Professional Membership

One of the joys of coming home from the clinic each night used to be getting the mail. The fun has worn off as much of what fills the box are bills, political advertisements, or those pesky coupon mailers. Recently, however, I have been getting a little more than expected.

Joining the Club

A couple months ago, I signed up for a professional physician organization. My intent was to become a member so I could participate in their conference. I had no idea that I would also be enlisted to receive books, peer reviewed journals, newsletters, and more conference announcements. Since I do have some affinity to Emergency Medicine, this was a perfect organization to join. As a student it was relatively inexpensive and the resources have easily paid for themselves. My problem now is that I have little time to dedicate to their perusal despite the appeal.

From what I gather, the residency programs appreciate knowing that applying medical students are genuinely interested in their particular field. One method of gauging this interest is by learning which professional organizations we have joined. It shows a sense of dedication and desire to know more; things which residency programs tend to seek in applicants.

While my trips to the mailbox still gives me plenty to recycle, at least I now have some decent mail worth keeping. To any student who may be reading this, I would strongly encourage joining a professional organization in your field of interest. In addition to filling your mailbox with more literature than you can handle, it may actually serve you well come interview season.

Question of the Week

A 57-year-old obese man with a history of smoking, hyperlipidemia, and hypertension presents with pain in his legs while walking. On further questioning, he reveals that the pain starts in his buttocks and extends down his thighs and into his calves. Previously, the pain disappeared with the cessation of activity, but lately it persisted in his feet even at rest. His symptoms can best be explained by which of the following?

A. Decreased permeability of endothelium
B. Narrowing and calcification of vessels
C. Peripheral emboli formation
D. Thrombus formation
E. Weakening of vessel wall

Answer & Explanation

Giving Thanks

In this season of thanksgiving, I reflect on that for which I am grateful. My supportive family and friends are at the top of my list along with endless opportunities to serve my community. I am usually not grateful for the ability to grow so much hair on my lip, but this month is a little different.

Local Volunteer Opportunities

With the little time we have outside of classes, it is refreshing to give back to the community on occasion. Since we are in medical school, it commonly comes in the form of optimizing health through sports physicals or public screenings. Recently, I joined my peers in a 5k walk for chronic hypoinsulinemia on behalf of the Juvenile Diabetes Research Foundation (JDRF). In addition to raising money for a good cause, we caught a little fresh air and exercise at the same time.

In an ongoing effort to address prostate cancer awareness, men all over the world are "changing the face of men's health" by growing a mustache for Movember. I joined my classmates as Student Physicians for Fuzzy Philtrums, with the goal of contributing our follicular skills to this beneficial cause. If you have a prostate or love someone who does, please contribute to this noteworthy cause by sponsoring my fuzzy philtrum with a small donation. All proceeds go to the Prostate Research Foundation in cooperation with the Lance Armstrong Foundation. (After clicking the above link, you will be able to provide your contribution information online, if you have questions, please leave a comment.) Your generosity is greatly appreciated.

Board Prep Question of the Week

A 29 year old female with type 1 diabetes goes on a trip to the Caribbean and loses her insulin on the way. Three days after her last insulin dose she goes to the hospital. Lab work shows hyperglycemia and increased anion gap metabolic acidosis. Which of the following pathways is mainly responsible for providing the substrate of her acid-base disorder?

A. B-oxidation of fatty acids
B. Catabolism of branched chain amino acids
C. Citric acid cycle
D. Gluconeogenesis
E. Glycogenolysis

Answer & Explanation

Not On My Watch

Iatrogenic (caused be medical personnel) and nosocomial (obtained in the hospital) infections are unfortunately a sad reality in healthcare. When we visit the doctor, the last thing we want is to become more ill than our initial visit from an avoidable cause.

Healthcare Associated Infections

Hospitals are rightfully expected to get you better but that's not always the case. Sometimes people are picking up infections, from pneumonia to antibiotic-resistant staphylococcus (MRSA), while under treatment for other health problems, or even while just in the hospital having a baby. That's a situation that could, and should, be completely avoidable.

The fast pace medical environments such as clinics and hospitals make it easy to understand how healthcare professionals can facilitate the spread of infectious diseases from one patient to another. As simple as it is, hand washing is still one of the most effective means of reducing the spread of infection. Research has shown that alcohol based lotions equally accomplish the task in less time, hence the common practice of their use in medical facilities.

