Surviving Medical Life: The Fifth Year a.k.a. Post-Graduate Internship

I write this entry with these people in mind: my unborn child, who [might] consider being a physician someday, for my future students [mwahahahahahaha!], and for myself, that I may be reminded of who I was as a student. This is the fifth part of the series.

You’ve survived clerkship! Congratulations! You’ve graduated and earned your Diploma. You bear the title of a Doctor. And we still have a loooong way to go!

The 5th year of Medicine is the Post-Graduate Internship year, as most Philippine Medical schools give their diplomas at the end of the 4th year. This is the year you’re no longer a student per se. You will become the Post-Graduate Intern, the “apprentice doctor”.

This is the year you will rotate one last time in all the different fields of medicine – you will be an internist, a pediatrician, a surgeon, a community doctor, an obstetrician-gynecologist, a researcher. Now that I’m close to finishing my medical internship, I realized that this is the last time, the last chance I’ll get to being as close to these fields of medicine. After this will come the board exams, and after, the many paths a doctor may take.

For the purpose of this entry, I will write about my experiences as a Post-Graduate Intern of the Department of Health – Centers for Specialized Health Care (DOH-PCSHC) program, and lessons I’ve gained along the way.

An Overview of the DOH-PCSHC Program

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The DOH-PCSHC Logo

The vision of the program is:

Five specialty medical centers under one umbrella that could provide world class specialized care to Filipinos regardless of social status in the most efficient, cost effective and sustainable way.

The mission of the program is to:

Provide a highly specialized medical SERVICE to all patients using modern, cost effective equipment and instruments.

Provide the setting and opportunities for the TRAINING and teaching of all types of health professionals

Provide the setting and opportunity for progressive and sustained RESEARCH in medicine and all its allied profession with the end in view of providing the highest quality of health service.

Institute provisions, procedures and practices that will ensure SUSTAINABILITY.

Established in 2005, the DOH-PCSHC program is one of the many Internship programs you can choose. It is a 12-month program where you will rotate in the different fields of medicine in the 5 DOH-affiliated hospitals in the Quezon Circle area – namely East Avenue Medical Center (base hospital), Philippine Children’s Medical Center, Philippine Heart Center, National Kidney and Transplant Institute, and Lung Center of the Philippines. You’ll also rotate in the Marikina Health Department for your community medicine rotation as well.

Choosing your Intenship Program

Graduating from medical school and being released into the world was initially a jarring experience for me. I was used to the systems of my former school that I found myself out of my comfort zone during my early days as a PGI.

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Working in the various DOH-PCSHC affiliated hospitals

When it comes to choosing your Internship program, you must consider the following:

  1. Desire for learning – as an oversimplification, I found that there are two types of PGIs – those who wish to focus on “book learning” and those who wish to have “experience learning”. Different programs offer different opportunities. Some programs are lighter than the others due to factors such as lesser patient loads, fewer facilities, and the like, which offer time for an intern to study. Some programs are conversely heavier than others, where one comes home, falls asleep, and survives another day. I found some PGIs chose their program that they can focus on reading their medical textbooks to prepare for the board exams, while some chose their program in order to improve their clinical skills. It is good to find a balance between the two, and to choose an appropriate program accordingly.
  2. Desire for compensation – the difference with this year and the previous one is that you’re now part of the workforce. You won’t pay any tuition fees, and some programs will even compensate you, in the form of allowance or stipends. It is in my opinion that you should put this in the least of your priorities when choosing a program, however, because the experiences you might get may outweigh any material compensation.
  3. Accessibility – Some PGIs choose their program for its proximity to their homes. I have a friend who chose her program since it was in Davao City, where she has been away from for almost a decade. Certainly being near family has helped her become happier with her work.
  4. Goals for the future – It is advisable to choose a program wherein you intend to practice in the future. It will help you get to know the culture of the program you’re contemplating, as well as getting to know your future seniors in the field. Knowing the protocols of the hospital certainly helps as well, as it will make you a more efficient and effective asset to the team should you be accepted there. One of the key advantages I noted was that I also got to know the residents and fellows of the different departments, whom I will refer to for guidance in the future.

