sidenote: April 2013

Everyday I'm Shuffling - a day in the life of test week

We're in the midst of test week. For those of you who don't know, how med school at MUSC works is - we have about 4 weeks of class followed by a whole week of nothing but studying. That's test week. It sounds great, but in real life it's incredibly stressful and crazy. To give you an idea - I'm usually home and asleep with my wonderful wife around 9 or 10 PM. This past week I've been at the library past 11 PM, twice. And I'm not even close to the craziest study week studiers. I swear it's the most anxiety-provoking thing they could have come up with. Anyways, here's what the library looks like at 10 PM on a Monday night of test week. Hope you enjoy. PS - bonus points to anyone who knows all the empty carrels.

still has coffee

just saw these two come back with
something called Full Throttle

happiest person here, must be the triscuits

study fort

not sure if awake

claiming islands

staying warm

doing it right

sad and alone

together and laughing

like a model

#lmc

my thoughts exactly

OK quick quiz - how many people had Beats?

see you on the other side,

from ken

enjoy sidenote in 140 characters or less @kensidenotelife.

To Rising M1 - What rising M2's wished they knew about med school

When I was going around doing medical school interviews, my favorite question to ask interviewees was: What's something you wish you had known before you started going down the MD track? I considered myself fairly knowledgeable, but I knew that it really takes experience to understand a life. And I wanted to gain from their wisdom.

From current M1's to future M1's

So I thought I'd ask our classmates to drop some wisdom on future M1's. Please forward to anyone you know entering medical school.

Daniel Morrison:

In my opinion, receiving very minimal advice would have allowed me to figure out my ideal approach to medical school much quicker, and could have made my first year a richer, more organic learning experience.

Kaleb Keyserling:

1. Don't study before med school. Enjoy your summer!

2. Living in walking distance of campus is helpful and gives you more motivation to go to class.

3. Review lecture notes on a daily basis instead of just cramming the weekend before a test. Big goal is learning the material for Step 1 rather than acing every test.

4. Take advantage of the shadowing opportunities and lunch time lectures 1st year. These experiences remind you of the reasons you want to be a doctor and keep you motivated to study (see Ken's post about burn out).

Sudeep Das:

Med school is a transition, roll with the punches. its hard but great. don't neglect investing in and getting to know your awesome classmates

Jordan Shealey:

I think I would've like to have known to be patient with myself and the material. I now know it will eventually come together if you keep working hard and push through those frustrating periods (i.e. the first 2 weeks of each block).

Sean Nguyen:

My advice is to not get caught up in all the hype and scare. Do what works for you and stay confident. Enjoy things one day at a time.

Rosie Taam:

Before school starts do something wonderful, have an adventure, travel. In school, do things your way, follow what interests you, not what you feel like you should do. And don't be disappointed when your cadaver doesn't look like Rohen's; its not about the finish line, its about the process (this reality is still sinking in for me)

My advice, one practical and another not as practical.

Practical: I wish I had experimented more with different studying methods. Flash cards, re-writing notes, going to class, home schooling, religiously reading the syllabus, etc. Studying in med school is different from undergrad, and M1 grades are fairly irrelevant. The point is to peak for Step 1.

Less practical: Don't be afraid to go out on a limb and do something different. The hidden curriculum forces homogeneity, so by taking the risk to be a little different, you'll stand out. Hopefully in a good way.

Please share with any friends starting med school this fall.

see you on the other side,

from ken

what do you wish you had known before med school?

I didn't choose the sidenotelife. The sidenotelife chose me.

Every once in a while I feel the need to update my about page. So here's the latest iteration. Hope you enjoy.

I didn't choose the sidenotelife.
The sidenotelife chose me.

My name is Ken, and there are two things you should know about me:

1- I want to change the world.

2- I don't have a middle name, but I always wished it started with E, so my initials could be KEN.

I'm a student in Charleston, SC pursuing an MD/PhD at the Medical University of South Carolina. As soon as I graduate, I'm planning to submit my job application for med school czar or medical-analyst at Grantland. Haven't decided yet.

Sidenote unofficially started five years ago when I spent a summer working in Yellowstone/Grand Teton. That summer I had an epic email chain with my friend Amulya Iyer. We talked everything from girlfriends, olympics, premed life, to the meaning of life. One night that summer I had a crystallizing moment. I was sitting under the one-of-a-kind Wyoming night sky, drinking beer and thinking about the meaning of life, and I decided I had to spend the rest of my life doing this.

