright and most likely hard-working, both desirable traits for a medical student. JT did fine in each section, but a 31, as evidenced above, is objectively average. Since the margin for error diminishes disproportionately as one approaches the higher scores, the difference between 15 and 11 on any given section is actually quite significant,. So, at least for those two subsections, LG is a world ahead.

But what about the third? Is LG a science whiz who struggles mightily in verbal? (That would be bad, since the VR section correlates most strongly with future clinical performance because it best approximates one’s ability to synthesize new, foreign information and make analytical choices without the benefit of tomes of background information and months of fact-cramming. It’s an extremely loose simulation of any clinical situation, sure, but the critical thinking it demands is a crucial asset for any physician.) Well, maybe LG is or isn’t, but looking at that score breakdown, my guess would be he/she was the victim of some unfortunate twist of fate. Perhaps LG mis-bubbled one of the earliest answers and thoroughly messed up the scantron. Maybe there was a scoring error that wasn’t corrected or some other inaccuracy that was no fault of LG’s. Contingent probability would suggest it’s extremely unlikely that someone capable of a 30 in two sections could possibly score 1 on the third. In fact, I imagine it improbable that LG would even get below a 10 if capable of such dual-section wizardry on the previous two.

What if we assume LG is not even capable of half of his typical brilliance, grant him the slight benefit of the doubt that something strange happened during his exam, and give him a 7. Now his conservative 37 is out of shouting distance from JT’s 31. And since these two candidates are more or less equally qualified in other respects, where does that leave them? At the very least, LG would deserve an interview and a chance to explain what happened, whereas JT might not even make that cut.

Admittedly, this is a unique, rather improbable scenario. To the extent that this would ever occur, the solution would likely be for the admissions committee to recommend LG take the test again to confirm his/her brilliance in all three subjects, reapply the next year, and then choose among the top med schools. But that’s just plain boring.

I’ve discussed this randomly with a number of people, most of whom would favor JT. I’m not so sure. As an extension, if it is completely inconceivable that someone with a 1 in any subsection could ever warrant admission, what if you had to choose, right now, who you’d prefer as your doctor in 10 years? That 1 might be a dealbreaker for acceptance, but who is more likely to pan out in the end?

Clearly, the only way to resolve this amazingly profound debate is for me to drop out, change my name to Lopsided Genius, retake the MCAT and get a 15-15-1, and see what happens. Might be unfair though – that name alone is probably worth an interview.

Kevin debunks 2 myths about medical school

1. Medical students are really smart

There seems to be some kind of general assumption that you have to be really smart to do medicine. Not true. Medical schools come in all shapes and sizes and with that, different entrance requirements. While the kids over at WashU are probably phenomenal test-takers and would be considered “smart”, the average med school is quite different. People come from all walks of life and while we’re certainly not dumb, most of us really aren’t that smart. The majority of medical students would not hack it in physics, mathematics, even engineering. Hell, looking at averaged VR MCAT scores, most of us are bad at reading as well. Unlike some other fields, medicine doesn’t require its applicants to be the sharpest knife the drawer, only the eagerest. Those who have academic deficits can more than make up for in volunteer work, perhaps save a few African babies. So what people lack in intelligence, they make up for in good ol’ fashion gumption. This isn’t really a bad thing. Medicine is ultimately a service industry and intelligence alone isn’t always enough (unless you’re a neurosurgeon, then it’s probably good enough). But regular people out there: your doctor may be smarter than the average Joe, but that doesn’t mean he’s a genius.

2. Medical school is difficult

The materials covered in medical school are not difficult. Everything is mostly memorization and regurgitation. Rarely do you have to take what you know and apply it to a truly novel situation. Perhaps this will change in second year but so far, it’s been pretty mundane. That’s not to say classes are not time consuming. Memorizing a lot of random facts takes a decent amount of work, but then again so is laying bricks and neither is really that challenging. A lot of my non-medicine friends really believe medical school is the pinnacle of academic rigor and honestly I don’t have the heart to tell them otherwise. Instead, I play into their assumption and pretend I’m just busy all the time with work. Sometimes I’ll tussle my hair up a little bit before approaching some non-medical friends so I look a bit more frazzled (ok not really but I’m willing to go this far if they catch wind of my ruse).

