I'm going to build my own fucking med school

having a deep conversation 
about bison hats with my nephew

Last night my friend who was entertaining a five year old mentioned to me that he just doesn't get kids, they make no sense. That's what I love about kids. They haven't been trained by the hidden curriculum of the world, so they still don't give a shit what the world thinks. Kids are the masters of keeping it real.

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"I'm going to build my own fucking hospital. And there'll be none of that there, thank you."

       - Paul Farmer

One of my favorite parts of undergrad was analyzing med schools.  Which med schools would be the best for me, what part of the country I wanted to live in, what sort of people I would meet, and so on.

Now that I'm in med school, one of my favorite past times is analyzing residency programs. Some of my classmates came in with a set vision for family practice or ortho.  sidenote - those two specialties seem to have the most people who are confident about their choice. Anyways, I'm not like that. I could see myself as a full-time basic scientist running the Whitehead, a peds heart surgeon, a psychiatrist, Dean of Medicine, the list goes on.

The common thread that I've noticed among my ideas is that I have two pools, and I jump back and forth depending on my state of mind: cynical vs idealistic. My wife once called me naively idealistic, yet my anatomy lab partner once called me the most cynical med student he'd ever met, so I guess I'm wired with a little bipolar disorder. 

On my idealistic days, I remember my days back at Kenyon College, when I wanted to change the world. [previous post: why Kenyon College kicks ass] I read Paul Farmer's Mountains Beyond Mountains, and I wanted to save people in rural Haiti from losing family members to treatable diseases. 

sidenote - the magic of Paul Farmer is not his work ethic, what makes him unique is that he maintained a child-like green-ness into his 30's and 40's. He ignored the lures of private practice, fast cars, and cynicism towards his patients. Instead he kept firm to his ideals and changed the world.

On other days, more cynical ones, I see the incredible work our administration has been putting in to renew our status as a licensed medical school and I sigh at the loops they have to jump through. 

As I've gone through med school, I see students in both the idealistic and cynical pools. Some of my classmates are in the House of God camp: bitter with the world, just want their degree, and get on with their life. Others of my classmates still naively hold on to their dreams of changing the world. The little that remains of my non-crushed soul goes out to those students. The hidden curriculum of med school is coming after them. If I ever build my own fucking med school, one question I want to answer is how to help students who are green stay green. I want to know how to cultivate more students who still have the energy to buck the culture and do what they're passionate about. 

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.

half-baked idea: building moral muscle

Part of my new plan for sidenote is to post more often, and that's going to result in me writing whatever bs is on my mind. Hopefully it's more good than bad, but either way I'll keep posting. 

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It's Tuesday, day 2 of being back at school. Fortunately, I'm studying from home and Starbucks instead, so it still kind of feels like vacation. 

Looking over the surface anatomy of the gut, my head was definitely spinning in all the new vocab. I wonder if it would be easier to learn if I had abs. Damn Netter.. now I'm definitely self-conscious about the cookies I ate yesterday. Just did ten push ups. Also, I would have posted a real picture of my abs but this blog is rated PG.

sidenote - on the topic of anatomy, I had a half-baked about building moral muscle. I'm not sure who came up with the idea of moral muscle, but it sounds like moral muscle = intangibles.  sidenote within a sidenote - I have this philosophy that intangibles represents everything that actually matters about humans, but it also represents everything that's difficult to quantify. So instead, we judge people by silly measures like MCAT scores, salary, lbs bench pressed, etc. One my life missions is to figure out how to understand intangibles better. Anyways, back to my idea: is it possible to build intangibles in the same way you'd build regular muscle? 

ie - if I wanted better abs I would do two hundred sit-ups everyday for a year.  ergo - if we take use humility as an example - I'd force myself to do something I'm obviously bad at everyday, and the process of making mistakes and seeing my limitations would eventually make me more humble..? Kind of a fake-it-till-you-make-it strategy.

