Half-baked idea: now recruiting guest posters

Sidenote has exploded over the past month or two. Thanks to my amazing fans. It's been cool to see the page views go up and up. I'm assuming I'll see a downtrend if I don't publish another kevinmd post, either way, it was cool to see all those views. At the same time, for now I don't desire a Pauline Chen/Atul Gawande level following. I figure I should wait until I'm actually a doctor and I know what I'm talking about before I build up to that size. For the time, my real goal is to build community here within MUSC COM2 (crazy, right?). 

So naturally, my most recent half-baked idea is to add guest posters/co-writers to sidenote. Let's be honest, my writing is fairly entertaining, but it centers around an extremely narrow wheelhouse. Physician burnout/hidden curriculum/running diaries/interviews. It's what I love, and I plan to keep writing about it. At the same time, if there's anything that the 'so you think you know' series has revealed, it's that everyone has a story to tell. 

One of the points of sidenote is conveying the med student life. Samuel Shem's great novel on physician burnout, The House of God, keys in on an important underlying truth. The struggle in internship is not just the stress of the job, part of the struggle is how isolating it can be. You move from thinking this (the job, the patients, the red tape) is crazy, to thinking I'm crazy. And when you start thinking you're crazy, then you spiral into mental illness, depression, burnout, suicide. All the good stuff. And that's why the life of the med student - complaints, the highs, the hopes - all of it has to be shared. 

This is what 'we don't believe you. we need more people.' is all about. We need more writers telling the story of life as a med student. We need single students that are out till 5 AM partying, non-traditional students that have had other jobs, female students, black students, students from non-MUSC schools. We need more people. Granted, there are other blog/websites that fit this function, and how is sidenote different? If you go read other med school blogs - there's some good ones, but it's also a lot of fluff, and not enough people keeping it real. sidenote has no financial incentive, and it is not tied to any larger corporations. It's just med students keeping it real, and telling the med student life like it is. 


Please join the movement. So far Paras Patel (M2) from MUSC is going to write about his summer, and two of my friends from Kenyon - Jon Weil (M1) at a TBD med school, and Aaron Yo (M1) at Harvard - are going to be writing about the first year life. 

If you would like to write for sidenote, shoot me an email! ken dot e dot noguchi at gmail dot com. It's not a bad gig - the past 30d we've had 7000+ views, and I think most of the rising M2 class reads it, so the audience is definitely there. Alternatively, if you know someone who would be great for this, let me know! We need more people telling the med student life. 

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.

half-baked idea: pass/fail pre-clinical years

Changing MUSC's grading system to honors/pass/fail was a great first step, but let's take it another step further - full on pass/fail. Several other schools already use P/F. Here's a quick list: Yale, Stanford, Columbia, UChicago, Harvard, UVA. Of those schools, UChicago is 100% unranked, which means the administration does not keep any internal rankings for future dean's letters. And Stanford also uses P/F in the clinical years. Wow that is bold. 

mecca

So why switch, what's the purpose of pass/fail? 

The idea is that pre-clinical learning is important, but only marginally so. In the skyscraper that will compose your medical knowledge, basic sciences are the foundation. At the same time, can't we cut out some of the syllabus? Is it really necessary to know every infant stage of development? How many pentose phosphate pathway enzymes do you remember? I definitely remember zero. I don't even really remember what PPP does. And you know what? It won't ever matter. 

I'm for any idea that lowers the stress level of med students. Producing more mentally sane healers has to be good for medicine. I also believe stress level can be lowered without losing quality. Happier doctors will produce better patient care. And that should be the ultimate end goal. Not having smarter doctors.

sidenote - story time - I took the MCATs twice. Before the first time I studied to the max, stressed out, and did less than I expected. I was pissed. I deserved to do well. The second time, five months later, I studied a couple times, then the night before the exam I hung out with one of my best friends and drank several beers. I went in the next day with a good attitude, probably a small hangover, and scored 3 points higher. 

This anecdote speaks volumes of the pre-med personality. There's a masochistic side to our personality that wants to feel intense. A part that believes that working hard and being intense makes us deserving of excelling. Unfortunately, that's not the way of the world. Hard work =/= success, that turns out to be one of the biggest misconceptions of our generation. The level of cortisol that allows optimal brain function isn't that high. Getting my results on the MCAT the second time around sold me on the value of not stressing too hard. I'd rather do well than try hard. 