Sidenote officially started July 10, 2010 when I moved out to Portland, OR. Where young people go to retire. I spent my days as a lab tech at Oregon Health & Science University, and weekends surrounded by hipsters and coffee shops. Naturally, it was the right time for sidenote

Before all that I went to a small liberal arts college in Ohio, Kenyon College. I officially studied the sciences of Molecular Biology and Math, but I unofficially studied the art of talking life while drinking beers. I loved Kenyon.

So what is "sidenote?" Sidenote is about the idea that you don't choose your passions, your passions choose you. And when you figure out what that passion is, you have a responsibility to work hard.

My passion is to think, and figure out a better world. Specifically, I'm passionate about medicine and medical education, but I'm open to bs-philosophizing about anything. When I look out to our world, it's not pretty. Wars, bullies, abuse, divorce, racism. If this is what the world is supposed to be, I will be disappointed. In my head, I feel like the world was supposed to look a different way. I like to refer to this better world as 'the other side.'

Sidenote is my attempt to spend my days doing what I love - thinking about how to bring the other side to real life.

If you are reading this blog for the first time, please start with the first post 'in the beginning...' or the artist's statement 'we don't believe you. you need more people.'

see you on the other side,

from ken

enjoy sidenote in 140 characters or less @kensidenotelife

Media Fridays: Atul Gawande

http://www.newyorker.com/online/blogs/newsdesk/2010/06/gawande-stanford-speech.html#ixzz2NQytXYiJ

dropping knowledge

This week's Media Fridays is an article that Susannah Brown sent me. It's a commencement speech that Atul Gawande (surgeon at Harvard med, wrote Better, Complications, Checklist Manifesto) gave at Stanford called 'The Velluvial Matrix.' Considering how burned out I feel, I thought it might be a good pick-me-up.

see you on the other side,

from ken

read something good? send it my way.

ken explains the hidden curriculum: how OSCE's turn us into robots

At the end of every block, we have a test of our clinical skills - talking to patients, taking vitals, doing a physical exam. It's called an OSCE, which stands for objective structured clinical examination. In theory, the OSCE is a great idea. There are definitely a baseline set of clinical skills we should have - off the top of my head: washing your hands, properly introducing yourself to the patient, knowing the components of the cranial nerve exam. But the list is a lot longer than a few things, and as always, the hidden curriculum is at work.

The hidden curriculum is trying to turn us all into the same robot interviewer. It's brutal watching interviews in small group sometimes - as long as everyone does their job, you literally watch the same interview three times in a row. Here's a sample:

--

Hi my name is __ and I'm a first year med student working with your doctor today, if it's ok with you I'm going to ask you a few questions.

Shake hands.

tell me more about that

So what you brought you in today?

Tell me more about that.

OLDCARTS

PMH

FHx

I'm sorry to hear that.

SHx

Any other questions you have for me today?

Shake hands.

Leave.

--

tell me more about that

The grasp of the hidden curriculum goes further than turning us all into robotic patient interviewers. It permeates our everyday interactions. I swear I've never asked, "tell me more about that," as much as I do now. It's even ruining my relationship with Katie.

Katie's been complaining to me recently because I had been talking weird. Whenever she says something - I'll respond in a weird monotone "pretty cool." My best pretend empathetic tone. And I'll follow up af her comments with, "Tell me more about that." Until Sudeep saw me in action, and commented on my empathetic comments to Katie, it never even occurred to me that this was happening. I was genuinely trying to be compassionate and empathetic, but my compassion and empathy neuronal pathways had been rewired.

That's fucked up.

One of my favorite authors is Abraham Verghese (Cutting for Stone, Tennis Partner). Both great, great reads. He doubles as an internist at Stanford, where he's a huge advocate for the physical exam. He believes a good physical exam can establish a strong patient-doctor relationship, and also provide higher quality care. He's developed his skills to the point that he gives patients a physical exam, but while he's giving the exam he goes through the patient interview. This way he can still fit in a thorough physical exam within the short patient visit time limits. Impressive. I imagine in an efficiency oriented world, he's not the only doctor that's mastered this skill.