David advises pre-meds against Biology

It probably seems counterintuitive that anyone would seek my advice about anything. Yet, believe it or not, I often get asked for words of wisdom about navigating the pre-med and med school application process. For any current or prospective pre-meds, here is perhaps the best advice I have: unless you absolutely love biology, enjoy it on a profound and fundamental level that resonates within your pre-med soul, do not major in Biology*. (And if you do love it that much, I’d also argue you should eschew medicine entirely, get a PhD, and cure cancer instead of learning how to treat it. But that is a rant for another day.)

Why? I’m glad you asked. Not majoring in Bio*

1) will help you decide if medicine is really for you.

I know every 4th freshman in college has felt some burning, innate desire to become a doctor and save the world. They played with stethoscopes as toddlers, volunteered at the local children’s hospital during high school, and have told every teacher, relative, and college admissions officer that they’re going to become a whatever-ologist because they really want to help people. Yet despite that medical love-fest, most people have no clue what being a doctor really means. They’ve settled on the ideal of making a difference and saving lives, but haven’t necessarily explored alternative career paths or taken the time to really understand what a physician does on a day-to-day basis.

In high school, everyone takes more or less the same classes and meets roughly the same requirements. College is the best chance to learn new stuff and explore new opportunities. Why pigeon-hole yourself if you don’t have to? The path to physician-hood is a ridiculously long process that requires a lot of personal and financial sacrifice. Pre-meds too often do a disservice to themselves by not exploring other options. So delve into a new subject, not just on a superficial level or even to get that minor you think med schools will care about, but all the way into upper-division classes that really show what the field has to offer. At the same time, do all the shadowing/pre-med club stuff too. The point is to see what’s out there and what you like the best, rather than mindlessly following the rest of the sheep without a second thought.

Finally, what if you major in Bio* and decide medicine is not for you. That's better than entering med school and hating it, but you're still looking at an uphill battle. Unfortunately, a successful career in research is going to demand a hell of a lot more than your BS, and non-science employers won't be that impressed that you know about cells. Again, if you just love the natural sciences and want to pursue the next step in education, this isn't a problem, but if you're banking on med school and it doesn't pan out, things don't look as bright.

2) will teach you something new and valuable.

Ok, so you KNOW you want to become a doctor. There’s no point in even exploring another field, the ingrained instinct to save the children is that strong. If for some unknown reason you couldn’t get that coveted MD, you’d be so distraught that you’d forsake the professional world, tie up a hobo sack, and ride the rails. Well, that’s awesome, congrats on the choice. Now go find something besides bio to learn about for four years.

Contrary to popular belief, biology, chemistry, biochemistry, etc. do not equal Medicine in College. Sure, your O-chem prof might spice up his lectures by talking about the structure of taxol or have you make god-awfully impure aspirin in the lab, but you don’t get to play doctor until MS-1. And once you reach med school, you’ll have two intense years of science and a whole lifetime of literature to satisfy your urges for knowledge. Why not take the chance to put another shot in your bag while you have the time? Major in English and learn about rhetoric. There will be exactly one gazillion times in your life where being a good, persuasive writer will help you. Major in Economics, Finance, Accounting, etc., so you’ll be better able to invest in the future, understand financial markets, and read The Wall Street Journal while holding your glasses loosely with one hand so that the tip of one earpiece is touching the edge of your mouth (then bust out terms like ‘basis point’ and ‘expansionary’ and watch all hell break loose). All of eternity awaits for that medicine-only focus. Learn something cool that you can use later on and you’ll never regret missing that extra bio class on the mechanisms of something the cell does that no one cares about.

3) will HELP your chances of getting in to med school.

Even though I don’t advocate going the non-bio route purely as a way to game the system, I still find it exceedingly obvious that being a non-science major is an effective way to stand out from the crowd.