In the right environment I can get pretty cutthroat and I don't mind competing, but I'm also a firm believer that there's enough cake for everyone. For better or for worse, we are in this together. If us doctors are expected to work together, they need to cut down competition in med school. The easiest way to do that? Get rid of grades. Pass/fail. 

The obvious problem to P/F is that students will be less motivated without honors. By the eye test, you'd expect super driven med students to overcome this problem. Most med students and pre-meds that I know are the types that can't turn off their drive. As it turns out, there's good hard data to back the eye test. 

UVA switched over from A-F grading to pass/fail and compared how their students performed under both systems. Under both systems, the students scored similarly on tests, clinical rotations, USMLE Step 1, and residency matching. Interestingly, the same number of students still attended class. The kicker - the P/F group scored lower on tests of anxiety and depression, while they scored higher on tests of general health and self-control. On top of all this, the P/F group reported a higher satisfaction with the quality of their medical education. 

Unfortunately, both groups of students reported similar stress levels the semester before USMLE Step 1. It's just a question of - is that stress really necessary for an entire two years? or can we just make do with one semester. The result that both groups scored similarly on Step 1 speaks for itself. 

I can say personally I would not work any more or less hard under a pass/fail system. I can also say that I stress out over the honors/pass difference during exam week. If we want docs to start cooperating better, isn't med school the place to start?

Could you see MUSC changing to a full pass/fail system?

see you on the other side,

from ken

enjoy sidenote in 140 characters or less @kensidenotelife.

half-baked idea: weekly conversations with patients

Adam Grant

This half-baked idea is inspired by this great NYT article, "Is Giving the Secret to Getting Ahead?" It's about Adam Grant, a Wharton (Penn business school) professor that is the youngest tenured professor at Wharton, but is better-known for being helpful and giving. His students love him for the career advice he doles out and the connections he's glad to set up. 

One of Dr. Grant's major research interests is the idea of motivating humans. He developed this interest at the University of Michigan where he was an undergrad, and he worked at a university fund-raising call-center. The job is known for being taxing and boring, but Grant desperately wanted to figure out how to increase production. His solution was to bring in students that had benefitted from the call-center's funds. Every week, a different student came in to share stories of being first-generation college students that saw the scholarships as a once-in-a-lifetime opportunity to attend college, stores of being elated to pursue a humanistic post-college path like Teach for America because they weren't drowning in student loans. As Grant predicted, productivity almost doubled.  

That constant motivation is the same underlying idea that drives the incredible success of institutions like Alcoholics Anonymous. The secret behing AA is not that they have an incredible message, it's that they keep you coming back every week, and they keep giving you just enough motivation to keep at it for another week or another day or however often you attend meeting. AA constantly replenishes your motivation to achieve the goal of staying sober. sidenote - In my opinion, this is one of the top reasons for organized religion, but that sounds like a topic for another day. 

So how does this come back to med school? 

One of the frequent complaints I hear from med students is, "I'm just not motivated anymore." The first week or two of a block aren't bad. Most of us had a weekend or a vacation to spend some time away from school, doing whatever we do out of school, and coming back refreshed. But that motivation juice doesn't last long, soon we're falling behind, and we're growing increasingly sick and tired of studying. sidenote - one of my philosophies with physician burnout is that you have to minimize the time you study while you're absolutely sick and tired of it. Sometimes when you study, you feel productive, and it's going great. This is a good time to study. Then, there are other times when it's an absolute struggle, you can't focus, and you find yourself hating yourself more and more after every slide. The more time you spend studying in this second "hating-your-life" zone is when you're creeping towards physician burnout. 

Med school is no different than the university fund-raising call-center. We need constant motivation. So here's my half-baked idea: Why not have patient/ex-patient volunteers from the hospital speak to students every month? 

They could give a glowing talk about what great care they received in the hospital, and how amazing their doctors were. Actually seeing the patients in real life, talking to them, and remembering why we got into this whole mess in the first place would be a great way to stay motivated and prevent physician burnout. 

