medicine

Doing Small Things Great: A practical guide to contributing to your team as an MS3

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“Go forth and do great things.”
– Anonymous
No one gets into medical school without a considerable dose of ambition. We want to be involved, to make a difference, to save lives. In short, we want to do great things. We spend years waiting in the wings, our enthusiasm funneled into pre-med activities, o chem exams, and countless hours of studying in the first two years of medical school. Like a horse that has been held tightly in the starting gate that suddenly swings up at the sound of the starter’s bell, we spring forward with unbridled enthusiasm into third year, dirt flying. Having spent nearly a decade in prep (if you start counting in undergrad), we are eager to actually do something and start making a difference. And yet, so much of third year can be sitting around, waiting for the action, and, when the action happens, standing in the back of the room.

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The Fatal Failings of Evidence Based Medicine

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The medical system (and much of the culture) these days is focused on group outcomes, not individuals. Personally, I think that stinks.
In medicine, this failing comes from improper use of what was originally a good idea—evidenced based medicine (EBM). EBM was developed to help overcome anecdotal medicine, in which a seemingly successful therapy in one patient gets adopted by a physician as the “way to go” and then preached to his trainees as the management of choice, and over time becomes unexamined gospel. “Anecdote-based medicine” is a form of groupthink, and groupthink is bad in general and particularly bad for the patient sitting in front of us on an exam table.
There needed to be some way to help doctors realize that an individual patient response is not generalizable to others.
EBM evaluates groups of patients to determine statistical responses to interventions. It was created (initially) to help doctors determine whether an intervention is likely to work in an individual patient. In that way, it was originally kind of the obverse of anecdotal medicine.

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A Day in the Life: A Look at the Medical School Clerkship Year – Part II

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Make sure to check out Part I here!

The remaining day

Following rounds, teams will typically “run the list,”or quickly review the to-do items discussed during rounds and delegate the work as necessary. Since medical students typically cannot input orders, which include things like prescribing medications, scheduling diagnostic imaging and tests, and requesting labs, this usually involves more administrative tasks: obtaining medical records from outside institutions, following up on tests, and other ancillary tasks. Most rotations also incorporate some form of formal teaching in the curriculum. As such, students may be expected to attend lunch lectures with residents or may have their own lecture schedules. Some attending physicians enjoy giving quick teaching sessions and will set aside 30-45 minutes to talk about a particular clinical topic (e.g., management of diabetes, working up an acid-base disturbance, and other common issues) each day in addition to the more formal teaching opportunities scheduled by the clerkship.

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A Day in the Life: A Look at the Medical School Clerkship Year – Part I

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A caveat, an introduction

To try and describe the clerkship year of medical school – the year-long, in-depth experience for students to actively participate in patient care in a clinical setting, usually in the third year – to those who haven’t experienced it firsthand is a difficult task. I steadfastly believe that medicine is an experiential endeavor, one that cannot be truly understood by someone until he has undergone it himself. The fact that each trainee has his own unique set of “critical-incidents,” to use a term from the medical education literature (1), that profoundly shapes the physician he will become makes the task even more arduous. Nevertheless, I will do what I can to try and give a good look at a day in the life of a third year student and what the experience entails.

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What’s in Your iTunes? Podcasts for the Medically Minded

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Whether your goal is education or entertainment, there is likely a medically oriented podcast out there you will enjoy. I’ve included here a sampling of the ones I found most useful or enjoyable, grouped by type. The first are geared towards the present task at hand – surviving medical school in general, clerkships in particular. The second group can help you learn more about your future specialties of interest. The last section takes a broader look at the world of medicine, tackling issues from recent scientific breakthroughs to medical ethics – those topics you feel you should be keeping up on, but who has the time? If you have other podcasts you have found helpful or insightful, please share them via the comments link at the bottom.

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