Sad though it may be, your 3.9/35 (or whatever strong combination you offer) from Look How Awesome I Am University doesn’t impress anyone on any admissions committee at any med school. They’ve seen you and a million more just like you come down the application pipeline over the years. Sure, there are amazing kids every so often that probably get in by virtue of their academic accomplishments alone, but that isn’t a feasible option for the average student. A History major, however, is relatively unique. Assuming you’ve done well in your science courses, the fact that you would bolster the intellectual diversity of an incoming class can only help. People reading your file are probably thinking “Wow, this kid did something cool and unique that will add to our student body,” not “Uh-oh, not enough science, he/she won’t cut it.” And in your interview, you’ll have the rare ability to talk about something you know more about than the interviewer. Who is Prof. Blah going to remember better, the mechanical engineer who worked on the solar car team or that other kid who did that one experiment with those flies?

4) will NOT hurt you once you reach the Promised Land.

“OK, David,” you say. “Sure, I can learn cool non-medical stuff and maybe even get a boost in the application process, but what about once I get accepted? It’s going to be all science, all the time, and my crappy Math degree is going to come back to bite me in the ass.”

Not so! There’s a reason med schools demand all those prerequisite courses in bio, chem, and physics. Those classes test your ability to work hard, internalize large amounts of information, and apply all the concepts you’ve memorized in new, unfamiliar situations. They also give you the necessary knowledge base to succeed in med school. Med schools aren’t in the business of accepting people who lack the requisite scientific background to keep up in class. Assuming you did well in your pre-reqs and got a good MCAT score, you definitely won’t be behind. If you can’t already tell, I was a non-science major in college, and I guarantee a PhD in biochem would not have had an appreciable influence on my experience in biochemistry so far as a med student.

---------------

So, there you go, several reasons not to major in Biology*. Take ‘em or leave ‘em. Hopefully the former, since I knew from my earliest moments that all I wanted to do is help people…

*This extends to Bio, Biochem, and any hybrid pre-health major that pre-meds gravitate toward just because they think it’s relevant or helps their application

David discusses the neurosurgery interest group

All medical schools have a wealth of student interest groups in a variety of medical specialties such as psychiatry, OB-GYN, IM, family med, surgery, etc. These groups can be extremely helpful; they provide students with information about the specialty, the associated lifestyle, potential practical workshops, networking opportunities, and some useful guidance about how to strengthen a residency application for that field. Still, I find it a bit curious that our school has a neurosurgery interest group.

As many people know, neurosurgery is not one of those fields someone just wakes up and decides to enter. It is one of, if not the most competitive specialties, and demands a kick-ass application with top board scores, clinical evaluations, recommendations, and probably some strong research too. Those qualifications – and I know it is nearly forbidden to say people can’t do something if they really, really, really try – are realistically beyond the average, above-average, and maybe even the near-excellent student. If I devoted my life to becoming a neurosurgeon, there’s a ridiculously strong chance I just wouldn’t cut it no matter how much I wanted it. Out of the 20,000 or so med school grads that match each year, only ~150 are able to do so in neurosurgery. That’s more or less one spot per med school in the entire country, meaning one has to be, on average, the top pre-NSG student in one's school to snag a spot. Even Best Medical School has a snowball’s chance in hell of sending more than a couple in a given year. So while learning about future career options is extremely valuable, and no one should ever be discouraged from dreams/ambitions, all of this seems similar to having a Fortune 500 CEO interest group in B-school or NFL player interest group in a DIII football program.

OK, enough musing. I’m running late for my plastics interest group meeting…

Musings: Med School Seating Chart by Maturity Level

Comic: Hard of Hearing

David discusses med school by correspondence

Normally, my rant:rave ratio here is pretty high, and hopefully that's something the six dedicated readers have come love. For once, however, I'm going to discuss something neither rant nor rave, but rather simply a part of med school I never expected.

I'm not exactly sure what I thought med school class would be like, but I imagined it would more or less follow the structure of my undergrad pre-med courses: go to class, take some notes, maybe read a textbook, study for exams, bubble in the scantron to make a funny picture and hope to live to do it all again in a few weeks. I figured there would be great, inspire-you-to-learn teachers, other, less effective profs that droned on and on, and a wide variety in between. One thing I did not expect was how much of the first year could be just as easily taught by correspondence as in class.