I can just imagine it. Do you guys remember the first lecture of the year, when Dr. McEvoy showed a picture of her daughter Ansley that had leukemia? What if he took it a step further and brought her in to chat with the class about how much she loved her doctors?

see you on the other side,

from ken

enjoy sidenote in 140 characters or less @kensidenotelife.

media fridays: Follow up to half-baked idea of 3 yr med school

http://www.nytimes.com/2012/12/24/education/nyu-and-others-offer-shorter-courses-through-medical-school.html?pagewanted=all&_r=0

If you're a fan of sidenote, you know I love the idea of shortening med school. I've written about the possibility of a competency-based curriculum where you could move at your own pace, as well as the idea of a 3 yr MD. Please read if you're interested in some background. 

So I actually did some research instead of just coming up with my own BS ideas, and I learned that NYU just started a 3 yr accelerated MD program. That's what the NYT article is about. There are similar programs at Texas Tech, Mercer University, as well as one in the works at LSU and several other med schools across the country. 

we don't believe you
you need more people

This same track could easily be done at other schools like Duke/Emory/UVA/Baylor that have the 3rd year as a research year. Why not cut that year out? We all know most med students do not like research, and there's too much wasted time in medical education. Don't you feel like you're wasting your valuable time sitting in a classroom and learning things that you know you won't ever use in the clinic? Isn't it a waste of your time cramming for Step 1, when most of that material will be outdated by the time we become doctors? Doctors ALWAYS say the material you learn in med school is out of date. 

The LCME set minimum for an MD is 130 wks of education. NYU's new program has 135. So my question to you: would you want to see this at MUSC? 

sidenote - I'm meeting with Dr. Pisano to discuss changing the MD curriculum to 3 years. I want to have some data to talk about so I set up a surveymonkey. If you're a MUSC student that is a fan of sidenote, it'd be awesome if you could help me by taking it. 

http://www.surveymonkey.com/s/5DVXK5J

see you on the other side,

from ken

read something good? send it my way. 

ken explains the hidden curriculum: MUSC match list breakdown

This table speaks for itself, but I'll throw out two thoughts I had: 

1- MUSC students match in sweet residencies. How many derm spots can there be? sidenote - quick google search says 270. Also, there seemed to be a high proportion of students matching into optho (avg salary - $300,000), but I couldn't find the national stats so I didn't put those in there. Storm Eye (the optho institute here) is highly reputed, so that probably has something to do with it. 

So this is good for us MUSC students (count it). We have a good chance of matching into a competitive residency, and this reinforces what we all know - that everyone is going into specialties looking to get money, get paid. ENT and Derm docs get paid an average of $300,000. Radiation Oncologists get an average of $500,000. Wow, no wonder rad onc is so popular lately - especially among research oriented med students.. 


2- Medicine has a problem. Too many people go into specialties, and not enough people are becoming generalists. The evidence is right here. At MUSC, an average to above average medical school - less than the average number of students go into primary care-type residencies and far more than the average match into competitive specialties. 

This puts a huge problem in medicine front and center - the lack of generalists. A problem that starts in med school because it mostly has to do with the match. Internal med/peds people can go on to specialize, but I imagine those people already have their mind made up to go into a subspecialty before they start. If we look at med students - how can we re-incentivize the system so that more students will go into primary care-type fields?

Here's one half-baked idea: guarantee a certain subset of students admission into med school but legally bind them to commit to family med/internal/peds from the beginning. This would guarantee med schools to have a minimum percentage of their classes to go into these specialties. Perhaps you could recruit a different subset of students into these spots, ones more interested in longitudinal patient care, with good people skills rather than focusing on finding the highest IQ's. Quick google search reveals that this idea already exists at Texas Tech and Mercer. Pretty sweet. 

I wonder if there are hidden curriculum factors driving students towards some of these more competitive residencies. I'll have to think about that. 

see you on the other side,

from ken

enjoy sidenote in 140 characters or less @kensidenotelife.

Half-baked idea: med school naps

The NBA has naps down to a science. It's common knowledge that you can't disturb NBA players at 3 PM because they are in a daily pre-game nap session. Supposedly it has to do with certain growth hormones that are upregulated during sleep, so if you take a 3 hr nap and get roughly 2 REM cycles in, you get that much more recovery for weary joints and muscles. I assume it also has to do with the late nights NBA players have to deal with on long road trips and late night games. 