I hope I can get to that level of patient interviewing. In the meantime, guess I should stick to my checklists. Thanks Step 2.

see you on the other side,

from ken

enjoy sidenote in 140 characters or less @kensidenotelife.

Ken asks the audience: commentary on - what is a date?

Last week's question was: what counts as a date?

Here's some commentary from Christian Baker and Trevor Henry:

CB: I'll send you what Rose and I think. We're working on this as the two of us...which brings me to point 1. In order for it to count as a date it must be just the two of us. (exception to the rule: double dates). One party pays. As a southern gentleman I'm inclined to say the male pays for the date...but as a starving medical student with a working fiancee, she will take over that role for a little bit. That doesn't mean we wont be going on any dates until I make a paycheck though. Thanks Rose! Moving along. I think for it to be a full blown official date it must be something special. It has to make the girl feel special like you went out of your way to do something nice. You've got to be intentional about it. That's Rose and my two cents worth.

TH: What is a date? The meaning of the word “date” depends on who you ask. Some of my friends consider the night they meet someone at the bar, share some laughs, and spend the night together as a first date. Some of them consider a date to be a personal encounter of 2 mutually romantically interested people, which begins with a formal invitation including explicit romantic intent. Some say a date is simply an intimate interaction between two people, a shared experience by two people in communication. Some see a date as a catch-up between people, whether the catch-up-ers are romantic or platonic. How many times have you heard “It’s a date!” as a confirmation to planning a get-together with an old friend?

I wrote a segment of this blurb on a plane last Sunday, sitting across the aisle from a talkative, particularly loud sophomore in college and her newfound friend, a businessman with a family. By the time we landed, I knew the girl’s hometown, family structure, professional goals, humor style and even some of her personality nuances. I had a formed opinion of the type of person she was. Was I on a date with this girl, unbeknownst to her? Had she and her seatmate shared a date with each other? They were laughing and telling personal stories…

Personally, I think a date is best defined as a feeling rather than an experience. I reserve the term for times I feel a reciprocation of enjoyment. In my world, the criteria contributing to a date are twofold. When 1) I feel someone takes special pleasure and satisfaction in experiencing me as a person, and 2) vice-versa -- a date has transpired. Now, feelings are subjective entities sensitive to misinterpretation and the complexity of the human brain. As humans, our emotional circuitry is ill-defined at best. The scientist in me would prefer a more discrete and objective description of a date. My definition involves the personal feeling that the other person took unique pleasure in experiencing me as a person; however, I can more easily determine whether or not I found enjoyment in my date. I’ve certainly told friends, “We had a pretty good first date!” followed by white noise when I reach out for the second date. In my 26 years I am nearly positive I have incorrectly felt that my date took pleasure and enjoyment in me, when perhaps the reality was that my date was smiling because they were uncomfortable to be sitting near me, or maybe that sweet laughter I thought was in response to my story was really their internal reaction to the ridiculousness of their escape route. Maybe that soft twinkle in their eye and slight twitch of their smile was in reality an allergic reaction to the cucumber in their cocktail manifesting itself at an inconvenient time. Would that make me a clingy, stage-15 psycho? Maybe. But hey, it’s my world – I call the shots.

--

Thanks Christian and Trevor!

I can't get the polling function to work. One day there were 9 results, the other day there were 2, now there's 6. So I have to scrap that, and I'm going to replace the poll with a 'Ken asks the audience' segment on Wednesdays where I'll just pose a question to y'all. This week's question? Something I've been wondering more and more as I reach the end of the year. How have your perceptions of med school/medicine changed since August?

see you on the other side,

from ken

want to provide the commentary? get at me.

big day

One of my previous posts was published on KevinMD.com! It's about the hidden curriculum driving med students to be out for themselves. Here's the link if you're interested.

see you on the other side,

from ken

enjoy sidenote in 140 characters or less @kensidenotelife.

half-baked idea: mandatory taco tuesday sessions @TriangleCharBar

One of my favorite things about Christianity is the idea of the bible study. You can tell a bunch of Christians at a church, at a school, wherever, tell them you're going to hold a bible study, and handfuls of people will gather together willing to discuss deep and personal life matters. People will bring their struggles and open up into deep serious life conversation. Since I love deep conversations I thought this was great. For me, my next thought was: how to translate this phenomenon into secular culture?

If you've read my artist's statement, and sidenote - yes, I consider myself an artist. If you've read it, you know I believe people need to engage in more real conversations, and use those conversations as a springboard to do cool shit.

