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 »
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 »
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 »
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.
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By David Johnson
Recently, the Association of American Medical Colleges announced that for the first time ever women comprised the majority of matriculants into US medical school programs. This triggered a few thoughts of my own.
In 2017, I debuted my Twitter account focusing on the history of medical regulation. In the fall of that year, I shared several historical snippets focusing on women in medical regulation. In one I focused on a regulatory trailblazer: Adele Hutchinson, MD, a graduate of Boston University who appears to have been the first woman to serve on a state medical board anywhere in the United States. This occurred surprisingly early–in Minnesota in the 1890s. The fact that two other women (Margaret Koch; Hannah Hurd) succeeded her on the Minnesota medical board struck me as all the more remarkable considering the male domination of medical boards individually and collectively throughout the majority of their history.Read More »
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 »
By Angira Patel
When I started my medical training, my pediatrics residency program banned all pharmaceutical sponsorship of activities. No free lunch in the middle of the day, no fancy dinners at expensive restaurants, or trips to conferences paid for by a pharmaceutical company. Even my lab coat was unadorned by the colorful pens given by various drug representatives. At the time, I remember thinking a pen or a free lunch would never influence how and what I prescribe to my patients.
As a young trainee, I did not appreciate why my residency program took this stance, but I do now. Read More »
By David C. Leach
It has been more than thirty years since she first came to see me – a vital woman in her early seventies who had detected a lump in her breast on a self-exam. A diagnostic work up confirmed cancer and the smallish lesion was removed. It never recurred. By the time a second lump appeared in the other breast we had come to know each other. She was now in her late seventies and this lump also proved to be cancer. It was removed. Postoperatively in the hospital she looked a bit depressed.
She was not an alcoholic, however, she had told me that she enjoyed an occasional martini before dinner. I did something I had never done before and have never done since. I brought a Waterford crystal glass containing a nicely mixed martini to her hospital room. She accepted it without comment. We talked while she sipped. She told me that she had discovered and joined the Hemlock Society. In her words: “Dr. Leach, I know that given your lily white ethics you would never countenance euthanasia so I joined the Hemlock Society. I now know what to do and you needn’t trouble yourself.” I thanked her for her consideration and we talked briefly about her concerns and choices. In my opinion she was not at risk for suicide. She knew that this lesion also was small and with negative nodes would likely not recur. What she wanted was to be empowered to make her own life decisions. I assured her that she was. . .
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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)
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By Virginia McCarthy
As a Jesuit, Catholic medical school, we have had several preparations for Christmas that may not be as “front-and-center” in other institutions. These traditions are deeply engrained in our culture and expected by our students. With the flurry of academic activity in the final weeks of the semester, the true miracle of Christmas might lie in the simple fact that anyone shows up to spend time together at all. In the busy-ness, we pause, but what exactly is it that we are trying to remember about ourselves, the community, the world?
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