As always, if it makes sense in the NBA, it makes sense in med school. There's research out there that suggests that learning is consolidated into memory during sleep. I know people who take short power naps for about 10-15 minutes to ward off sleepiness, but what if we started taking 3 hr naps in the middle of the day to consolidate some of that studying we did, then continued studying later into the night? You'd consolidate the stuff you learned early in the day, and also have a little bit of an energy boost going into your second study session. It also doubles as the perfect solution to the mid-afternoon 4 PM wall that inevitably leads to zero productivity and lots of internet reading. 

courtesy Ashley Smith

There's also this thing called the "caffeine nap" where you chug a cup of coffee (caffeine takes 20-60 minutes to kick in), then take a quick 20 min nap. Studies show a decreased incidence of simulated driving accidents. It also makes perfect sense, except for the placebo effect. I feel like I get a boost from coffee as soon as I start grinding the beans. I would prefer power nap followed by coffee. 

courtesy Tej

The biggest downside to naps: your boss won't like it. Except, in med school you don't have a traditional boss. That's why being in med school is great. As long as you do the 3 hours or so a day that's mandatory, the rest of the day is entirely up to you to organize. Being a student is the ultimate job to use naps. 

All that said, now I'm really curious to learn if anyone keeps a religious nap schedule.. The 3 hr nap experiment seems intriguing. Also, what about power napping in the 15 mins inbetween classes? So many possibilities. 

see you on the other side,

from ken

enjoy sidenote in 140 characters or less @kensidenotelife.

half-baked idea: competency-based MD

I was having a conversation the other day with one of my older friends in the MD/PhD program here at MUSC. She was trying to decide whether to get her ass in high gear for a few months and try to graduate a little on the early end, or spend another year in the PhD program and come out with a stronger thesis.  That's weird, to some extent, she had control over when she graduated. You can't do that with an MD. But, why not?

We had some classmates decide to drop out because the workload was too intensive, but that student could have been a great doctor had they spent 5 years in medical school, drawing out the work a little bit. 

On the other hand, a fast-learning student could put in 3 years and cover the same amount of material. Why keep those students from being doctors for a whole year?

The good news is that this system already exists. It's called competency-based education. The idea is that students focus on mastering a set of skills rather than completing course work over a pre-determined period of time. Basically, it's like the OSCE - there'd be a list of tasks you need to complete, except you could take the OSCE whenever you felt ready. Only takes you two weeks instead of four to get through UG block? Well now you wouldn't have to spend a week rererereading the syllabus, instead you could take the exam early and move on. Want to take 8 weeks instead of 5 to get through neuro? It'd be a more personally tailored style of med school.

I'm sure you can see the potential here. 

What if there was a mega lists of 100 clinical procedures we had to learn during M3. We had to spend time in the sim center, watching youtube videos, practice on each other, to master the procedures. Then we'd get tested whenever we felt ready. Less time being wasted randomly walking around the wards figuring out what to do next. SO efficient. 

What if M1/2 were like the OSCE?

This would be huge for the pre-clinical years. This is the time in med school where students are the most diverse. Some students came in as undergrad English or Psych majors with little background in the basic sciences. Other students were biology majors that took anatomy labs in college. Yet other students have been out of school for ten years. Do you really think all these students need the same time to master the same material? My guess would be no. Why force them to work at the same pace?

You'd pick up the syllabus - then take the test whenever you felt ready. If you pass, you'd move on to the next syllabus. If you don't, you'd try again later. 

This system would eliminate grades as an arena for competition among students and produce happier doctors. As well as provide flexibility for students with non-syllabus interests. Tuition is still paid per time so it would incentivize graduating earlier, and working harder, which would prevent students from getting too lazy. 


See you on the other side,

from ken

enjoy sidenote in 140 characters or less @kensidenotelife.

half-baked idea: improv classes

Going back to my breast exam running diary, the easiest part of learning  to give a breast exam was actually touching the breast. It's just skin and fat. The hardest part was talking about breast, and watching all the words you use. Don't use inspect, feel, sag, etc. Don't stutter. Don't be nervous talking about breasts. So my half-baked idea is that we should work on our talking skills by taking improv classes. 

that's all, folks

I don't know anything about improv other than the few articles I just read about Stephen Colbert and Tina Fey, but it sounds like a great way for us to become comfortable interacting with patients. 

Here's 3 pieces of advice I just looked up about how to be good at improv:

1) Make a connection to the other player.
2) Never expect a certain answer, just react to what was actually said.
3) It doesn't matter what you're doing on stage as long as you sell it.

You can probably make the connection from these three points to medicine, but I'm going to lay it out for you. 

