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 patients, we think of working with medical students as a good deed, a necessary evil to improve the future doctors of America. You spare the extra time, discuss your mother’s sister’s medical history, a detailed account of your drinking (not quite) habit, and succumb to a physical encounter rivaling the awkwardness of a junior high date.
But medical students are changing. Today’s students are starting medical school with more experience …
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Today’s medical students are better prepared to practice medicine
An excerpt from Pet Goats and Pap Smears.
Life changes in a heartbeat.
In the “Events of the Cardiac Cycle” lab, four students are assigned to each dog. Instructions: Inject the live dog with epinephrine and study the EKG. Sever cardiac nerves. Carve open the chest and shock the heart. As the dog’s blood pressure drops, remove the heart. Now, stab …
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Bambi Syndrome saved my life
There were many things I pictured myself doing as I endured four years of medical school: building relationships with my patients and their families, performing complicated procedures, sleeping with my shoes on so I could jump up at any moment when I was on call. One thing I didn’t imagine was that I would be learning about and becoming a part of the labor movement.
My experience at UCSF Benioff Children’s …
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From the bedside to the bargaining table
Adapted from a keynote address given to the graduating medical class at the University of Toronto.
When I was asked to give the keynote to graduates of the class of ’14, it was an honor that nevertheless filled me with terror and a bit of wistfulness.
My sense of fear in giving advice to these amazing young doctors comes from not being sure I belong in the same company. They are whip smart, …
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The human cost of physician burnout is almost unfathomable
While running several times over the past week, I have thought carefully about our profession. I cannot imagine having chosen any other profession than medicine, nor any specialty other than internal medicine.
But that is me, is it you?
A medical tweeter than everyone should follow @medicalaxioms had these tweets recently:
If you become a doctor for wealth or prestige, you are going …
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Want to become a doctor? 5 criteria you should consider.
As I begin another year teaching EKGs to our new residents, I find I am increasingly asking myself, “Where to teach?”
I do not mean to imply a geographic sense to the word “where” (although this is difficult, too, as residents move from hospital to hospital in large health care systems like ours as they change rotations), but rather as more of a “level.” What level do I teach our residents …
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The desire to spoon-feed medical residents today
Learning in medical school often feels like learning a completely new language. There are numerous acronyms (OPQRST, CAGE) and molecules (IL-1, TGF-beta) and more. But most striking to me are two particularly ubiquitous buzzwords: “high-yield” and “protected time.”
I feel like I heard both these terms — and particularly the former — thrown around every single week of this past school year. High-yield has been used to refer to, as you …
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High-yield and protected time: A medical student’s take
My high school graduation ceremony was your typical Californian high school graduation — the sun hovering lazily over us, a cool, ocean breeze bringing wafts from the sea. As I listened to my principal deliver his address, my attention waned in and out. The sun was too warm and the wind was too soft. When the student speaker came up to speak, I reclaimed my attention to listen to him …
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Emphasize the attention a doctor pays to the patient
Today, I saved a life.
And I wish I could tell you a story about fancy heroics — about an exploratory laparotomy, a chest thoracostomy, or a patient that coded and I was the last person to perform the chest compressions that brought them back to life. But I can’t. But I can tell you that I saved a life.
She was 16-years-old, and moved here four years ago from a different …
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Today, I may have saved a life
In case you haven’t noticed, a hot new topic in education is “grit.” In order to reduce the long-standing 20% attrition rate of surgical residents, some say we should select applicants who have more grit or conscientiousness.
A recent paper in Surgery reported residents who dropped out of programs had decreased levels of grit as measured by a short-form survey. But due to unexpectedly low attrition rates in the surgical programs …
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Selecting grittier surgeons is harder than you think
Recently I attended a national academic conference, and while I’ll admit that, having brought my husband and son along for the trip, the balance of time spent was skewed more toward pool and beach activities than academic sessions, I did indeed attend several and overall they were of good quality. One left me somewhat disappointed, though, because although it addressed what I would consider an important topic within my field, …
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Can we get more from our medical meetings?
She’s 58, but appears maybe three days older than 42. Her eyes are sunken, tearful, worried, anxious. She tells me about her two grandchildren, and how she just visited them in Michigan. She came to the hospital, straight from the airport. She’s worried.
She’s worried because her shortness of breath hasn’t gone away for over a month now. She has had breast cancer, and opted for a more conservative approach: a …
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I am just a medical student
Two years ago, I received my first employment contract. Not long after Match Day, I did what 115,000 physicians in training did that year and will do again this year: I signed the contract promptly and returned it. I tried to read the contract carefully, but it didn’t really matter. Unless you no longer want to be a physician, there is no other choice but to sign.
Today, as president …
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Medical resident pay needs serious reform
In a New York Times column, Thomas Friedman recent wrote about what Google values and seeks in its new employees. Striking to me was the fact that overall intelligence ranks lower on their values totem pole than several traditionally more important attributes.
So, what can medicine learn from Google and how can we apply it to our admissions process? Here are five key points from the article, adapted to our admissions process:
1. …
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What can medicine admissions learn from Google?
No medical resident looks forward to working night float. The initial glamour of doing chest compressions in the rising light comes up against a litany of administrative tasks. As the glamour wanes, the gulf between the objective curriculum and actual practice widens. On paper, residents learn how to manage acute emergencies and learn deeper clinical reasoning. Actual practice, or the “hidden curriculum” of training, can be a different experience, involving …
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Learning from the lessons of night float
Dear new medical student:
Congratulations! You are about to embark upon an exciting, life-altering experience, one you will never forget. You are about to join an elite group of people who will now be your peers going forward.
You will be continually fascinated, and not a single day will go by from now until you retire that you aren’t challenged by something you have never encountered before. You will be solving problems …
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A letter to new medical students
Last August I sat surrounded by 163 other ambitious, new medical students on our “introduction to the profession” week. Anxiety was high with undertones of self-doubt mixed with lofty goals. Another distinguished figure had taken the floor to introduce us to the concept of medical professionalism: commitments to patient-centered care, intellectual honesty, social responsibility and advocacy. The long list of medical virtues we were to develop, cherish, and exemplify in …
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What is professionalism and wellness in medical education?
I thought the most important thing I had learned while working in the emergency department as a first-year medical student was to bop and weave. The impeccable foot skills I harnessed as a youth lacrosse player were put to great use- to stay out of the way. The quiet whisper of a nurse trying to slide behind me, and — BAM — back against the wall. I can hear the …
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The first-year medical student and the 114-year-old patient
I performed my first paracentesis in November of my intern year. It was 3 a.m., and I was on overnight call in a packed ICU. The patient, a 45-year-old male with hepatic encephalopathy, was hardly alert enough to remember my name. He didn’t know I was an intern. He didn’t know I’d never even attempted a paracentesis before.
After I finished, I added the patient’s name to my procedure card. I hurried to get an ABG …
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The ethics of trainee-patient encounters: Are we practicing on the poor?
