Medical Student's Journal

I deactivated facebook. Signed up with Kaplan Center for a review course for USMLE Step 1. As an international student, I needed F1 visa (student visa to study legally in US) so Kaplan is sponsoring this for me. I guess you can consider me taking time off to really study for this exam. But I do plan on being with them for Step 2 and 3. So, no...I didn't forget about Tumblr. Thank you for all your comments and anonymous questions. 

The research experience in the ER was amazing. I did couple of projects, but all of them required interacting with the patients. For example, one of the research was to enroll patients into our studies on screening for cancers (such as cerival and colon-rectal) and collect data. My colleagues and I took turns in different 4-hour shifts doing so. We had to do overnights too, which was my favorite shift because you get to see many cool things in the ER (aka trauma). It was scary at first talking to the patients. Some people didn't want to talk. Many agreed just to pass time by. And you learn a lot just by listening to them talk. 

When we have time, we are allowed to shadow the doctors. The staff treated us really well because we were also helping them. We timed the doctors on how fast they can treat a patient in a traige area on another project. That was pretty fun. I remember being on my feet most of the times. It's a fast paced environment, you have to either move as quickly or get out of the way. 

A 35 year-old male patient had grown out warty roots on his arms and feet after a cut from his knee when he was still young. Unchecked, the warts spread out through his body and left him disable.

Test results showed that his condition was caused by Human Papilloma Virus (HPV), a common infection that causes small warts to the host. The patient had a rare genetic problem that suppressed the immune system, so his body was unable to contain the warts. The virus had hijacked the human skin cells thus commanding them to massively produce the substance that caused the tree like growth on his hands and feet.

The warts on his arms and feet had multiplied and expanded like roots. His hands were consisted of yellow and brown branches extending to 3 feet. The growth weighed nearly 12 pounds. He could not clench his hands into a fist. Even picking up a spoon or fork was a daunting task. The patient complained of exhaustion after a few steps as well because of the warts on his limbs.

His parents and siblings did not show signs of developing lesions. He maintained a healthy lifestyle despite his condition. Although attempts were made to surgically remove the warts, no signs of improvement were seen.

This post is for the premeds and the anonymous questions I have been getting relating to medical school acceptance. I answered similar question before here. But I don't mind doing it again. 

Become a premed student- You are a premed when you intend to enroll in all the required classes for medical school. These courses include 1 year or more worth of credits (with lab) in chemistry, biology, physics, organic chemistry, and calculus for example. You need to communicate well with your academic adviser that you want to go to medical school so he or she can help recommend the schedules and classes suitable for you. 

Major- You can major in anything you want. It does not have to be related to science at all. You will see many students do so because it is easier to finish the science major (especially chemistry and biology) and premed requirements at the same time. Stand out by choosing a major of your passion such as English, philosophy, arts, or music. Unless you LOVE the hardcore sciences, do try other majors that you are more enthusiastic about. 

GPA- Yes, it is important. But a lot of medical school do not only accept students with 3.7-4.0 gpa. Grades are definitely not the only factor in medical school admissions. You should always aim for an A and do well in your science courses because sometimes schools look at your science gpa more than your overall gpa. All I am saying is that it is not the end of the world if you get anything below a perfect score. As long as you are above 3.0, you still have a chance. Even if you got C's, you can make it up by retaking the course and do an excellent job on the class (especially if you fail). What you can also do is take higher level classes to prove that you can improve and excel in harder courses of the same subject. B's are good enough too, so please don't feel like you need to retake organic chemistry for an A. 

Optional classes- Depending on what schools you want to apply, they might "recommend" you take a year worth of other courses such as calculus or physics. Treat these "recommended" classes as if they are "required" to show the schools that you really want to get into their program and you are ready for the challenge. So if your schedule allows, take them.

MCAT- You should get 30 or above to get a decent chance for medical schools. You can retake them too, but more than 3 times would be bad for your application. Take prep courses if you must. Even you have lower gpa, MCAT can really help boost your application if you score well. Higher gpa can help balance the lower MCAT scores too. 