#1 - Make a connection to the other player. 

This has obvious implications in medicine, where half the battle is gaining the trust of your patient. Getting sensitive information from your patients - whether you need a thorough sexual history from an elderly lady or you're trying to talk to a teenager about alcohol abuse - it can be tricky. Not every patient is going to be a fire hose of information like our standardized patients. Not to mention, if you're going to approach patients about making a serious change like quitting smoking, you need an established relationship. 

#2 - Never expect a certain answer, just react to what was actually said. 

The small group interviews are good practice but it's a pretty straightfoward process. OLDCARTS. You already know exactly what you're asking before you go in, so you're basically rehearsing from a script. The problem is that when you're actually seeing patients you have to do a lot of winging it. Patients aren't going to tell you exactly how pain radiates. Doctors need to practice talking to human patients instead of robot patients.

#3 - It doesn't matter what you're doing on stage as long as you sell it. 

Patients are scared to see their doctors. Waiting for a second opinion on a cancer diagnosis is going to be tense. They don't want to see you nervously fumbling and trying to find the words to explain the situation to them. Patients want doctors to be confident. 

--

How expensive would it be to hire twenty local comedians and have them teach an improv class for 2 hours? I can tell you how much it would cost. Here's a local improv class:

Students would totally think it was fun, which would make it unique among required med school activities. It'd be a good group bonding activity, watching everyone screw up and have a good time with it. 

Not to mention, it wouldn't hurt doctors to have a sense of humor. 

See you on the other side,

from ken

taking requests for future blog posts. please comment or email.

half-baked idea: 3 yr MD

Just saw this article on an unnamed med school blog I follow. Sounds great, lots of relaxing and fun vacation activities. I'm sure it's nice after three years of working yourself into the ground. 

I have a handful of friends that are fourth years, and their life is indeed a glorified vacation. Everytime I go into the lounge to heat up my lunch and go straight back to eat at my desk, I see them hanging out and watching TV. I see them laughing at us while we're going for that second pot of coffee, obsessing over the vertebral level of the superior mesenteric artery. Is it L1? L2? L1/2? Somebody tell me. 

L1. It has to be L1. 

Except, there's one problem. You are paying money out the freaking window to take this vacation. Now that subsidized Stafford loans are a thing of the past, every year counts. The cost of med school has to be one of the biggest detractions to med school. It pushes away talented could-be doctors, and simultaneously pressures young MD's to chase high paying jobs so they can pay off their loans. One of the attendings at a bible study I attend has four kids, his oldest is 12, and he just finished paying off his loans. 

So here's my half-baked idea: what if we shortened med school by a year? 

There are already schools (Duke Emory, Baylor, University of Vermont, UPenn, UVA, Lerner, to mention a few) that shorten the 2 clinical years and the 2 basic science years by just enough to give you a free year to pursue an independent project ranging from bench research to community outreach. This idea if GENIUS. At Stanford they give you every Wednesday off so you can pursue an activity of your choice, which I've covered here. What a great chance to think about what you can do for the world. So I love the idea of having a free year, but what if we just cut out that year entirely?

It would work out logistically. Given how unimportant the pre-clinical years are, there should be no problem with cutting out some M1/M2 time. sidenote - If you don't believe me, look up NRMP residency match statistics. The only things that really matter - step 1 scores and third year clerkship grades. 

First - we'd cut out M1-M2 summer (3 months), a resume-padding waste of time. We'd limit biochemistry to only a few fundamental concepts, cut out 75% of it, and you'd learn the rest of the stuff as needed (1 month). We'd get rid of OB-GYN and peds as req'd clinical rotations (2 months). So you'd only be required to do the fundamentals - surgery, internal med, family, and psychiatry. Then you'd remove half of 4th yr (6 months), which we've established is a long vacation. 

The money you'd save by spending one less yr in school is huge, but the MD appears much more doable as a 3 yr degree. At that point it's just as long as law school, and they're flooded with applicants.

The only possible downside - you're a year younger, so you'd be slightly less mature and prepared for actual medicine. This is where I'd combine this idea with my half-baked idea of mandatory year off between undergrad and med school would come in, so you'd be the same age when you graduated. 

3 yr MD. Sounds great?

