Sunday, April 25, 2010

Hands On Training

Hands on training always seems to draw more interest than lecture and books. Despite the risk for injury or mistakes, it is likely we actually get more out of it than a textbook could ever offer.

Clinical Skills Lab

As I walked back to my lab station with a pig's foot cut in half, I admired the piece of anatomy and questioned how this was deemed appropriate for a Jewish institution to support. Apparently, it is "Kosher" as long as we are not eating it. Pig's feet never had the same appeal as bacon, so I don't think that will be a problem.

After creating a laceration in the foot, we learned various suture styles to close the wound. It was more of a crash course in instrument handling as I quickly learned how clumsy my rookie hands performed this common clinical task. Nonetheless, it is a skill I will be needing in the future and any exposure is good exposure.

The next station, phlebotomy, was old hat. While my partner fretted the experience, I couldn't wait to get my hands on a needle again as it had been too long since my last stick. To my surprise there were quite a few in the class who have drawn blood in one form or another. On the other hand, those who attempted it for the first time would shake at the thought of hurting their partners. Learning new skills in the classroom has obvious benefits over learning them in the clinics, fortunately it leaves room for mistakes. Even though my partner impaled me twice before striking gold, he did a great job for his first experience.


Board Prep Question of the Week
On your rotation in the intensive care unit, you follow a patient with advanced sepsis from a central line infection. On exam you notice marked petechiae on his extremities as well as some large clots around his mouth. Concerned about disseminated intravascular coagulation, you check his labs. What would you expect?

A. High platelets, low bleeding time, high PT, high PTT
B. Low platelets, high bleeding time, high PT, high PTT
C. Low platelets, high bleeding time, low PT, high PTT
D. Low platelets, low bleeding time, high PT, high PTT
E. Low platelets, low bleeding time, low PT, low PTT


Answer & Explanation

Sunday, April 18, 2010

Student Loan Debt

The start of our last block sure feels good. Soon enough we will be seeing patients and interacting with physicians in the community, unfortunately that comes with a price.

Student Loan Repayment Options

Just as we are preparing to file our FAFSA for the next year we received the bad news that there will be a 5% tuition increase! Apparently this figure is low, but it still adds up. The AMA reports that the majority of medical students have more than $100,000 of debt. Ask a student and after performing the math they will tell you that their debt is closer to $200,000 or more. We have no idea how the health care reform will affect future medicine and the financial concerns it carries. From my understanding, it is difficult to be a physician and not be bothered by the monetary repercussions of business. In fact, many practicing doctors are still paying off student loans.

A growing concern is the dwindling number of family practice physicians. For many students the pay alone is a deterrent that promotes interest in medical specialties. Fortunately, there are some specialties that are eligible for loan repayment opportunities. Here are a couple resources worth investigating if you are looking to get that student loan monkey off your back and you are not interested in the military scholarship:
  • National Health Service Corps - Family Medicine, Obstetrics/Gynecology, General Internal Medicine, Gerontology, General Pediatrics, General Psychiatry
  • AAMC - Loan repayment/forgiveness and scholarship opportunities by state
Board Prep Question of the Week
A 6-year-old child is brought by ambulance to the emergency room following an automobile accident. She is covered with blood and unconscious secondary to hemorrhagic shock. Her parents urge the physician to do everything possible, but implore that no blood products be used to treat their daughter. What is the best course of action for the physician to take?

A. Administer blood without delay and contact child protective services
B. Convene an urgent meeting of the hospital ethics board
C. Engage the parents in a discussion of why they hold these beliefs
D. Transfuse blood as needed, explaining the situation to the parents
E. Treat the patient without using blood products, per the request of her parents

Answer & Explanation 

Sunday, April 11, 2010

Basic Life Support

Nearing the commencement of our clerkship rotations, we eased our way back from spring break by receiving training in basic life support (BLS) also known as CPR.

Cardiopulmonary Resuscitation

You never know when you are going to need CPR. For that reason alone, it is wise to at least have some understanding of what to do in an emergency situation. Despite learning the skills, I always seemed to have a difficult time counting the 30 compressions in a real situation. Fortunately, when there are other providers available, the actual count is not as significant as when you are alone.

My experiences in the emergency department have prepared me well for this sort of training. Looking back, I would say that working in the health care setting before coming to medical school has helped more than anything else. Exposure to real situations, with real people makes a significant difference when learning the skills needed to succeed. For this reason, we spend a large portion of our time in the clinics honing clinical protocols and learning the standard of care. As we said in boy scouts "Be Prepared." CPR is a skill that is never to late to learn.

Board Prep Question of the Week
A 70 year old man was brought in the hospital by ambulance subsequent to chest pain that lasted 40 minutes. In order to assess the degree of stenosis of his coronary arteries, he underwent coronary angiography, a procedure during which a contrast dye was injected in his coronary vessels. To which phase of the ventricular action potential does visualization of the stenotic lesion correspond?

A. Phase 0
B. Phase 1
C. Phase 2
D. Phase 3
E. Phase 4


Answer & Explanation

Sunday, April 4, 2010

Spring Boarding Into the Future

Despite the obvious enjoyment of our spring break from medical school, we are also gearing up for the most important exam of our life...boards. Translation: very little vacation and lots of time to study.

Vacation vs. Study

Call me crazy, but I have a feeling that I am not the only student spending my vacation reviewing concepts, exploring question banks and preparing for the months ahead. I have taken time to enjoy the time off and even managed to reproduce my annual farmer's tan in the meantime. Nevertheless, I was compelled to dedicate a portion of my time to catching up where the routine studies made me lose ground.

I think the simple fact that so many have gone before and there will be more to come is reassuring. This metaphorical med school sandwich means there is hope yet. In the back of my mind I pretend that just by registering for the board exam and enduring classroom lectures, the examiners will congratulate us all and send us happily on our way. I know the reality is that these exams are in place to protect the public from incompetent practitioners. This is a roundabout way of expressing my fear, but I would be lying if I said I felt confident at this point. When it just becomes too much to handle, I stop and follow the advice of my high school algebra teacher; Count to ten...in Roman numerals and things usually start to feel better. I, II, III, IV...

Board Prep Question of the Week
A 6-year-old child is brought by ambulance to the emergency room following an automobile accident. She is covered with blood and unconscious secondary to hemorrhagic shock. Her parents urge the physician to do everything possible, but implore that no blood products be used to treat their daughter. What is the best course of action for the physician to take?

A. Administer blood without delay and contact child protective services
B. Convene an urgent meeting of the hospital ethics board
C. Engage the parents in a discussion of why they hold these beliefs
D. Transfuse blood as needed, explaining the situation to the parents
E. Treat the patient without using blood products, per the request of her parents


Answer & Explanation

Subscribe to Life as a Medical Student