Healthcare associated infections not only have a significant financial impact on the medical system, but they are detrimental to the health of patients everywhere. The global campaign, "Not On My Watch" aims to educate healthcare providers how they can participate in reducing the spread of infection. If we all do our part, we can play an important role in the health of others and our own.

Board Prep Question of the Week

Five days after a mitral valve replacement, a 63 year old woman becomes hypotensive, tachycardic, and febrile. She is rushed to the CCU where an emergent transesophogeal echocardiogram shows multiple vegetations on the new mitral valve. Blood cultures are taken the patient is started on vancomycin and gentamycin. The initial Gram stain shows gram positive cocci. What additional bacterial characteristics are likely to be found?

A. Catalase negative with no hemolysis
B. Catalase negative with partial hemolysis and a positive quellung test
C. Catalase negative with partial hemolysis and no capsule
D. Catalase positive, coagulase negative
E. Catalase positive, coagulase positive

Answer & Explanation

Things I Wish I knew - First Year

After becoming a second year medical student two days ago, I looked back at the last year and gave each week a point value between 0 and 10 signifying my interpretation of medical school intensity where 10 is the greatest. Low points were often vacations (with the next few weeks prorated) and tallest peaks represent block weeks. Call me a geek if you will, but I think it's pretty cool to see the year in graph format.

Things I Wish I Knew

This last week of exams was not difficult academically, but was more so in anticipation of summer break. With one year behind me I have come up with a list of things I wish I knew before my first year of medical school.

1. Not all the textbooks were necessary - In addition to presentations and notes, the textbooks added a valuable resource, but there was simply not enough time to read every assignment. Occasionally, books were not even used. Contact current students and find out what they recommend. If possible, get used or discounted books. Often times they will already have markings of the material that is important and you save a little money too.
2. Much of the day is spent sitting - Time management is crucial to success. With excessive amounts of lecture and self study, there is little time to exercise. Elbows become sore and dry from hours at the desk, the back sore from pore posture, and the neck aching from constantly looking down. Exercise can be difficult to fit into the rigorous schedule, and it will make a great difference if included on a regular basis.
3. Organizing study habits takes time - It seems like a moot point because most people who get into medical school have some experience in studying. As one who has never used a laptop during class in undergrad, it took some time to learn how to organize my notes. When I realized that wasn't for me, I had to move back to paper. Transitioning between school and home is a challenge that requires attention. Having specific times dedicated to studying and following them will help significantly. Do what you are comfortable with, and most importantly how you learn best.
4. Associations are everywhere - At first it seems like you are struggling to get the fire-hose out of your mouth as far as information goes. Whether it is anatomical structures, terminology, or concepts it can quickly become overwhelming. For example, if you have experience with a condition you are studying (clinical, family or friends), it makes it a lot easier to remember and understand. Making associations to things you are familiar with personalizes the same message in a way you can comprehend.
   
5. Get involved - At first it was hard to imagine that there would be time to do anything but read. Initially, I was going to avoid the groups and activities until I could handle more which was not wrong thinking, and permitted proper time to habituate. Study groups are vital to bounce ideas and thoughts around. Student organizations are a great way to participate in community events and gain more experience. There is no better time to become a team player than in your first year class.

I am but one medical student in the sea of many. If you have something you wish you knew before your first year of medical school, please share.

Student Organizations

With the latest public health scare, swine flu, people are taking drastic measures to avoid exposure and in some cases society. There is no need to show up at work or school in your bio-suit yet.

Medical Student Organizations

I am certainly not avoiding the masses, at least not those that get together at school or in the community. As the first year of medical school comes to a close and the second year students are graduating from the classroom setting, each organization has to pass the torch to next year's student officers.

Organizations range from student government and class officers to a smattering of specialty interest groups. Recently, I was voted into office as secretary/treasurer of both the TUNCOM a cappella singing group "in TUN" and the "Emergency Medicine Interest Group." With the course load I anticipate next year, preparing for board examinations, and my involvement in another handful of groups these positions suit me just fine.