Research- Many schools say research is "optional", so treat this as if it is a requirement. Ask your science teachers if they need research assistants for their research or if you can help out your upperclassmen's projects. You should know how to write a research paper too. Or better yet, propose your own research and enroll into higher level classes that will mandate you do a research or experiment. Do a thesis if possible. 

Shadow a doctor- You need to do this. Before you apply to medical schools, you should at least shadow a doctor so you get a better idea what you will be doing in the future. How can you want to become a doctor without seeing how one works? Once you go down this road, it will take away a lot of time and money. You have to be sure that medicine is what you want to do. All you have to do is ask, and you might be surprise to see some of the doctors' responses. You have nothing to lose anyway, so keep asking!

Volunteer- It would be better if it is in a hospital setting, but it doesn't have to be. Medical schools want to see that you want to help people and that you are compassionate. Do you have something worth fighting for? For example, sex trafficking, gender inequality, gay rights, etc. Volunteering opportunities can lead to important connections too. Do it from your heart and time will fly.

Personal statements and references- These are opportunities for the schools to look at you as a person rather than numbers. Make sure you write more than 5 drafts of personal essays and have someone (professors, English major friends, parents, etc.) you trust to look over your work. By junior year, you should have at least 2-3 professors you are close with who can write you references and recommendation letters to schools. It is a plus if you work on a research project with them or have taken their classes for a year or more.

Interview skills- It matters how you talk and present yourself during the interview. You will be interacting with a lot of people in medicine. You can't be good doctors without being good with people. Practice answering interview questions with your academic advisers or other mentors your college has to offer. 

Be polite, but persistent- Visit the medical schools you want to apply to (tours). Keep in touch with the admission officers if possible. Even if you get rejected, don't give up. Send them a follow-up to ask how you can improve on your applications. Then act on them and reapply.

Alternatives- You can practice medicine in other countries too. Many foreign or offshore medical schools will accept your MCAT scores. Some may ask you to take their own exam that would be equivalent to MCAT. Remember that schools in every country is different. Make sure you read their requirements well before considering. Some schools are 6-year programs since their medical students start as soon as they finish high school. Plus, you can still come back and practice medicine in US too, although the chance of that happening is decreased compared to if you were to study in the US. 

1. Student Perks- Just about every program, school, or organization has student perks that you can score. Some conferences and resources are free just because you're in a medical school, like medical journals or various website memberships. To find out more offers, you should ask your peers or listen/read school's announcements. 

2. Sign up for your favorite store card membership- Do you find yourself going to one or two particular stores often? It is good to sign up for the store's membership. You can get rewards for spending money, receive cash back, gain discounts, and improve your credit scores. 

3. Hunt for local deals- Many businesses around your school knows that their potential customers are mostly going to be students. They will try to attract more attentions by giving you discounts. Have your student ID at all times! Groupon or Slickdeals work too. Don't forget to look at the local's or school's newsletters. 

4. Go to medical conferences- There will be freebies flying everywhere at the medical conventions and conferences. It's a great way to find out about the latest technology going in the medical world and to meet new people. And I bet you can get in for free or inexpensively for being a medical student.

5. Eat at home- The less you eat out, the more you save. Buy in bulk will always be cheaper than buying one at a time. 

6. Textbooks 2.0- Nowadays you can get the books online, check them out from the school's library, or download applications right into your phone. Sometimes, you don't even need to buy it since the schools provide them for you. If you must get books, get them used or from upperclassmen who had taken the course. If you want to invest, I suggest getting review books like the BRS series and/or First Aid. Ebay and Amazon still have the best deals.

7. You don't need expensive supplies for clinical portion- Yes, Littmann stethoscopes are great. Getting the Lightweight or the Classic ones are sufficient enough for us to learn what we need. Once you graduate, you can get more expensive and higher quality of stethoscopes like Master Cardiology. Getting used ones aren't so bad either. Students don't even get the otoscopes anymore because its unnecessary (class/hospital usually have ones you can use) and expensive.