See you on the other side,

from ken

taking requests for future blog posts. please comment or email.

half-baked idea: mentored day off per week

I threw out a half-baked idea last week about taking a mandatory gap year between undergrad and med school. Part of the motivation for the gap year would be to help med students develop passions. Here's a second half-baked idea to go along with it. 

Half-baked idea: Mentored day off per week. 

I'm sure I don't need to sell med students on a day off every week, but hear me out. 

the hub

Stanford, probably the best at innovative med education is already on this train. They give their students every Wednesday completely off from med school obligations. sidenote - Palo Alto would be one of my top career destinations if not for the cost of living. Absolutely insane. One of my friends did an away rotation there, and he told me his attending rented a house there because he couldn't afford to buy. I can't remember what specialty he was in, but the average doctor makes six figures easily. Probably looking at $200,000+ per year. And he couldn't buy a house... Durham or St. Louis it is.

Anyways, back to Stanford. When I unsuccessfully interviewed there, I met a student working on an Immunology PhD, another that tutored undergrads in anatomy lab, and I heard of others that took literature courses at Stanford undergrad. sidenote - Abraham Verghese (Cutting for Stone, Tennis Partner, My Own Country) teaches undergrad writing courses at Stanford. Would love to take those classes.

can I just hang out with you?

I love this idea of giving students free time, but let's face it. Do I have time for this? No. I have to figure out what the hell a uterus is. I have IP assignments to do. 

Med students are busy. If I had one day off from class I'd definitely just study more. So here's the added caveat for the day off -  meeting with a mentor. sidenote - Atul Gawande wrote this great article about the need for coaches in medicine. 

At MUSC there are 280 faculty members in the dept of general medicine, 100 in the dept of surgery, 160 in the dept of peds, 240 in neuro/psych, and 30 in ob/gyn. Between those 800 diverse faculty members, we could assign each med student to a faculty mentor. Every incoming student would choose one of these specialties, undecided students will get thrown into general med, because statistically the most students will end up there. 

We could even add niches like doctors interested in working with minorities, teaching on the wards, writing and interweaving humanities, using social media to reach the uninsured, being pregnant while in med school, you can use your imagination. 

So every Wednesday during the school year, the student and faculty mentor would meet for 30 minutes to chat over coffee and break down life. They'd mainly focus on what they're doing with their Wednesdays. It would double as career mentoring and therapy. The faculty mentor would decide if the student was doing a satisfactory job of meeting the 'Wednesday' requirement, which would be a given. 

rosie

And what would students do on these Wednesdays? Well, here's one half-baked idea within a half-baked idea. Rosie Taam, from my small group, took a gap year and became a yoga instructor. Wouldn't it be a cool way to develop as a doctor to teach something 'alternative' as yoga? I always wondered how she could work this into her life as a physician, and on Wednesdays she could keep teaching yoga one day a week and develop a vision to weave yoga into her practice. What if she ran a private practice where she taught a yoga class to her patients? I guarantee there would be a patient population and investors interested in backing that practice. Why shouldn't med schools be helping students come up with ideas like this? 

If nothing else, it just seems like a good idea because a lot of us young med students are confused. I bounce between interests in specialties every five minutes. I also want to have a family, and would love some advice from older doctors. Doesn't it just make sense for us young confused people to have contact with established slightly less confused older people?

See you on the other side,

from ken

taking requests for future blog posts. please comment or email.

half-baked idea - mandatory year off between undergrad/med school

Back in 2005, the NBA agreed to scale back the influx of high school players by setting a mandatory age limit at 19 and requiring that players be one year removed from high school to enter the NBA. Players don't have to attend college if they don't want to, some players go for the D league, others like Brandon Jennings go ball for a year in Europe. 

This rule makes total sense. What 18 year old is prepared for a biweekly paycheck in the tens of thousands? 

Stan Van Gundy rocking a Dwight Howard Loyalty shirt, priceless

You can't tell me that Andrew Bynum wouldn't have benefited from a year or two in college. Not everyone is LeBron James and physically/mentally prepared for life as a professional basketball player. I know I wasn't anything close to a functioning adult at age 17. 

So here's my half-baked idea: Let's put two requirements on med school education - applicants must be age 22 or over, and have a bachelor's degree before submitting the AMCAS. This would force undergrads to take at least a year off before beginning med school. 

