Sunday, August 28, 2011

Education Beyond the Classroom

Learning the tricks of the medical trade comes from lots of exposure to lectures, books and hands-on experience. Initially we are expected to be attentive to professors who create a basic foundation and then pick up the rest on our own time through personal study and discussion with colleagues. When it comes to the clinical setting, the direct form of teaching dissipates and we carry more of the responsibility to be self taught. Yet there remains plenty of room for a student-teacher relationship. [Classroom at the Washington University School of Medicine 1943]

Learning Through Respect

In speaking with one of the residents at the program I am visiting, he reminded me that not all physicians remember what it is like to be a student. They have forgotten the basics and want to be identified as one who no longer has to be "at that level" of training. In doing so they often seem to have a chip on their shoulder, teach very little to students and ignore even the existence of students trying to be friendly. So doctor, my morning greeting was not an attempt to waste a breath of air, it was intended to be pleasant and acknowledge your existence in hopes that perhaps you would acknowledge mine. Little things like that are what really set a tone in my opinion. It standardizes a sense of mutual respect and understanding allowing for potential growth beyond that point. Maybe it is perceived as a "brown-nosing" tactic wherein I am gunning for a response. Whatever the case, I thought it was a simple common gesture in human interaction. What do I know, I am just a medical student.

Medical students just learn to grow thick skin. Patients give you grief because you are the first person willing to listen to their complaints and desires. After hearing out the patient, the student finally presents to the residents who are the first to think you have set them back because "you must have been delivering a baby in there." If you are not thinking what they are thinking, they will let you know without hesitation that you are wrong. But this mode of action comes from their superiors too. The attendings are looking at them in a similar light but may not always say so out loud. So it only makes sense that the residents become calloused and project their troubles onto the medical student who will smile, be pleasant and always take a verbal lashing for the ever coveted passing grade. All the while the student is thinking, "why do I pay good money to be demoralized in front of patients and coworkers?" We know our end goal and will walk through the gauntlet to get there, even if that means we will be red in the face a few times.

Once in a while, however, there are those who will remember the emotional strain medical students experience. In their wisdom, the residents will slow down and teach or maybe even learn something because we are all in this together. What one person may have recently studied, the other has not heard in a while. This resident remembers the efforts students are making to impress and succeed even if they fall short once in a while. The effects of the classroom extend beyond those four walls into the community and clinics. It has the potential to reside within each relationship we have for better or for worse. I refuse to let my education be compromised by those who have forgotten how a patient teacher can influence an eager student.

Question of the Week
A 24 year old medical student admires and begins to pattern her life after her surgical mentor. Which one of the following defense mechanisms does she exhibit?

A. Introjection
B. Projection
C. Rationalization
D. Identification
E. Conscious Control

Answer & Explanation

Sunday, August 21, 2011

Peanut Butter and Jelly


The gourmet classic of any medical student is obvious; one slice of bread slathered in fruity preserves married to another slice plastered with smashed peanuts. It’s the “go-to” of meals when the cereal box has poured its last bits or the milk carton has gone dry.

The (Un-Starving) Nourished Student

Available on my shelf of kitchen space I have a small variety of cold cereals, half a loaf of bread, half a container of peanut butter and a can of beans. The half shelf in the refrigerator is barely enough room for a half gallon of milk, a handful of bananas, celery and a few remaining hot dogs. The granola bars are used to stock my work bag in case of a snack attack and I have some Tootsie Rolls to complement my meals as a small dessert. There is no question that my in-house meals are lack-luster and definitively not the most nutritious. The occasional meal is had at the hospital or a fast food joint on the way there which is surely not helping my case. I am just now realizing that I don’t even have said jelly on hand…how pathetic is that?!

Just when you thought medicine was about teaching healthy habits, you notice that those who teach it are having a hard time following the rules. Certainly, this does not go for every student as the outliers exist, but if you ask, there is commonly a stock of supplies to make the most basic of meals. Whether short on time to prepare meals, no desire to eat healthier, or an attempt at saving money we are probably not properly filling our fuel reserves. One student I work with is staying in a local hostile making the effort to find the nearest free meal even if it means walking into a nearby hotel for their continental breakfast! The best counsel I heard a while back: “somewhere there is a free lunch, and it is my job to find it.” It holds true, but when the advice proves futile I return to my meals of simplicity with minimal ingredients and little variety. So Mom, no need to worry, I am being fed and there is something from every food group.