8. Visit thrift shops- You will definitely risk getting bodily fluids on your clothes even when you have your white coat on. You can find great selection for fraction of the prices you would pay in stores. Burlington, Walmart, or even Target will have cheap clothes too. And they can look real good. You don't need to dress to impress (unless you're going for interviews). Just need to look neat and professional. You know what, you'll probably end up in scrubs most of the times anyway. 

9. Barter- How about you buy me lunch and I'll tutor you in Biochemistry? 

10. Know your budget like the back of your hands- Be careful especially if you have debts or low credit score. Create weekly or monthly budget that you know you can live by and stick with it. Always pay off you credit card or loans if you can afford to do so. Free websites like CreditSesame to help you keep track of your credit scores and budgets. 

     Although the author if Mark Brown, M.D., the book it consisted of actual stories written by different medical professionals. It is kind of like Chicken Soup for the ER Medical Professional's Soul. I picked up this book because I always have an interest in Emergency medicine from the time when I was an EMT at my college. Some of these stories will make you burst out laughing and some may bring tears to your eyes. I think all medical students interested in this field should at least go through this book once. Pre-med are especially encouraged. This collection of experiences help draw out the reality of working in the ER. Below is one of the stories written in the book.

We are comfortable with body parts, touching, viewing, discussing. It's part of the job. No big deal. We ask people to disclose, then listen and probe without a second thought. We casually discuss baseball scores and recipes while engrossed in intimate patient contact. Sometimes we get a little too casual, seeming to forget just where we are.

Here is the list of potential career paths or specialties that medical students can think about before applying for residency. 

Anesthesiology- specializes in administering medications and other agents to prevent or relieve pain during surgery.

Child Neurology- specializes in brain disorders in children.

Dermatology- concerns with diagnosing and treating skin disorders.

Emergency Medicine- cares for patients with acute illnesses or injuries that require immediate medical attention.

Family Medicine- consists of primary care physicians.

Internal Medicine- deals with nonsurgical illnesses of internal organs for mostly adults. It also has many subspecialties such as cardiology, gastroenterology, oncology, etc.

Medical Genetics- diagnoses and manages hereditary disorders. 

Neurodevelopmental Disabilities- specializes in those with neurodevelopmental disabilities.

Neurological Surgery- involves brain surgeries.

Neurology- specializes in brain disorders.

Nuclear Medicine- utilizes radioactive substances to diagnose and treat diseases.

Obstetrics-Gynecology- consists of experts for pregnancy and women's health.

Ophthalmology- expertises in eye disorders.

Orthopedic Surgery- is a branch of surgery related to musculoskeletal systems.

Otolaryngology- relates to diagnosis and treatment of ear and throat.

Pathology- deals with lab examination of body tissue samples for diagnostic or forensic purposes.

Pediatrics- specializes in illnesses in children.

Pediatrics/Child Psychiatry- involves mental health of kids.

Physical Medicine & Rehabilitation- aims to improve or restore the functions of physical disabilities.

Plastic Surgery- concerns alterations, corrections, and restorations of form and functions. 

Preventative Medicine- emphasizes on preventing a disease rather than treating patients' symptoms. 

Psychiatry- specializes in mental health of adults.

Radiation Oncology- relates to treatment of cancer using radiation therapy.

Radiology- Diagnostic- uses various imaging tools to diagnose diseases.

Surgery- deals with operations and instrumental techniques on patients to investigate or treat pathological conditions. It has many subspecialties.

Thoracic Surgery- focuses on operations of the heart, lungs, esophagus and other organs in the chest. 

Urology- concerns urinary tracts disorders.

Vascular Surgery- is a branch of surgery regarding operations of arteries and veins.

Write it down. It can be during a lecture or while reading a text. Don't try to copy the entire paragraph from a book. Write short notes- simple, easy to understand, and straightforward. You can even use flashcards or website like Quizlet. Outlines, pens with different colors, drawings, or even highlighters can also help. This can help you create "cheat sheets" that you can easily recreate from memory during exams. 