In preparation for residency programs, many students incorporate a variety of skills to better their curriculum vitae. Participation in student organizations provides opportunities for leadership, community service, and an unique way to learn a new skill or interest. Officers and members of these organizations build skills that are valuable in residency and future careers. Holding leadership positions, however, build a student's CV for the upcoming residency interviews. The bottom line is, get involved. Just like going from college to medical school, they will be looking for diversity and experience.

If your school doesn't have an organization that you think would be helpful, start one. Not only would you be a member, but you could be the founder too. If you are looking for organizations outside of school you may consider the Red Cross or Medical Reserve Corps for opportunities to get involved in your community.

Tax Time

Just when things start to mellow out, I can feel Uncle Sam reaching deep into my already emptied pockets. It's that time of year again when W-2 forms show up in the mailbox, numbers get crunched, and taxes get paid.

Tax

Considering all the things that taxes are used for I guess they aren't too terrible, but they certainly don't help my situation financially as a student in plenty of debt. Once all the government documents arrive and get filed we get to file even more as students.

It wouldn't be possible to pay for school without a little help from the government. Therefore, completing the FAFSA and other scholarship opportunities permits my education to continue. Considering some of the tax breaks, the process a little more bearable (thank you new house). I certainly don't mind being able to file taxes for free.

Expenses

As the numbers become quite important, I thought a running total of expenses for Touro University Nevada's College of Osteopathic Medicine would be appropriate.

• Tuition - Roughly $37,000
  
• Books - $1000.45 (Used and new)
  
• Equipment - $1,550.65 (Laptop, lab coat and diagnostic tools)
  
• Clubs - $40
  
• Extra - $202.29 (Software, vaccines, etc)

Obviously these will vary from year to year and student to student, but it is in the right ballpark. Moving, housing and food expenses have not been included. With Valentine's Day around the corner, you can help curb some of these costs and get some fantastic deals, consider some of these great gift ideas.

Clinical Corner

Epistaxis (Nose bleed)

Research says that about 90% of nose bleeds occur as a result of damage to Kiesselbach's area. It is found in the front part of the nose and has a rich blood supply. The predominant reoccurring trauma is caused by fingers that are doing too much scratching. A smaller percentage comes from the back of the nose that cannot be reached by fingers which often requires medical help. Stopping a nose bleed may take time, and is good knowledge to have if you ever need it.

White Coat Ceremony

I walked in a student and walked out a “Student Doctor.” Bally’s Resort and Casino event center in Las Vegas was filled with family, friends, and healthcare-professionals-to-be. We literally walked into the beginning of our new profession.

Coat of Honor

When we matriculated, we knew the goal was to walk away a physician educated in the art of medicine. Some have said that by the end of four formative years in medical school, the white coat is donned four years too late. Rather than waiting until our two years of classroom work and two years of clinical studies are completed, the esteemed white coat was presented to us this last week as a manifestation of the profession we are entering.

A historical tour of medicine reveals that the white coat is reserved for the medical professional. With more experience, it is appropriate for the coat to become longer. Thus a medical student wears a coat that reaches to the waist whereas that of a seasoned physician will hang at the knees. Both are a symbol of the provider's dedication to the practice of medicine and the patients with whom he or she interacts.

Dignified Ceremony

Seated guests looked for ‘their’ student as they processed to the chairs at the front of the hall. The color guard presented the nation’s flag and I participated in the a cappella group that sang the national anthem before taking my seat among my colleagues. As TUNCOM is a Jewish institution, the governing Rabbi offered an invocation in the Hebrew tongue. The Dean of the school took a moment to express the significance of this event and then read each name one by one.

Students crossed the stage and handed their white coat to a member of the faculty who shook the coat before handing it to another professor who then assisted the student into their coat. This symbolism represented the formative classroom and clinical years respectively. Once the coats were received, the students stood to take The Osteopathic Oath:

I hereby affirm my loyalty to the profession I am about to enter.

I will be mindful always of my great responsibility to preserve the health and the life of my patients, to retain their confidence and respect both as a physician and a friend who will guard their secrets with scrupulous honor and fidelity, to perform faithfully my professional duties, to employ only those recognized methods of treatment consistent with good judgment and with my skill and ability, keeping in mind always nature’s laws and the body’s inherent capacity for recovery.