I have a hypothesis - students who came straight through college have a higher average MCAT, higher undergrad GPA, and better CV's than students who took time off after college. They're better med school applicants, and I would assume if you compared grades you'd find that they are better med student. Except, here's the problem: they've never had time to think about their life and evaluate what they want from it. They've spent their whole life running down the track of academia - getting good SAT scores in high school, entering college knowing they were smart enough to declare pre-med as their major of choice, knocking out biology and chemistry classes, and before they knew it they had an MCAT score that was good enough for med school. But do they know what med school entails? Aren't there handfuls of students that ended up in medicine that don't want to be there?

The short answer is yes. At least half the times I've told doctors about how I want to be a doctor - they ask me to reconsider. It's not what you think. It's not like what House or Grey's Anatomy. It's a lot of paper work. My patients are all old and hate me. You don't know what you're getting into. 

Why are docs giving me this advice? Well, one possibility is that they wish someone had told them that twenty years ago, when they were at the crossroads I'm at. Maybe they've just been at gogogo speed on the academia-biology-premed-medschool track for years without half a second to re-evaluate their values in life. 

hey guys, I know I've only been here for
a few months but, just give me the damn ball

NBA sidenote - let's take the Rookie of the Year conversation - the leading candidate is Damian Lillard. DL is the starting point guard for a surprise .500+ team. He leads rookies in points, assists, and minutes. He went to four years of college, and carries himself with swag. He's the only rookie to hit a game winning shot all year. 

Lillard talks a lot about his time in college in this great interview. He faced his first serious injury - a broken foot - nine games into his junior year. It forced him to take some time to re-evaluate his game. He religiously studied film of elite guards like CP3 and Westbrook. He came back from his injury stronger than ever. He had a career year that launched him into a lottery pick. His coaches kept pushing him to be better and better, and Lillard thrived under the attention as the leader of his team. 

What 18 year old basketball star ever regrets going to college? You're the big man on campus, go to tons of parties, dominate every basketball game, and have a ton of time to develop your skills while hanging out with a bunch of other guys that love playing basketball? 

Now, here's 3 reasons why this would be great for med students.

1) Maybe this would give them a chance to slow down, if only for a year, and figure out if this is really what they want. I've had friends that went down a Teach for America path and decide that all they wanted from life was to reach young people through teaching, and it wasn't worth it to them to spend hundreds of thousand of dollars in loan money, not to mention the better part of a decade in training. I've also had friends that spent some time on a Teach for America path, and realize what they really wanted to do was medicine. They came back more passionate than ever, prepared for whatever medical education put in their way.

2) How many people do you meet in med school that are boring? All they do is numbly go through the day-to-day - study, work out, get blitzed on the weekends. One of my theories is that the world would be a better place with more passionate, interesting people. The year off would be HUGE for that. Future doctors could spend it discovering passions that correspond with a career in medicine. Or maybe they could just add a hobby like fishing that could keep them sane. Or they could get married. 

3) It's common knowledge that physician burnout is a huge problem. Think a year of rest would help? Yes. The answer is definitely yes. 

I dare you to tell me why we shouldn't do this. 

See you on the other side,

from ken

taking requests for future blog posts. please comment or email.

half-baked idea - New M1/M2 class: Patient Care Technician

Brian Still, Jordan Shealy, Kaleb Keyserling

Thanks to Brian Still, Jordan Shealy, and Kaleb Keyserling for helping me with this post. Brian worked as a Patient Care Tech, Jordan was an Anesthesia Tech, and Kaleb was a nursing assistant.

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Here's one of my frustrations about med school.  We came here because we wanted to help people. Specifically, sick people. So we spent four years of undergraduate lives putting up with insane BS to get here. Now that we've arrived, we put up with more BS. We have to spend our time on pretend patient write ups, study endless details about mechanisms of drugs that aren't even used in clinics. What if we had a chance to actually do something useful.. AND learn something? 

We have a class called Fundamentals of Patient Care - where we learn things like measuring blood pressure, follow around nurses to learn about what non-doctors do as a part of the medical team, generally learn about non-classroom things. Except the problem is - we do it in a classroom. Are you sitting? Good, because I'm about to drop a ground breaking idea on you - what if we learned non-classroom things, not in a classroom?

Hear me out. Let's bring pre-M1's to campus 8 weeks earlier and put them through a combined orientation/PCT training. It'd be a great time to bond with classmates without the awkwardness of orientation, and it'd be exposure to the clinic. Then, after those 8 weeks the M1's would be certified to be patient care tech's at hospitals.