It may be no great revelation that the MS-1 curriculum is mostly about learning the vocabulary of the body and disease and important background information about biochemical, immunological, blahblogical processes, etc. Beyond the obvious exceptions - anatomy lab, clinical stuff - most of this information can be effectively taught through textbooks or a solid syllabus. Of our many classes, a few have concise, well-written syllabi that comprehensively present the important information, some interesting extra details, and do a generally excellent job of teaching the material. It's no coincidence that the professors for these classes, as a result of good preparation/organization/whatever, also tend to deliver good lectures. Yet since the provided written materials are so strong, and because it takes even the most gifted lecturer much more time to deliver a talk than it takes a student to read that content in condensed form, many people appropriately choose to skip those lectures. And it's not because they're lazy students. I imagine they make the calculated decision that they can save time going over the material at home or would rather dictate their daily schedule and decide exactly when they want to review that information.

On the flip side, in classes without dependable syllabi, where the organization is relatively poor and the expectations for students consistently vague, attendance skyrockets. Not surprisingly, these lectures are often disjointed, even incomprehensible, and sometimes I come away far worse for the wear with almost no new knowledge to show for it. (Loyal reader, you might be thinking, "David, that's probably because you're an idiot." True though that may be, I assure you that I am not the only one that feels this way.) This theme doesn't necessarily depend on the content of the class or even the attitude of the professors towards student learning, it's just a product of how well the course and study materials are organized.

Maybe this isn't surprising, but it seems odd to me that the most engaging professors who have the most well-developed lectures are the ones that face an empty auditorium, while those running the classes that most frequently frustrate the students get a full house. What's more, if the latter profs emulated the former, there would be virtually no reason for many people to attend class at all. Students would have high-quality study material, complete all of the educational objectives set forth by the faculty, do well on exams, and basically be med students by mail. This dynamic would collapse later on during the transition to the wards, as well as in those aforementioned pre-clinical classes that provide exceptions. Still, on the whole, a University of Phoenix-style curriculum would be about as pedagogically sound as the one we have now (that's right, I used 'pedagogically', what of it?).

Not to complain, because I do think we are getting a good education, but isn't that still a bit strange?

Comic: Oops

Kevin Realizes Mistakes Happen All the Time in Surgery

For those who don't know, I'm in a surgery preceptorship this quarter where I get to watch a surgery once a week. This is quite an amazing experience since I'm literally standing shoulder to shoulder with someone who is wrist deep into someone's heart (not metaphorically either, although im not sure what that metaphor would imply). Of course this intimate glimpse into the OR is not without its surprises...

Just last week, I was observing an ascending aortic composite graft procedure when out of the corner of my eye I noticed the scrub nurse engaged in a muffled conversation with the circulating nurse about something.  Then the  circ nurse suddenly drops to the ground and starts crawling around.  5 minutes of her best illegal immigrant maid impersonation later, she comes up and  seems to wave a "Negative" to her sterile compatriot.  The scrub nurse then turns to and asks:

"Kevin, can you look around for a needle, it should be attached to some blue suture."
"Uh... sure," I said, fumbling around my little section.  By the way, the universal "fumbling and patting the pockets" motion when pretending to look for something makes you look retarded while gowned up in an OR.

After 5 more minutes of my fumbling, I was forced to give a negative as well.  So finally the nurse tells the surgeon: "Doctor, we're going to have to x-ray this guy after you're done, I can't find a needle."  Oops.

Kevin and David Present: The Top 10 Things We've Learned in Med School

To commemorate the completion of our first half-year of med school, we present the top 10 things we've learned so far:

10)  Experts tell us having kids and being married both suck.

9)    Experts consist of random 38 year-old "young" adults.

8)    Eighty percent of future doctors are brunette white women.

7)    Kevin wants to learn, David wants The Truth.

6)    (Kevin doesn't really want to learn, but David really does want the Truth.)

5)    You can teach an entire lecture with inspirational quotes alone.

4)    We have something in common with a football player from Duvall (pronounced "Dooooo-         vuhl").