I've spent a lot of time thinking about this question: How to translate the deep conversation phenomenon of bible study into secular culture? And so far my answer is Taco Tuesdays. Sudeep, Sudeep, Daniel, Sean, and Keith are familiar with this event since I drag them out just about every other week. Taco Tuesdays is my attempt to bring deep conversations into med student life. We usually chat about topics like what sort of legacy we want to leave, our relationships, and generally deconstruct life. I can't speak for all of them, but I usually come out of it feeling a little lighter and tad less burnt out.

Triangle Char & Bar is a bar in West Ashley, just over the bridge on Savannah Highway:

They have great nachos and burgers, but they're at their best for broke med students on Tuesdays. They have $3 tacos, Corona's, and margaritas. Thus, Taco Tuesdays. Plus, they have an overall great vibe with outdoor seating when it's warm. Full disclosure, I did not receive any supplemental income from Triangle, but if anyone from Triangle happens to read this, I am 100% open to receiving free beers.

So anyways, this has been a drawn our explanation, but my half-baked idea is that all med students should have their own Taco Tuesday. Everyone should have a space to share life, drink some beer, reflect a little bit, and talk shit about life.

Oh, and let me know if you want to join Taco Tuesdays/start your own Taco Tuesdays. I would love to help.

see you on the other side,

from ken

enjoy sidenote in 140 characters or less @kensidenotelife.

Relationships in med school pt 17 - so you think you know Rodman Singleton

An interview with the one and only, Rodman Singleton.

Ken: Tell me 3 things about you.

Rodman: I was born in Beaufort, SC. I am very non-traditional as far as med students go. I am a veteran.

K: How was growing up in Beaufort?

R: Although it was rural, what you see now is very different from what I grew up in. Our county was one of the fastest growing - some of the townships grew 1200% in 10 years. It's very different. We always had things to do. It's coastal so it has lots of beach access. It's part of the Gullah Geeche corridor, do you know about the Gullah Geeche corridor?

K: [embarrassed] Just what we learned in class..

R: It's a unique culture. We preserve more of our African heritage than any other African Americans in America. We have a distinct language.

K: Do you personally retain that culture?

R: Yes definitely the cuisine. My family can speak in the dialect very fluently. Before I knew the beauty of it, I kind of rejected it. I was big on language and perfecting English. A lot of people can't even tell I'm from South Carolina. I had a kind of complex.

K: And let's go back to the 3 things you told me, what makes you non traditional?

R: I'm old. [laughs]

K: You're not the only one that's old.

R: There are kids, [laughs], and I say kids. Paras had a 23rd birthday the other day. Are you serious? I had a high school 10 year reunion. Two years ago.

K: What were you doing at 23?

R: Well, I was on my fifth year in the navy. I was on my second deployment, Enduring Freedom in Afghanistan.

K: Tell me more about that.

R: It was interesting. It was ok for a war. I wasn't on the front line, I was doing nuclear engineering.

K: And how does that experience help you today?

R: The navy curriculum has a reputation for being difficult, we actually received a lot of college credit for it, which helped me get there. It really prepared me a lot for the stress of med school, that feeling of being overwhelmed. I had responsibility very early.

K: So to change gears a bit, do you consider yourself a spiritual person?

R: I'm definitely spiritual but I am not religious. Spirituality to me means personal relationship with a higher power. Yahweh, Jesus, God, in general whoever values the personal relationship with the deity. I was raised as a Baptist, but around the age of fifteen when I started to read for myself, and I came into my own identity, I wouldn't say it was necessarily rejection but I strayed from the doctrines of Christianity. Much to the chagrin of my parents. I'm very spiritual, though my views don't fall in line with any mainstream religion I'm familiar with.

K: Yeah I get that. To change gears again, what's your favorite thing about med school?

R: In a nebulous kind of way it has nothing to do with being in med school, but learning all the part of the body and how it remains healthy, I just realize how much can go wrong. I feel more blessed about my own healthy, even with my children, all these things that could go terribly wrong. And I just gained an immense appreciation for health itself.

Actually, I have two favorite things. What med school has taught me, it's that I have a tremendous amount of confidence in myself. I had angst coming into med school. Everyone was so smart. But now being here and succeeding, it made me realize how much I was slacking before I came to med school. Had I applied my God given intelligence.. Now I just look back, and the things I thought were difficult, I look back in retrospect and they were not difficult.