I chose the DOH-PCSHC program for the following reasons:

  1. I wanted to improve my clinical eye by exposing myself to many varied cases. (I wasn’t disappointed with what I’ve seen along the way.)
  2. I wanted to improve my clinical skills through its performance in my duties.
  3. I wanted the challenge of working under pressure in resource limited environments.
  4. I wanted to discover the work culture and the environment I hope to work in the future.
  5. I wanted to apply for an Ophthalmology residency at the East Avenue Medical Center.

Level Up!

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Open Heart Surgery at PHC

As a PGI, you will don for the first time your white coat.

The history of donning the white coat began in the 19th century, where physicians began to wear it to symbolize the transition to the scientific approach to modern medicine, and to distance it from the quackery and mysticism of its predecessors. The white coat is more than your uniform – it is the symbol of your status as a man of science and learning. It is a reward you gain for your years of sweat and tears, and also a reminder of the responsibility of how your words and actions will impact another.

Hopefully, you worked hard as a clerk, and gained plenty of experiences and knowledge along the way. During internship, from being the “grunt”, you are promoted into a “sergeant”. During clerkship, you worked under your PGIs; now that you are one, you will take under your command your clerks, whom you will hopefully teach and nurture to become better doctors in the future.

Guiding Principles

When I was a clerk, I was exposed to different types of PGIs. There were PGIs who deserve praise and respect, as they taught me things that weren’t written in the books, and then there were those who taught me what not to be.

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Rest and Recreation is part of training too!

  1. Learn to prioritize tasks. Time management is an invaluable skill for Internship. You will be given lots of responsibilities – lab work, monitoring patients, doing paperwork, doing census, interviewing patients, assisting in procedures, to name a few. A good rule of thumb to prioritize tasks is to concentrate on those that will give the most benefit at a certain time. For example, if a patient has a deteriorating level of consciousness, certainly referring it to your senior takes precedence over doing paperwork. This is similar to the triage system in the ER, where you will focus concern on the emergency cases and less on the non-urgent ones. I found how this was not much of a concern when I was a clerk, as I only followed orders. In your PGI year, you will constantly make decisions on your feet, so make the best ones and make them count.
  2. Take care of yourself – this principle still holds until this very year. Internship will entail new responsibilities and challenges that will test you. Along the way, you might neglect your health and well-being, and it will manifest itself insidiously. At best, you’ll become irritable and you’ll feel like giving up; at worst, you’ll compromise your care of your patients. Take care of yourself. You cannot give what you do not have. There are some rotations that are lighter than the others; use them to reconnect with your old friends, go out with your family, watch movies and read non-medical books.
  3. Never forget who you were – you were once also a JI/Clerk. This year will put you in command of clerks. Do not become a “kupal” or a douchey PGI – treat your clerks the way you wanted to be treated as a clerk – with respect. They may not say it, but they will look up to you. Lead them by example. Give them time to eat and rest, and teach them concepts and skills you wish you knew at their level. Your goal should be to make them better doctors than yourself. Listen to your clerks when they refer to you, and do not discard their intuitions. I always tell my clerks that I don’t care if what they refer is trivial; as long as it makes them concerned about the well-being of a patient, they should by all means refer their concern. By doing these basic things, I found that my clerks would work harder and would generally tell me that they were happier with their rotation, despite its challenges. This would translate to better communication among the medical team, as well as better patient care.
  4. Respect your seniors – you will meet different doctors with varied personalities this year. Respect them for what they will teach you, and learn from them what books cannot explain. As you do not have a medical license, always consult with your seniors first before performing an intervention. It is their license on the line if anything happens to a patient.
  5. Teamwork is key – you will not survive this year without the combined efforts of your colleagues. The lone wolf archetype truly is not fit for medicine – you cannot treat a patient with multidisciplinary problems alone; you need the help of everyone to provide effective care.
  6. Communication! I’ve learned that the bulk (almost 90%) of medical work is communication. You communicate with patients to know their disease and other factors that affect their treatment. You communicate with your colleagues and allied health personnel. You label the specimens you send to the laboratory. You tell a brief history and physical examination when you get initial readings for imaging work. You endorse your patients to your replacements. You clarify the orders of your residents/fellows/consultants. You refer your patients to your seniors. You write (and pair) your orders in the chart. You write referral forms, discharge summaries, clinical abstracts. You talk to the patient and the family regarding their diagnosis and options for treatment. Communication. I honestly didn’t realize how medicine is unfit for introverts like myself. I confess that I also tire of talking to people, and that sometimes I wish I could just hide in my room for the day. But it is a reality you will need to accept everyday, and one that you have to strive to improve upon.
  7. Look out for opportunities, and take them – there are plenty of opportunities to learn and grow in internship. My fiance told me that internship year is mostly self-directed learning, and if you complain that you don’t learn anything in a rotation, it’s your fault for not grabbing opportunities as they come. You will only become as good as you allow yourself to be. When you come upon a new case, read about it when you can, and learn its unique signs and symptoms. Ask questions from your seniors on its management, and research updates on treatment. Don’t be afraid to attempt new procedures and grab everything opportunity you have – I once did an ultrasound guided IJ catheter insertion (and probably the last time I’ll do it in my lifetime), and I’ll never forget the thrill and reward of doing it. I once held a beating human heart, delivered a baby, saved critically ill infants, called a code, intubated an unconscious man – experiences that no book, no matter how brilliant its explanation, can ever match.