Experience it. Why do you need to go into a lab and dissect a cadaver for anatomy class? Why must you go through clinical rotations before graduation? It is because you best remember what you learn through an experience. When you are confuse about definitions like adduction and abduction, just do those actions while recalling the terms until you are confident. 

Watch it. There are many videos that were created to help medical student memorize textbook information. Yes, they can be corny and horrible but they can also work wonder. Have you tried singing those medical songs?  There are places such as Nucleus Medical Media and ORLive too. If your professors do not teach in a way that suits your style, you can listen into lectures of the same subjects from different school too on YouTube Education or the school's website. iTunes may even have their podcasts. 

Roman room system. It is similar to drawing a mind map where you draw the main subject in the center and branches of associated information. Instead, you are using a room or a house. Then you put various objects and associate those with information you want to remember. Afterwards, you can imagine yourself trying to find those objects to retrieve the information. Takes practice but it can be quite helpful.

Mnemonics. Initials can either help you or hurt you. Sometimes, people will end up remembering the initials but not their actual meaning. Some Lovers Try Position They Cannot Handle, for example. Try to come up with your own or the ones that work best for you. You may also substitute stories with mnemonics instead. 

Repetition. Sometimes, you may just have to shove that information forcefully through repetition. There can be no other way around it. You need a routine. You want it to be in your long time memory, not a short one. You can even try teaching it to others.

Organization. You need to be able to organize your notes (handwriting!), thoughts, study breaks, study spaces, and even relationships. You only have to be organize to yourself. Make you sure you can explain to others so they too can understand you, especially in relationships. If you have a horrible illegible handwriting, practice calligraphy before going into clinical portions...for the patients' safety.

Application of knowledge. Before taking board exams, professors and other medical students recommend doing LOTS of practice questions (USMLEWorld or Kaplan) so you can practice, know what to expect and work on your weaknesses. They will also make you do physical examinations on each other for the same reason. It is part of the experiential learning style.

Play brain games. I highly recommend Lumosity. But you can also play other games that will help you expand your ability to memorize and remember other things unrelated to your study. They are fun and entertaining. They may even help you relax and release your stress.

Rest well. Sleep helps improve your memory. Period. Try not to cram the night before, if you can.

Go to the library.50% 75% of the time, you'll see us studying in there. You can "accidentally" (some acting may be required) run into us there while acquiring new knowledge by borrowing books, studying your own subjects, or researching your passions. But the fact that you never stop learning turns us on. 

Volunteer your body for mock physical examination(s). We are supposed to learn how to observe, auscultate, palpate, and conduct couple of tests on a human body. Of course, we would like you to be available when the topic of phlebotomy comes along too.

Don't ask us about medical conditions just yet. It really is for your own good. Instead of giving you one diagnosis, we will give you several that may scare you enough to go see your primary care physician. Yes, most of us are hypochondriac even if we do not admit it. And no, we can't give you drugs.

Invite us to potluck. Wherever there is cheap or free food, you will find us. Give us food and you shall have a special place forever in our heart.

Invite us to exercise. After studying, it's nice to get a chance to work out. Let's go for a run! We can even have a wrestling match. Or you can try the gym either early in the morning or late at night. If we refuse, remind us that exercise can boosts our memory and promotes better sleep. Sold!

If you still can't find us, have you tried Starbucks or a nearby cafe? Don't forget to check the dark corners.

Do ask about our experience so far as medical students. We will tell you how it is so you can get the idea of what we do on regular basis. From here, you can probably judge how much free time we have and what our schedule is like. You will also quickly find out if we have the "half-empty" or "half-full" attitude based on our answer.

Let us sleep. It is rather important...

Become our cheerleader. There will be times when we become stressed out or bummed about our test scores. Our confidence may even decrease. It is definitely nice when you show up with a cheer-up package (Please use your imagination for this part).

Ask us out on a date. We will give you hundred of reasons not to date us. You find that one reason strong enough to change our mind. But remember, "dating" definition may be different for everyone. It may not mean we want to be in a relationship with you. Be patient. We will let you know when we are ready. And when we are...that will be another story.