Question of the Week

A known alcoholic man presents to the emergency department showing signs of confusion, unsteady gait and horizontal nystagmus. Upon questioning he tells you he does not remember much about the day but just finished eating a meal fit for a king. What is the first step in treatment and what structures are likely being affected?
A. IV glucose, mamillary bodies
B. IV thiamine, hippocampus
C. Oral glucose, hippocampus
D. IV thiamine, mamillary bodies
E. Disulfiram, amygdala

Answer & Explanation

Sunday, August 14, 2011

Digital Medical Instruments for Your Phone

The effect of the smartphone on technological advances is undeniable. With apps for everything these days people are expanding to a peripheral market to expand the functionality of smartphone products. If you are in medicine, there are some fun gadgets you might consider adding to your black bag arsenal of portable instruments.

Smartphone Adjuncts

Of course you could use your phone as a reflex hammer, but that is just not as exciting as having a few gadgets and gizmos on hand. So if you are looking for a medical gift or something to put on your wish list you might consider some of these ideas that are sure to draw some attention from your coworkers. Many of these have either received FDA approval or are in the process of doing so and will be available for purchase soon. The majority of these devices are expanding use beyond the Apple operating system so keep an eye out for developments if you do not already use the iPhone.

Stethoscope
  • Price - $90
  • Designed for iPhone/iPod but it looks like it would function in any headphone jack
  • App not needed
  • Other - iStethoscope Pro app ($0.99), Does not require attachment
Pulse Oximeter
  • Price - Unknown
  • Designed for iPhone and works with Android, Windows etc
  • App required
 Blood Pressure Monitor
  • Price - $130
  • Designed for iPhone, iPad and iPod
  • App required
Electrocardiogram (ECG)
  • Price - Less than $100
  • Designed for iPhone and iPod Touch, plans to be available for other operating systems
  • App required
Blood Glucose Monitor
Dermatoscope
  • Price - $1,200
  • Designed for iPhone 4
  • App required ($5.00) Compatible on iPhone, iPad and iPod Touch. Can be used without the attachment.
Ultrasound
  • Price - $7,500
  • Not currently available on a smartphone but expected to integrate that function eventually
  • Available only to medical professionals and comes with visualization device
The practicality of some of these devices is obvious. When traveling or doing house calls to friends and family they could definitely be useful to have on hand. If you are aware of any similar products, I would love to add them to the list. Please take a minute to comment on them below with any information you have found.

Question of the Week
A mother brings in her 3 year old child for a well-baby office visit. She is concerned her child is not progressing normally because he has not memorized his own name, address and phone number? You explain that children are expected to obtain these skills at which of the following ages?

A. 12 months
B. 3 years
C. 5 years
D. 7 years
E. 9 years

Answer & Explanation

    Sunday, August 7, 2011

    Anti-Medical Meanderings

    All this humid weather has kept me under a fan, in the air conditioning and rarely outside. The times when I am exposed to the elements are usually reserved for travel to my clinical site, exercise and exploration. Here in Miami Beach there is plenty to explore especially since I am coming from a desert.

    Beautiful Exploration

    Taking time out of an already busy schedule to investigate a new location is not always easy, especially when time is limited. When traveling to rotation sites out of my home city, I like to get an idea of what the community has to offer and what attractions may be in the area. On a day off, I drove to the Florida keys. I've always been curious about the tropical environment there with its long stretches of road linking numerous islands. Beautiful skies were complemented by the temperate waters and lush greenery. It was a short lived getaway that I needed. Upon my return to the mainland I pit-stopped on one part of the seemingly never ending beach. The entire coast is Atlantic Ocean beach front covered with tourists, towering resorts and one of the nicest boardwalks I've experienced. City life is bustling and the art deco facades a glimpse of times past. This is definitely a colorful place to experience medicine as the hospital caters to those who live and play here.

    Traveling to places unknown is a challenge when adjusting to the newness of lifestyle and environment. If the residency match places me here, it's nice to know what I am getting myself into. To me that makes the exploratory day trip worth the effort. Getting a sense for the people and their mentality in and outside of the medical setting is key to making what will be a life influencing decision. On the flip side, this is Miami and summer, I don't know how I could have come here and not experienced what this place has to offer! Living among the locals definitely helps get an idea for what there is to do and see. In exchange for all of this I have to learn to live with the humidity which has been tougher than I imagined.

    Question of the Week
    An 8 year old boy with rapidly deteriorating cognitive function is not oriented to time, person, or place. On exam he has nuchal rigidity and a high fever. His mother tells you that he has been swimming in a lake at a campground in Florida. You diagnose the boy with meningoencephalitis. Which of the following represents the most likely infectious agent?

    A. Neisseria meningitidis
    B. Haemophilus influenzae
    C. Streptococcus pneumoniae
    D. Naegleria fowleri
    E. Mycobacterium tuberculosis


    Answer & Explanation

    Subscribe to Life as a Medical Student