On top of that M2's would arrive early to do the M1 training. This would double as M2-to-M1 mentoring, but also provide clinically relevant summer jobs for M2's to pad their resume's. Everyone wins.  

sidenote - at USC Greenville they have a similar program where M1's arrive early to become EMT's. This idea ALREADY exists. If MUSC is truly the flagship South Carolina med school, it has to get on board with the shift of med school education to clinical training.

Here's the part that might be unpopular.. we'd put M1's and M2's on a monthly shift at the hospital 7 PM to 7 AM shift.  Would it be a lot of work?  Yes, but we could replace many things. Hospital visits would be out, so that's 4 hrs per 6 wks. Small group would be gone - 3 hrs per week. We could also get rid of classes where we learn how to talk to patients, learn to deal with minority groups, understand healthcare disparities, etc. Plus the senior mentor program because we'd be seeing elderly patients every shift. That's probably 4 hrs per 6 wks, which adds up to 17 hrs per month. You would actually be saving time, plus making yourself useful during your pre-clinical years. 

sidenote - Isn't there also some valuable to starting from the bottom of the totem pole?  Shouldn't future leaders of healthcare teams have to understand the jobs of the techs? Shaving a patients private areas, measuring blood glucose, putting cushions under comatose patients to prevent sores. 

This would also give med students a greater appreciation for vital signs, which are interestingly enough, called vital signs because they are vital.  If we could make diagnoses and understand physiology better from a vital sign perspective, it would pay dividends for saving money on excessive diagnostic tests. 

This would also improve interprofessional communication because med students that went through this program would have better relationships with nurses.

EVERYONE WINS.

And to pile it on, what about the Malcolm Gladwell Outliers 10,000 hr theory - we need 10,000 hours of doing anything before we can truly become great at it?  Shouldn't we be devoting as much time as possible to hit that 10,000 hrs of patient care time as soon as we can? The answer is yes, as future doctors we should be investing our energy in becoming good future doctors.

See you on the other side,

from ken

taking requests for future blog posts. please comment or email.

Why I am not a fan of Interprofessional Day

Here are the 4 stated Learning Objectives of Interprofessional Day via screen shot:

I'm all for all of these things.  I'm all for doctors and nurses and techs having better communication and helping patients get better treatment, but the real question has to come back to basic human psychology - in a work environment, how can we get people to communicate better?  

shoutout to the best
lab bench mate ever

When I look back to my last job where I was a lab manager, I know that I often chatted with one of my co-workers that was one of my good friends.  We regularly drank coffee, had lunch, went out to bars, and had a mutual respect for each other.  Naturally, this made it easy to communicate at work and ask each other questions.  

On the other hand, I had other co-workers that only talked to me when they needed a new reagent.  These were co-workers I rarely talked to, even if when I knew it would help me.

So based on n = 2 I'm going to draw a conclusions - co-workers that have a relationship, or at least have respect for each other will communicate better.  Interprofessional communication is important.  At the same time, my fear with Interprofessional Day is that it's just lip service.  If you did a controlled study across academic health centers before and after Interprofessional Days were implemented, would you actually see an improvement in communication between nurses and doctors?

My thoughts would be - no change.  Which isn't a huge problem.. except that having an Interprofessional Day allows the administration at academic health centers to claim that they're addressing the lack of interprofessional collaboration, then after that one day everyone forgets about the problem, and the status quo goes on.  Med students still think everyone else hates them for being so awesome.  Nursing students still know med students have never respected anyone.  No respect, no relationship, no communication, patients still suffer.  Real change is not about a single big day of celebrating interprofessionalism, it's about day after day of getting it drilled into student's brains through practical experience.

So I'll leave you with a half-baked idea: instead of spending a day talking about how we need to work together.. what if we actually spent a day working together?  What if we went elementary school-style and had field days?  Split everyone up into teams by alphabetical order, and spend all day competing in dodgeball, 3 legged relays, whiffleball?  

What if we just spent a day with our classmates, had fun with them, and in the process, learned that nursing students and medical students aren't so different after all?  This is the truth - we're all just people, and no right-minded person wants to sit and listen to lectures and run through cookie cutter small group activities on a Friday afternoon.  

See you on the other side,

from ken

taking requests for future blog posts. please comment or email.