Know your responsibility. Find out exactly when and where you need to be there. You should know who you will need to see to "sign-in" (like a resident or an attending). By this time, you should already have an idea of the hospital's layout too. Make sure you understand your tasks on what is expected of you so you don't get in other people's ways.

Create allies. Make friends with your colleagues if you don't already know them well. Get to know the nurses, residents, and everyone else on the floor. You'll be spending hours together, might as well try to entertain each other. They can give you insights and secrets of...various things. Be careful not to distract each other from tasks at hand though. And no, a computer does not count as an ally.

Bring food. Snacks would be nice too. Figure out the closest vending machine and be sure to bring some coins. Trust me, you'll get hungry. Really hungry.

It's okay to nap. This goes with tip #2. Once you create allies, you can switch taking turns to sleep when you're tired. Set up a certain time that will allow you and your partner(s) to rest. Even residents on-call fall asleep.It is important that you know your limits. They already have enough patient so you don't need to add yourself into the equation. Take a nap before you go into your night shift if you must. The hospital will most likely have a "student on-call" room with beds you can use. Just...check what is under the cover first.

Bring something to read. Sometimes, things can get really slow. You will probably have time to read so make sure you use this time to enhance your medical knowledge. Or you can simply entertain yourself with Harry Potter or Twilight too. 

Ask when you're not sure. Remember, you are dealing with real patients and their lives may be in your hand. When you're unsure, just ask! No one is going to get mad at you for asking. They will, however, eat your head if you do something without permission like giving foods or drinks to patients (some of them may have restricted diet or preparation for a surgical procedure).

Smile. Do it to the patients. Nurses. Doctors. Medical technicians. Medical students. Every one. It's night time and people can be cranky (lack of sleep). A smile and polite greeting can go a long way.

Follow and learn. This is a great opportunity to learn clinical cases first hand. Don't be lazy and stick to a computer or a bed. Night shifts have some of the most fascinating cases, especially in the ER. You are ultimately there to learn from a doctor and assist in any little way you can. The only rules are don't hassle them and don't get in the way. Sometimes, the staff might try to convince you to go home. If so, then it's really up to you on what you want to do. 

Adjust for the next day. When the next day comes, you will get the day off since it is your post call. Take as much rest as you need to get back to your regular routine. It might be tough when you're doing a day shift in the following day but it's definitely doable. 

Share. Okay, it can be considered as bragging. The point is for you to share your experiences with your colleagues. Tell them what they should be aware when going night shifts. Let them know what you saw or did, and how they can do the same. One day when you need similar information from them about the other rotations they have done, they too will fill you in. It's all about sharing! And a little of bragging rights.

At the moment the US, there are 17 states and District of Columbia where the use of marijuana is legalized for medical purposes. Yet, the debate is hotter now than ever. Should marijuana be legalized completely? Or only for medical purposes? Should it even be legal at all? 

The truth is there is not enough evidence (unbiased, controlled research) to prove or disprove claims about clinical advantages of marijuana. There is a lot we still do not know about this drug, and to eliminate its use totally without further investigation would be irrational. For example, we have a drug called Marinol which is a "purified" form of marijuana in the market. It is often given to patients going through chemotherapy to treat nausea and vomiting. What are the differences chemically between Marinol and smoked marijuana? I seem to have problems finding the answer to this question.

Perhaps there are alternatives to marijuana that we should push for. Maybe we should focus our attentions on more dangerous substances...like alcohol. Can US be better off legalizing, controlling, and taxing marijuana? Or is the cost/benefit ratio not worth it? The more I think about the issue, the more questions it raises. On one hand, if it will help patient's care, shouldn't we consider it? But if our patients become addicted to the substance, should we be protected or held responsible by law? 

With the limited knowledge that I have on marijuana, I can only say I wouldn't recommend marijuana for medical (and non-medical) purposes unless it is an absolute. By that time, I would already have exhausted all of the other options. But would that be the right thing to do...?