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.
I am three months into my medical residency, and I am getting fat. Not the noticeable change-in-pant-size fat, not yet. But I am most certain that what was once muscle is now just “padding,” and I can no longer solely attribute the words “muffin top” to the anatomy of the snacks that I scrounge to stay alive during the long hours in the hospital.
I am three months into my medical …
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Medical residents need to be accountable for their own well-being
I open the heavy, wooden door to the unit. On my left are the patient rooms, equipped with minimal privacy; to my right are members of the healthcare team shuffling around. I continue toward my destination, a small room containing a couple desks and computers dedicated to mid-level providers, but cannot help but notice how eerie the unit is. Although there are at least fifty individuals within this space, it …
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Morning rounds in the SICU
Listen.
I know that you are in your junior year in college.
I know that you’ve picked an unsustainable, or unrealistic. major. For instance, I know that at this very moment in time you have (finally) made the revelation involving your slim-to-none chances of owning the Jets by means of your pending Sports Management degree.
I know that you are now in the throes of career-choice turmoil.
I understand that the only council you …
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Becoming a doctor in a family of physicians
As this is the season for spanking-new physician trainees to flood hospitals around the U.S., I decided to chronicle my own very first 24 hours as a doctor so the reader can get a better insight into this annual event.
2000 hours, evening before: With my newly starched white coat, stethoscope and light pen packed neatly into my Tumi man-purse, I make believe that I am sufficiently prepared for the first …
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The first 24 hours of being a medical resident
A real code deviates from what they depict in medical dramas like Grey’s Anatomy. Television chest compressions are usually too slow and superficial, they are nowhere near forceful enough to sustain blood flow throughout the body. There is no foreboding soundtrack to hint at what’s coming, only the numbers that appear on the monitor that suddenly dip in the wrong direction.
Although I understood the magnitude of the situation as it …
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The importance of letting go after witnessing a code
I sit at my home in New Jersey as I anxiously await my 6am flight two days from now that will take me to the Caribbean island of Dominica where I will begin to take my first steps in the journey of becoming a doctor at Ross University School of Medicine.
Many people attempted to discourage me from continuing on the path I started on. Doctors I shadowed would warn me …
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Pre-meds: Do what it takes to get into medical school
For thousands of first-year medical students, including myself, last week marked the beginning of classes and our official entrance into the medical profession. We sat through lectures on the normal functions of the body, and many of us even set foot in the gross anatomy lab for the first time.
At my school, we didn’t just delve back into the basic sciences—on day two, we also began a class that will …
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Patient centered care starts in medical school
Inhalation. Exhalation. Perspiration. Equivocation. Self-Abnegation. Devastation. Urination.
The list of things I’ve endured in the name of getting to medical school could go on, and I doubt it’s any different from my classmates’. But we’re here, finally, freshly white-coated and already racing just to stay on track.
The White Coat Ceremony was a timely, though sometimes tearful reminder of what we did to get here, why we did it, and what we’re …
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In medicine, is there a place for learning from those we serve?
I’ve written about this before, but some recent encounters with medical students have me thinking about it again. I went off to medical school thirty-eight years ago. For the era, I went to what folks regarded as a very progressive place. It had a curriculum that was quite revolutionary for the time. Among other things, we started having interactions with actual patients during our first year, rather than the third …
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The need to watch medical students interact with patients
Last week, I tried something new with our residents. We tried to talk about why physicians overuse tests. This is the topic of the moment, as the American College of Physicians (ACP) just dropped their long-awaited new High Value Cost Conscious Curriculum for what has now been dubbed the “7th competency” for physicians-in-training.
In addition to the ACP curriculum, which I served as one of the reviewers for, I also …
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Teaching the cost of tests in medical education
When I was a surgical residency program director, I often wondered what the establishment, you know those guys who ran surgical education, was thinking. Some may remember the rule that a resident had to see at least 50% of the patients he operated on in the clinic or the private surgeon’s office in order to claim credit for having done the case.
There was the emphasis that still exists today on …
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Why do we teach surgery the same way we did 40 years ago?
One evening during my first year of medical school, I was waiting by the entrance to The Salvation Army to let another student back into the free clinic. The weekly clinic was organized by MEDiC, an organization of student-run free clinics in the Madison area. A family with four small children was returning to spend the night at the shelter, and one of the kids saw the stethoscope around my …
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Reinforcing my desire to become a pediatrician
“Dr. Fisher, can you teach our residents EKG lecture series?”
Naively, I said “Sure!”
What I didn’t realize is how hard this is to do today.
Much of this is not residents’ fault. They only have so many hours in so many days to attend lectures while caring for patients. Thanks to residency work-hour restrictions, those hours have become even fewer. To make matters much worse, through the year residents are torn to …
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EKG reading: It’s shocking what medical residents don’t know
“I swear to God, if you come any closer, I will kill you,” said the 30-something year old, arms as wide as bazookas, eyes as piercing as the very needles I was about to stick him with. He was hooked up to IVs on every limb, had tubes coming out of his nose and going down his throat, but other than that, he was about as physically fit as anyone I’d …
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Learning about patients as a phlebotomist
There are some things you learn best in calm, and some in storm.
– Willa Cather, The Song of the Lark
Over the past year I have been blogging for The Lancet Student. As luck would have it, I ended up writing during my 3rd year of medical school, American Style. This is my “clinical clerkship” year. In a way, my posts have been a record of my journey during that year.
As …
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Embrace the storm in medical school
Whether you’re starting medical school or beginning your second year, this post is for you. Will probably work just as well for PAs, NPs and any other health professional student who hasn’t started clinical rotations.
Our former babysitter just graduated from medical school and the WhiteCoats are just as proud as her parents are. Then I started thinking, what advice would I give to students starting medical school?
Our first day of …
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9 essential tips for new medical students
Years ago, I spotted an acquaintance I hadn’t seen in a while. The conversation was odd. A few times, I would ask a question and he would begin to respond, only to trail off into silence and stare blankly into space. He would remain frozen until the moment I said something else, whereupon he would act normally. He seemed completely oblivious to the fact that he had trailed off and …
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Thought blocking and the privilege of becoming a doctor
I recently took an exam focused on the pathophysiology and clinical risks factors of cardiovascular disease, the number one cause of morbidity and mortality in the developed world. Atherosclerosis, hypertension, and smoking were all there, front and center. Ironically enough, since it was the final exam of our first year of medical school, the instructors decided to reward us with dozens of Krispy Kreme donuts to enjoy during the exam. …
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Health promotion needs to start in medical school
With the passage of each summer’s day I am getting closer and closer to starting medical school, and with that the beginning of the rite of passage that is gross anatomy. Each Fall, first years across the country walk with a mixture of nervousness and excitement into a room full of covered cadavers and are introduced to the first person placed in their care – their “first patient.”
The men and …
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The first person entrusted to my care
I participated in a medical mission to Haiti with the Hope for Tomorrow Foundation. The trip only lasted a week, but the impression it made will stay with me forever. I experienced a culture shock stepping off the plane: “tent cities” sprawled the streets, sewage and garbage piled up to no end, and the people had nowhere to go.
Upon arriving to the hospital in Les Cayes, there were hundreds of …
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Medical education needs to get a passport
