Students, residents, and educators writing on KevinMD about how physicians are made: medical school, the match, residency, duty hours, supervision, assessment, mistreatment, and the path from student to practicing physician. Many contributors write while still in training, and many write anonymously. For a maintained record of what students and physicians have said about medical school since 2004, see Medical school: what students and physicians say, in their own words. For what residents and attendings have said about residency itself, see Residency: what residents and attendings say, in their own words.
As physicians, we are trained to look for change. We look for changes in lab findings and change medications, and we ask our patients, “what has changed since I saw you last?” We are always trying to get our patients to change in one way or another. Doctors are hardwired to seek changes that produce a dopamine release in our brains. We love it when patients see an improvement in …
Read more…
This medical student went to rehab. Here’s what she learned.
On my medicine sub-internship, I took care of an elderly man who was a retired military surgeon. When he first came into the hospital, mentally altered from an underlying infection, he was irascible and unpleasant towards many staff members, swatting their hands away as they attempted to draw blood for lab tests.
As the infection came under control, the shell of rage fell away to a quiet dissatisfaction. The bed was …
Read more…
Sometimes I see my ghosts in the form of my patients
When I was an intern in medicine, I couldn’t wait to start my role as a radiology resident. Even though I cared for my patients to the best of my ability and studied their diseases, I knew that my time in the department was limited. I wish I could say that I put my whole heart into my work, but with all of the extraneous demands of intern year — …
Read more…
From medicine intern to radiology resident: Is the grass greener?
As a second year resident, I often do not feel like an expert in anything. Every day I learn more about medicine and realize how much more I still want to learn. In spite of the emotional, physical and mental challenges that being a young doctor entails, I have remained positive and have grown stronger throughout residency. As I reflect on the past year and a half, I appreciate the …
Read more…
10 tips to make residency more enjoyable
As a medical scribe to physicians, I’ve entered over a thousand different exam rooms and listened to a thousand different patients give their unique histories, but the morning of October 28th was quite different.
On this chilly late October morning, I knocked and stepped into the exam room of my very first “patient.”
“Mrs. Laura Williams” was an elderly woman, old enough to be my grandmother, but slightly taller and a lot …
Read more…
The difficult questions have to be asked in the exam room
Readers are slowly learning about my admiration for the Farnam Street Blog. The about page describes the blog in this way:
My goal is to help you go to bed each night smarter than when you woke up. I’ll do this by giving you tools, ideas, and frameworks for thinking.
I’m not smart enough to figure all of this out myself. I try to master the best of what other …
Read more…
These are the words medical educators should think about
“I remember how hard it was to be a third-year medical student,” one of my residents once said to me. “You have to appear constantly enthusiastic. You feel continuously judged and evaluated. And worst of all, you know, deep inside, that if you were to get a cold or something and not show up one day, not one bit of the daily workflow would change because as far as pivotal …
Read more…
These are the words that helped a medical student through her struggles
I recently recreated a now-famous business school study on a subset of residents in my internal medicine residency program.
In the original study, researchers asked students to read a case of the real-life venture capitalist Heidi Roizen, who expertly leveraged an extensive professional network to forward her career. Half of the students read the original case; half were given a case in which Heidi’s name was switched to Howard — a …
Read more…
Female leaders in medicine: It’s lonely on top
Her nails were painted.
She probably had them done just a couple of days ago. The bright red polish glistened on her perfectly filed fingernails. She had her toes done too.
Was she preparing for the holiday season? Had she begun her Christmas shopping yet? Was she making a list of new year’s resolutions?
It didn’t matter anymore.
She was lying there. The cold metal table provided the platform for her lifeless, still body. …
Read more…
A vow to live a little more and worry a little less
Last year, I visited my brother in Rhode Island at Johnson & Wales University. We took a culinary school class together learning about the fundamentals of Italian and German cuisine. What were two medical students doing in culinary school?
As a fourth-year medical student, I learn the science and art of caring for the body and mind. Unfortunately, the majority of patients are plagued by ailments secondary to chronic preventable diseases …
Read more…
Cooking is just what the doctor ordered
Premedical education has become disconnected from medicine. Rather than helping students evaluate whether medicine is right for them or preparing students to enter the discipline, the premedical gauntlet encourages students to blindly discipline themselves according to rigid criteria.
For example, during a recent trip to the pre-health advising office at my university, my advisors presented me with the “A.C.E. checklist.” It includes the three accomplishments every candidate should have before applying …
Read more…
Why premedical education is disconnected from medicine
Dear third-year medical student:
It’s hard to believe as I am writing this, that I am in my last rotation of third year. This year has been amazing and has gone by so quickly. There is no way to predict or to prepare for what your third year will have in store, but if it is anything like mine, it will be full of ups and downs. Moments that you will …
Read more…
A letter to a third-year medical student
In 1978, my mother interviewed for dental school. On her post-interview tour of the school, her male tour guide assumed she was applying for dental hygiene school and showed her only those areas of the school. Upon my mother informing him that she was applying for dental school, he smirked and said, “Good luck getting in, you’re a woman,” and walked away laughing.
Of course in 1978, overt sexism was neither …
Read more…
Misogyny in medicine is alive and well
I watch as my almost-2-year-old daughter awkwardly climbs the stairs. I do not hold her hand, but I do not turn my back on her either. She is still clumsy, and her little-bowed legs often miss their targeted landing spots. She holds on to the rail with a vice grip that steadies each monumental step forward and upward.
Every so often she wobbles as she miscalculates the distances and her toes …
Read more…
Are we training a generation of soft doctors?
As a third year medical student, I am as green as they come. As much as I feign familiarity in the hospitals, each day of every rotation brings a host of firsts: first time suturing, first natural delivery, first terminal patient, first 24-hour shift, first code blue. The novelty of these experiences is equal parts exhilarating and overwhelming. As future physicians, we have invested the better parts of our time, …
Read more…
May my humanity heal where my science cannot
I remember attending an eight-hour seminar on my job, where experts educated new nurses about the transition we would experience in our profession. We learned about the change theory and the different levels of transition, from novice to expert. I remember not taking the two-day session very seriously, thinking that my accelerated three-year nursing degree had prepared me well for the workplace. Now that my one year of practicing as …
Read more…
My first year as a nurse taught me what true resiliency is
Studies have varied in their estimates of depression in medical school students, but they all show a similarly startling trend. Medical students have a higher depression rate than their non-medical counterparts. This culminates later in life with physicians with higher than average alcohol abuse problems and higher than average suicide rates, with male MDs 1.5 times as likely, and female MDs twice as likely to commit suicide than their Read more…
Medical students are depressed, but they’re taking the wrong drugs
The holy grail of clinical reasoning is, in a word, assessment. Ought we to measure clinical reasoning as a function of experience, knowledge base, or as a process measure? In medical parlance, there is no “gold standard.”
In 2015, to tell whether your doctor is a great diagnostician is based more on reputation than hard evidence. This gap in evidence is all the more interesting given recent press about the inattention …
Read more…
Searching for the holy grail of clinical reasoning
Receiving medical school interview offers simultaneously provides relief, justifies the incredibly hard work you’ve put into your primary and secondary applications, and confirms that you are indeed cut out for medicine.
In other words, you’ve convinced them — at least on paper — that you will succeed in their program and make an excellent doctor.
So why do they even want to interview you?
Consider what schools can only learn about you in …
Read more…
Use the power of psychology to ace your medical school interview