Moving Forward

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DOH PCHSC Batch 2016-2017 Team C, taken during our Med Mission at Tayasan, Negros Oriental

My Post-Graduate Internship year in the DOH program was one of my most rewarding and fulfilling years in my life as a physician. I can definitely say that I’ve grown more confident in my skills from what I’ve been exposed to in the program. I’ve seen cases that books say are uncommon, and even rare. I’ve experienced making and calling decisions to save lives. I’ve seen suffering and death, and I’ve seen health and vitality, and have grown to accept one or the other. I felt the gravity of my words and deeds to those around me. I no longer am afraid of facing a critically ill individual, because I was taught what to do. I still weep for those patients I’ve lost, and I learn to move forward for those who remain.

I’ve always wanted to become a doctor. I’ve always imagined what my 5-year-old self would think if he saw me now. Despite the dark circles under my eyes, my constant coughing fits, and my aching limbs, I’d like to think that he’ll be proud of me.

What you are right now is what kind of physician you’ll be. The medical intern is father to the physician. I hope one day that the physicians of the future will be those that their young selves would pride to boast of, those with bright passionate eyes despite the dark circles, those with pure hearts despite the unhealthy coughing fits, and those with unrelenting will despite the aching limbs. I hope we become the doctors we wanted to be.

I wish for you a prosperous and fulfilling year ripe with learning and growth! I will see you along the way.

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Surviving Medical School: The Fourth Year a.k.a. Clerkship

I write this entry with these people in mind: my unborn child, who [might] consider being a physician someday, for my future students [mwahahahahahaha!], and for myself, that I may be reminded of who I was as a student. This is the fourth part of the series.

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uerm.edu.ph

Congratulations! Third year of medical school was hell, and by surviving it, you are surely on your way to becoming a physician. You are now going to begin your clinical years, earning the experience needed to function in any setting.

When we were having our orientation at the start of my clerkship year, all of my seniors succinctly described it using this statement: “Ito ang pinakamasayang year na ayaw nyo nang ulitin.” [“This will be the happiest/funnest/best year you’ll experience that you never want to go through again.”] I kept thinking about the meaning of this statement as I went along the journey that has been this year, and only in retrospect will it be clear why.

This is the year you will experience this rite of passage for all doctors.

This year, you will be deep in the trenches, fighting in the front lines of our war against suffering and disease. You will deliver babies, you will perform minor surgery, you will perform your basic medical interventions to your heart’s content, you will talk to and examine endless numbers of patients, you will educate you patients on their diseases, you will persuade your patients to take their medications, you will perform CPR, you will hold the hand of the dying, you will talk with those who all hope is beyond reach. You will experience the highs and lows of your budding medical career; you will share in the triumphs of your patient and medical team; you will share their sadness and their pain. Friendships will be formed, and friendships will be tested.

You will find yourself in the best and the worst of times, so get ready!

Mission Briefing

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Cavite, 1898: A medic attends to a wounded Filipino soldier (peopleus.blogspot.com)

Clerkship is a 1-year “on-the-job” training, where you will rotate in the various disciplines of Medicine, namely, Internal Medicine, Surgery, Obstetrics-Gynecology, Pediatrics, Psychiatry, Ophthalmology, Otorhinolaryngology-Head and Neck Surgery, Neurology, and Community Medicine.