K: What else have you learned about yourself in med school?

R: I learned that, apparently, I'm argumentative.

K: [laughs] How did you learn that?

R: People told me. It requires some introspection because people will talk, but if you hear it enough like 5, 6, 7 times, maybe I am that way. I just think I'm misunderstood. I value truth, and knowledge. Maybe that comes off as argumentative, if it brings about truth that's fine with me.

K: Ok, ok no arguing here. And what's your least favorite part of med school?

R: I wish I had more time for my family, especially my two children. It's hard making peace for yourself, but in the pursuit of something great you have to make sacrifices, like the times you spend with your children. I struggled with that the first six months, I felt like a geographic deadbeat.

K: And how did you come out of that struggle?

R: My father and I have an interesting relationship, and we sort of became best friends over time. He assured me I wasn't being selfish to pursue medicine. What I'm doing here transcends myself. I had a lot of pressure when I first started med school, and a lot greater than the expectations I had for myself. Where I'm from, there aren't a lot of doctors or lawyer. It felt like a big deal when I got in to MUSC. I had numerous parties thrown for me. Whenever I go back home, everyone's asking me how I'm doing. I represent more than who I am.

K: Tell me more about what you represent.

R: Our class has 12.5% African Americans. In a class of 170 people, we don't even make up our share of the population. I'm one of what, seven black males that make up the class?

I remember when I was applying - thinking to myself that I wanted to do something about this, this stigma. And stigma isn't exactly the right word, but there's this perception in the black community that no one serves as an example so that you can't be the example. It's a cycle of stagnation. You don't understand the benefit of example. Everyone knew it was possible because their dads and moms are doctors, but it's not like that where I'm from. In that sense I represent something bigger than myself.

K: That's really great. Respect. Any last things you want to share with the class?

R: We need to be more social. Literally, yesterday. I saw 6 people yesterday and I didn't even know they were in our class. That's my appeal to the class. We need to get together.

K: preach.

see you on the other side,

from ken

want to be interviewed? get at me.

Jason Derulo explores the other side

"The other side initially started out as a party song. Very uptempo, uplifting, and fun, but I didn't want to talk about a party. I wanted to talk about something that I was going through in my life. Something that was personal. I think this particular record will make people go, huh? It kind of made itself."

- Jason Derulo

see you on the other side,

from ken

enjoy sidenote in 140 characters or less @kensidenotelife.

Media Fridays - overwork worse than overtime?

http://well.blogs.nytimes.com/2013/04/18/doing-the-math-on-resident-work-hours/

The latest from UCLA surgeon Pauline Chen. Here's an excerpt:

"Health care trends over the last two decades have only exacerbated young doctors’ workload. Admissions to teaching hospitals increased nearly 50 percent from 1990 to 2010; in that same period, the number of doctors in training available to do the work increased by only 10 percent. And because insurers are pushing for shorter hospital stays, only the sickest patients, many of whom require complex care, remain hospitalized."

Hospital admissions increased by 50%, # of docs increased by 10%. That's a huge increase in workload. Dr. Chen's argument is that the hour work limits has not affected patient care or doctor mental health because doctors have compensated for the cut in hours with an increase in workload in those hours.

So my question: Is the solution more doctors? More funding for residencies and less pay for attendings? Speculate away.

see you on the other side,

from ken

enjoy sidenote in 140 characters or less @kensidenotelife.

Everyday I'm shufflin - photo running diary

Please forgive me for the poor quality of photos. This is an experiment. Let me know if you like it. In twitter/instagram style.

4:55 AM - Wake Up

4:55 AM - Arrive studying cave/craft room/storage.

4:57 AM - Commence Anki.

6:07 AM - Make breakfast. The only chore I still do. #greatwife

6:30 AM - Car pool arrives. Depart MUSC.
Still dark. #smh

6:46 AM - Morning routine. Maintain mental sanity.

8:03 AM - Second breakfast + caffeine fix #1.

9:05 AM - I don't always come to class, but when I do
it's for a professor that controls $2.5 million in research grants.

9:47 AM - Watching video about monkeys controlling robot arms with their brains. They are developing it to allow quadriplegics to kick the opener of the 2014 World Cup. Wow, I love science.