3)    Kevin is 1/32nd cardiothoracic surgeon but he's pretty sure he's ready now.

2)    David still thinks he's in business school. 

1.5) Your patients won't care how much you know until they know how much you care.

1)    Never donate your body to science.

Comic: Bad sign for the future

Inspired by Linda's adventures with electronics:

I had just gotten the coffee maker, and I made coffee almost everyday. It was exhilerating[sic]. Then one morning, while I stood in the kitchen and Penny sat at the dining table, I was horrified to find that when I pressed the on button, nothing happened. No coffee.

NO COFFEE.

Shit! I said to Penny. Look! The coffee maker's broken.

She told me to check if it was plugged in. Oh, I said. So I picked up the white plug behind the coffee maker and plugged it in. But still, nothing happened, no red light. Now I was really scared; I started to panic.

I frantically pulled and replugged the cord into the wall socket. Oh no! It's broken! It's broken!

Then I looked emphatically back at Penny to see why she was not also panicking.

She said, Linda, that's the rice maker.

Apparently she had been sitting at the table watching me freak out while the light on the rice maker went on and off, on and off.

So I changed plugs, made coffee and we both went back to studying.

David Anticipates an Unexpected Consequence of Kevin*

After reading Kevin’s latest post, one can’t help but envision the following probabilistically inevitable scenario:

Kevin tells me his name is quite common amongst immigrants from the motherland. A quick Google search for “Kevin*” confirms this to be true, returning 22,800 hits. Given this high number of Kevin*s running around and the extreme virulence of the aforementioned disease, it seems likely that there might come a day when one of those countless Kevin*s was…wait for it…infected with Kevin*. How exactly would that doctor-patient interaction go?

------

Doctor: Kevin, I have some unfortunate news. You have Kevin*.
Kevin: Excuse me?
Doctor: Kevin*, you have it.
Kevin: Are you stupid? Have what?
Doctor: Who’s on firs…Err, there’s a disease called Kevin*, Kevin. Unfortunately, you’ve got it.
Kevin: You’re kidding?
Doctor: Actually I’m not.

Kevin: ...

Doctor: ... 

Kevin: ...

Doctor: What are the chances, eh? If you think about it, it’s actually kind of fun–
Kevin: Die.

------

One can only imagine what would happen if the original Kevin* was this Kevin*’s doctor, delivering the news and explaining his reasoning for naming the disease. Or maybe bad karma would win out and original Kevin* would get ALS.

These are the things I think about sometimes. Why does my brain hate me…

Kevin considers Infectious Disease

Back in the glory days of medicine when old white men ran the show and nurses wore skirts and paper hats, medical research was pretty egotistical. Whenever someone discovered a genetic disorder, he would inevitably name said disorder after himself. Thus you have your well known diseases such as Alzheimer's, Huntington's, Tay-Sachs... the list goes on. Yet, even back then, no one wanted to name infectious diseases after himself. Dumb. Infectious diseases are the crazier, flashier, version of their more homely counterparts. The evidence is in the movies.  Infectious disease has given us adrenaline-pumping thrillers such as Outbreak, 28 Days Later, I Am Legend just to name a few.   Genetic disorders on the otherhand gives us Bubble Boy, a trainwreck I'm sure Jake Gyllenhal would like back.  

You decide

So that gets me thinking. Naming such diseases after the infectious agent is boring and predictable.  If I become an infectious disease specialist I will dedicate my life's work to finding the most dangerous virus/bug out there. But I wont name it something boring like Africanized AIDS (although that has promise). No, I will name it after myself. Why, you might ask. I'll tell you why. Imagine the headline possibilities.

AFRICA IN CHAOS AS KEVIN* RAGES ACROSS CONTINENT

Or maybe something more akin to the movie Outbreak:

CALIFORNIA UNDER MARTIAL LAW TO CONTAIN KEVIN*

"Oh my God his body is completely destroyed by Kevin*"

I'm pretty sure  that would cement my place in the medical as well as the history books.

*Obviously I would use my whole name to maximize my glory and minimize confusion, but for internet purposes, first name is enough.

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