I will be ever vigilant in aiding in the general welfare of the community sustaining its laws and institutions, not engaging in those practices which will in any way bring shame or discredit upon myself or my profession. I will give no drugs for deadly purposes to any person though it be asked of me.

I will endeavor to work in accord with my colleagues in a spirit of progressive cooperation and never by word or by act cast imputations upon them or their rightful practices.

I will look with respect and esteem upon all those who have taught me my art. To my college I will be loyal and strive always for its best interests and for the interests of the students who will come after me. I will be ever alert to further the application of basic biological truths to the healing arts and to develop the principles of Osteopathic medicine which were first enunciated by Andrew Taylor Still.

In the presence of this gathering I bind myself to my oath.

Similar to the Hippocratic Oath given to allopathic counterparts, this oath embodies the characteristics of sound, dedicated physicians. It is a standard of care physicians attempt to deliver every day around the world. Although the formalities of the evening may be over, the journey is still in its infancy for the many medical students who wear the white coat and experience this honored rite of passage.

Yom Kippur

Once again Touro students find themselves at a time of holiday. Almost ten days ago Rosh Hashanah started and we are now in the midst of Yom Kippur, or the "day of atonement." It is considered to be the most important Jewish holiday, representing repentance and the atonement. An extended fast is performed during this time which is accompanied by considerable prayer. A normal day usually consists of three prayer services whereas this special day commonly has five.

Yom Kippur falls ten days after Rosh Hashanah when it is believed that God writes the fate of individuals into the book of life. The ten day period between offers time for repentance at the start of the Jewish New Year. Yom Kippur is the day when the "verdict" of God is sealed. May your Yom Kippur be a day of renewal.

Rationed Time

The long days that never seem to end are certainly anticipated experiences. Only in the beginning of the whole process, I am learning to ration my time to the many tasks that demand my attention.

New Home

We finally closed on our new home and moved in last week (hence the missed post). It took our mortgage broker a long time to finalize the transactions and was more than a headache with a new problem or delay every day. Being first time home buyers has been quite the hassle and I know many medical students wrestle with the decision to become home buyers or simply rent.

In making our decision we had learned that renting a unit in Las Vegas would cost nearly the same as a mortgage. Our struggle was mostly with the mortgage lenders being flexible once we found the house we wanted. We waited until the very last minute before making the deal official.

All I can say is that if you are entertaining the thought of home buying, start well before matriculating. We ended up staying with family for almost a month. It was great to spend time with them, and we will forever be grateful for their hospitality. We just hate to have out-stayed our welcome. Renting sure sounded tempting on occasion, but our new home was worth the effort.

Student Loan

Reimbursement for the expenses of medical school cannot come too soon. With all the costs of living increasing and becoming more abundant, staying financially afloat is a rather fancy dance. I can come up with a lengthy list of debts, but if you are reading this you could name them just as well.

My financial institution is finally funding my tuition and reimbursement checks. It is a huge relief to know we will be able to buy groceries next month and have a roof over our heads. Visit the past post for more student loan info.

Exams

I knew medical school would move quick, but I had no idea we would cover an entire book in less than a couple months. Midterms were only one month in and next week will be our first week of exams. "Block week" as they call it, occurs three times a semester, testing our memory and endurance skills. With 24 credits this semester, I should start having nightmares any night now.

Somehow I managed to make it through my first couple tests despite the late...late nights of studying. This method is not recommended for two reasons: 1)Taking a test while fatigued makes information recall ineffective and 2)It's bad for your physical health. Of course I would like to have performed better, but the information was spilling out of my head by the time I took the test. I think I need to reformat my cerebral hard drive and free up a little space.

Student Organizations

I have been blown away and slightly annoyed by all the organizations vying for my money. Who knew there were so many student medical associations? Each one asks for membership money but none really have a significant impact that seems evident. The benefits they have expressed usually include free meals, discount suture clinics, and the ever popular screen printed tee-shirt.

I may be new to this medical school thing, but I'm not an idiot. My intention is to pass and earn a degree. If that means I cannot join an organization my first week of school, please support me in that decision. Perhaps down the road I will share a portion of my student loan with you so I can say I belong to your club. Maybe in the meantime you could come up with better reasons than a free lunch to be a member of your organization.