Closing the Door on the “Closing Doors” Metaphor: Reframing our Step 1 Advice

By Emily Green

Anyone who advises medical students about USMLE Step 1 will be familiar with the metaphor of “closing doors”.  Upon receiving their Step 1 score, worried students wonder if the sound they are hearing is the slamming shut of gateways to particular specialties.  The problem with the pervasive “closing doors” metaphor is that it presents career options as being either available or unavailable, with little in-between.  In a student’s mind, a score of 240 might mean that the door to a particular career is open, but a 239 means that it is closed.  Convincing students the wrongness of this thinking is a challenge.Read More »

In My Panic Zone: Teaching Feedback Seeking

By J.M. Monica van de Ridder

Teaching is something that I have been doing for over 20 years. So, in general, I don’t worry about it. I think I know what works and does not work.

Things were very different for me this time. I was worried, and I felt very much out of my ‘comfort zone’ almost in my ‘panic zone’ (Brown, 2008; Palethorpe & Wilson, 2011). I had developed an intersession for M1 and M2 medical students on how to optimize their learning processes in the clinical setting through goal setting, self-regulation, receiving and seeking feedback. The content on feedback I am familiar with, from goal-setting and self-regulation, -I assume- I know more than average.

I tried to discover my fears. What is worrying me?Read More »

Extension

By Tim Lahey

Every March I run the last required course at our medical school. It’s a three-week-long, 47-hour sprint – a sort of boot camp for professional formation. We polish clinical skills, revisit foundational sciences, let students pick from a menu of interesting tutorials, and discuss professional formation.

Students grapple with hypothetical gastrointestinal crises on scatalogically-named student teams. They resuscitate rubbery patients with various flavors of hypotension. I don a sparkly red bowtie to MC a game show called Antibiotic Jeopardy.

Throughout, we discuss the evolution of their professional identities. I ask how their idealism has changed during medical school, and every year over 60% say it has waned. We share the stories that shape us, and how they can stay true to the values that brought them to medical school in the first place. Then they hand in a tall stack of confidential essays that I reply to on nights and weekends right up until the day they speak the Hippocratic Oath. Read More »

What Diversity and Inclusion Means to Me: A Science of Learning Perspective

By Adrian K. Reynolds

Over the past few months, I’ve been on a quest to answer this one question: How does my mission to create opportunities for students to develop self-regulated, active learning1,2 skills support diversity and inclusion?

In this quest to raise my level of critical consciousness3, or, in my African American Vernacular English, to “stay woke”, I’ve asked, how do the learning opportunities I’ve provided for students foster a culture of inclusion for all, regardless of gender, ethnicity, race, age, religion, sexual orientation, socioeconomic status, origin, language, ability, or political beliefs?  Well, I thought to myself, as a Black male teacher of Spanish in the K-12 school system, then later as a college instructor of English as a Second Language (ESL), and now as an academic enhancement specialist in the medical school setting, the learning opportunities I’ve created for students from all walks of life have, I believe, reflected meaningful contributions to building a culture of diversity and inclusion.  Not being completely satisfied with this response, I continued along the path of critical self-reflection. Read More »

From Marjory Stoneman Douglas to Medical School: A Call to Action

by Zarna Patel

I cannot find the right words to describe how it felt when I read news: “School shooting at High School in Southeastern Florida.”  Despite the 239 school shootings since Sandy Hook, nothing can prepare you for the numbness of having it happen in your hometown.  The way your heart leaps into your throat, the way all sound is muted, the way debilitating fear takes hold from your head to your toes.

“Are you OK?  Tell me you’re OK?!  Please answer me!”  Never in a million years did I think I would have to send a text like that to my 16-year-old cousin, whose biggest worry last weekend was her upcoming SAT test.

Knowing how many innocent children would never return to their parent’s arms that night was paralyzing.  I couldn’t close my eyes for more than a few minutes before flashes of my old high school haunted my dreams.  The large courtyard we ate lunch in, smeared in blood.  The freshman building we loved to hate, filled with kids running away, hand raised. The large auditorium where I spent four years performing, now filled with the cries of distraught children.

Read More »

Overcoming Uncertainty through Experience

By Michelle Sergi

Coming out of my first year of medical school I struggled with my sense of confidence.  After endless nights of studying, a multitude of experiences at our Clinical Training and Assessment Center, and specialized clinical experiences, I felt that I could take on the challenge of counseling patients.  On the other hand, when I thought about being on my own to take care of patients, I was terrified.  My pharmacology knowledge was insufficient, and even though I knew how to conduct a full physical exam, did I really know what was normal compared to abnormal?  These questions proved to me that I lacked the clinical experience necessary to become a good physician.

When I heard of the opportunity to apply for the Leroy Rogers Preceptorship, I immediately knew that it could help bridge the gap between my medical textbooks and clinical knowledge.  This program gives preclinical students the opportunity to choose a preceptor for a four week, hands-on family medicine clinical experience.  I had shadowed a family physician, Dr. Andrews, in my hometown several times before so I knew he would be the perfect preceptor.  I also felt that I would learn from his patients, especially because many are medically underserved.Read More »

New Year’s Resolutions – Walking the Talk with Compassion

By Hedy S. Wald

Take two Tootsie Rolls and call me in the morning. Self-prescribed for sweet tooth me. Not such a blasphemous “drug of choice” (I’m not even using caffeine!) but it’s New Year’s, that infamous time of resolutions. And I’d like to “kick the habit,” do all that stuff the nutritionist advised and ramp up the gym visits. Jogged 2 miles and took a 1/2 mile swim today to start the new year “right” – hopefully burned off the chocolate high. Fueled by endorphins and feeling oh so optimistic, I’m writing this blog. The question is – what happens on January 2?

The ongoing effort to implement and sustain behavior change has given me a profound appreciation for some of the struggles our patients (and even our colleagues and students) endure. Harnessing motivation can be tough and self-flagellation for not following through can make it tougher . . .  this is where some self-compassion with an attitude of kindness and acceptance toward ourselves may make a difference (1). Self-compassion can promote self-improvement motivation given that it encourages us to confront mistakes or weaknesses without either self-deprecation or defensive self-enhancement. (2) According to Breines and Chen, “resolving to make changes can be scary, as roadblocks and setbacks are inevitable along the way. From a self-compassionate perspective, however, there is less to fear.” (2)

Read More »