What we need is an app that could keep track of every time you do something humble, like a workout log.  We'd also need certified trainers that would tell us how to become humble, as well as workout buddies to keep us accountable.  I really like the parallel of athletics to life. I feel like this is going somewhere but I'm out of ideas.

See you on the other side,

from ken

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

House of God Book Review and thoughts on burnout

The House of God is a pseudo fictional memoir that takes a cynical look at the training of young doctors. The protagonist Roy Basch is a naive grad of BMS (best medical school) working as a first year intern at a hospital called the House of God.  The story chronicles Basch's year as his mental health spirals down due to poor working conditions, brutal superiors, long hours, and a severe lack of time to spend with friends and family outside the hospital.  

Shem drives home the point that internship takes up so much time and mental energy that doctors lose their humanity. They slowly get isolated from friends, family and even fellow interns- and when that isolation happens, they move from thinking this is crazy to I am crazy. One intern in the House of God commits suicide because he bottles up the madness of the hospital within himself, he eventually can't handle it, and has no other ways to release that stress.  

So the moral of the story - everyone needs to deconstruct all the craziness going on around them. Cope or perish.  

According to some quick some studies I pulled up on pubmed - 45% of physicians experience at least one form of burnout: emotional exhaustion, feeling unaccomplished, and losing empathy for humanity. Half of all doctors are feeling burned out!  That has to be terrible for healthcare?  On top of that, male physicians are 50% more likely to commit suicide than the general public, and female physicians are 200% more likely!  

Sidenote - Residency training may be when the stress of dealing with patients peaks, but what if the real root of the problem is earlier?  What if interns are arriving at their residencies already so burned out from med school that they're already on the highway to that depressed, burned out, suicidal hell?

white coat ceremony - the bright eyed days

Before I started med school someone told me to enjoy the first few weeks - everyone is bright eyed and happy to be there, still friendly, and tan from the summer.  Now, almost three months into school - no one's that tan, you can start to pick out the gunners, and the bright eyes are slowly fading to zzz.  

I've been getting a lot of that frustration and burnout myself. I drafted out an entire post complaining about being burned out, then I decided it sucked and wasn't up to public consumption.  Then I hated myself for being terrible at writing, and then I hated myself again for procrastinating instead of studying.  Self-hate has to be one of the top signs of burnout.  

The last block definitely burned me out.  I was talking with my similarly overwhelmed and burned out classmates - and we literally couldn't figure out what to do to unburn out.  I try to study all day and fail - I watch recorded lectures in the corner while checking gmail, MUSC email, facebook, grantland, the NYTimes, really I'd rather look at anything than the syllabus. 

Last block we had a lecture on physiatry - the cushiest specialty in medicine, you play volleyball every weekend, and you get tons of $$. Physiatry is looking better and better everyday.  

I need to come up with some half-baked ideas to fix physician burnout.  

See you on the other side, 

from ken

physiatry life

Insane in the Sarcolemma: test week #2

So we just started test week #2 - musculoskeletal aka f-load of anatomy.  For non-MUSC readers, before every test we get a week off from classes and small group discussions to focus on studying.   I thought the last study week was crazy.  [link to test week #1]  Turns out that was only the beginning.  

don't waste your time

The last test went well - the class average was an 88.  That block was mostly a review of undergrad, but this musculoskeletal block has been completely different.  The material is almost all new, and there's a TON of it - one of my friends estimated 650+ powerpoint slides of anatomy - slide after slide of muscle, nerve, bone, ligament, artery, repeat.  It's hard to describe how hard it is, but I consider myself a fairly intelligent guy, and I've had to wake up at 5 AM just to cram in enough time to study.  And I just scored a 40% on the metabolism self-assessment.  

In a sense, this was the block med school got real and lived up to the hype.  It definitely got hard.  

exactly how I feel

But.. how real is it?  Anatomy seems pretty useless, although you could maybe sell me on it - I guess we should understand the structure of the body.  On the other hand, I'm about 200% sure glycolysis has nothing to do with being a doctor.  Personally, I want to be a cancer scientist - and glycolysis/TCA cycle/oxidative phosphorylation is even meaningless to me.  Sidenote - I'm pretty sure the Warburg effect is controversial, which isn't surprising considering Otto Warburg came up with it 50 YEARS AGO.  I would not be happy to see it on an exam of modern science.  Anyways, It might help to have a general understanding of metabolic principles - but to know the exact name of each enzyme?  Absolutely useless - just wiki that shit.

So why do we learn this?

Maybe we're trying to develop a crop of doctors that's planning to dominate bar trivia - I swear my classmates would be the top 160 trivia masters in Charleston.  We are REALLY good at memorizing facts.  But if any of you have complaints about your doctors not spending enough time with you, or not having a human side - don't hate the player, hate the game.  I'm surprised any doctors come out of this training system with a lick of humanity left in them.  

But anyways, here's my simple answer to why we're trained in this outdated style - because the class of 2015 learned it, and the class of 2014 learned it, and the cl...  It's the status quo.  But is producing trivia robts really what med school should try to accomplish?  Do patients want robot doctors?  Should students be investing $200,000+ in loan money for this?  Don't we deserve to get training that will actually help us be better doctors?  

See you on the other side,

from ken

Insane in the Membrane

This week is block 1 test week.  To translate - before every test at MUSC we have a week off from our usual routine to study.  On the surface it seems great. 

ah the old lecture hall

We get a break from the usual bullshit of med school like cultural sensitivity training and following nurses around like lap dogs for 4 hours.  Wait, we're really going into hundreds of thousands of dollars in debt to do this? When normal people go into hundreds of thousands of dollars in debt they're buying fast cars, fake boobs, and big houses. 

Sidenote - the world needs to know that the education process of doctors is 70% bogus.  People, we could have more doctors by just shortening the MD training.  

if you're the president of AAMC
you can thank us later

Half-baked idea: cut out summers, condense the first 2 yrs (18 months total) into twelve months. Think about it - only about 70% of the syllabus is useful.  If I ever get pimped for not knowing the molecular mechanism of microfilament assembly I will shoot myself on the spot.  3rd year is actual time practicing being a doctor so say we leave that alone, but 4th year is mostly interviewing and sitting around, so that can be condensed into 0.5 yrs.  We add that up and you get an MD in 2.5 yrs.  

But as you dig deeper, test week is pretty f-ing crazy.  For several reasons:

1) It's incredibly unstructured, which doesn't work for 90% of students.  That's why we had to be students - for the structure.  If you left us alone we'd just go home and write blog posts complaining about the system or watch endless episodes of Grey's Anatomy.  For the 10% of students that are disciplined, it's equally terrible because you spend way too much time obsessing over every little fact you don't know yet.  That can't possibly be good for a subset of the population that is already ADD and/or on fluoxetine. 

2) It's the ultimate peer pressure experiment.  The library is literally a scary place to be.  There's about 80 stressed out young people wired on coffee thinking about nothing but vitamin B3 deficiency, receptor tyrosine kinase signaling, and neural tube formation.  I can't deny that everyone has been friendly on day one of test week, but at the same time… it's feels a little bit crazy, I'd rather hole up in a room by myself and listen to my neon green beats. Sidenote - if you were wondering, yes, they do sound better than the other colors.

the library during test week

You either have a whole week to obsess about the test inside your head and wonder if you’re insane, or you have the whole week to complain and bitch about it with your friends, confirming the insanity.  

It's like throwing a 17 year old Kobe Bean Bryant into the LA spotlight and the NBA.  Yeah it worked for him.. but it’s not like it was the ideal path.  Similarly, yeah med schools churn out doctors, but most doctors I talked to before med school have told me to reconsider my career choice, so it’s not perfect.  Anyways, I should get back to anatomy flash cards. 

See you on the other side,

from ken