Your rotation will revolve around the “Pre-Duty-From” schedule. Pre-duty schedule is from 7AM to 5PM. Duty schedule is 7AM to 7AM the following day. From schedule is 7AM (following duty status) to 12PM. Pre-duty is like Sunday, feeling as if it’s before the weekdays. Duty is the weekdays, where you will grind yourself to work. From-duty is like Saturday, where you’ll get to rest. The concept of a 7-day week will transform into a 3-day week, as you will discover.

Before you start clerkship, know that this will be the year that you will discover what kind of doctor you are. Wordsworth once wrote: “The child is father to the man.” The medical intern is father to the physician.

I want you to be the best doctor you can be, but only you can make yourself so. Before you start, set your goals for yourself this year. These were mine:

  1. Learn the common diseases, their epidemiology, pathophysiology, management and prognoses.
  2. Communicate effectively with the patient and the medical team.
  3. Become skilled in the basic medical interventions (Life support, IV therapy, surgical skills, etc.)
  4. Discover how to listen more effectively to my patients and colleagues.
  5. Develop common sense.
  6. Develop compassion.
  7. Network with colleagues and friends.
  8. Accept failure, defeat, surrender.
  9. Stand again after every failure.

Ten-Hut!

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1899: Regular soldiers of the Philippine Revolutionary Army stand at attention for an inspection (explorer-philippines.com)

Preparation is key to surviving the war in the clinics.

  1. Take care of yourself. Remember to eat healthy, get good rest (if you can, that is, without being a slacker or a liability to the team), keep yourself well-groomed. The stresses you will face this year will test you, so build a good physical foundation to mount your offense.
  2. Take care of yourself, please. I forgot to mention that you should also take into consideration your emotional and spiritual well-being. Burn-out is common during this time, and you’ll need your support systems to back you up.
  3. Get the right equipment. If you haven’t bought the equipment to function effectively, do so now. Invest in good equipment – your stethoscope, sphygmomanometer, thermometer, pulse oximeter, etc.; you’ll be using it for the rest of your professional life. One thing I want to emphasize is to buy good shoes. Do not skimp on good shoes! I destroyed 4 pairs of shoes this year. The worst enemy that will gnaw at you at the end of the day will be your sore feet.
  4. Read your manual, and attend the orientation. Your medical school will probably provide you with a house staff manual or a handbook. Read it. It will save you a lot of trouble in the future. Attending the orientation wouldn’t hurt as well.
  5. Read up on the common cases in the clinics. You should always strive to arrive in the clinics knowledgeable and eager. Easier said than done, but do try.

In the Trenches

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Manila, 1941: The first “Women Guerilla” corps (theatlantic.com)

It is hard to describe how the typical day of a medical intern goes. Your day will either be benign, in between, or in hell. The level of “toxicity” will depend on the rotation, as some rotations are more demanding than others as you will learn; on your team mates, as you will see them at their best, and at their worst; and on yourself, as you will also be at your best and at your worst.

Expect anything, and expect everything.

The experiences you will face here will be unique. I have found some common tenets to live by to survive. Some of these I learned from my mentors, some I learned by making mistakes. I’d like to credit Dr. Miggy Unabia for some of them as well, as I based some of these from a post he wrote for us before our clerkship year started:

  1. Think of the patient first. It is our vow to put our patient’s welfare and well-being first before anything else. I know I wrote earlier to take care of yourself, but you will have to accept that you will make a lot of sacrifices from here on onward. You will feel dizzy of hunger, you will feel irritable of thirst, you will complain of sleep deprivation, you will feel the need to pee but can’t, you will feel depressed and burnt out. The patient feels twice, thrice, or more suffering that what you’re suffering. They look to you for help. They may not show gratitude. They may even shout at you and curse you. You will feel frustrated. Yet our promise to serve humanity is our ultimate purpose.
  2. Be civil to everyone. Clerkship will put you in close proximity to people. People who you respect and will most likely refer patients to in the future. People who disgust you and feel disappointed for. People who you will work with for a year, or possibly a lifetime. We had this story of an intern who was approached by an old lady, dressed in simple clothing, who was asking about a patient. The intern, who was under stress at the time, was brusque in his reply, only to be met by the seething bite of an offended consultant.
  3. Don’t be a doormat. Then again, don’t be afraid to stand up for what is right. If there is a problem, isolate the person you have a problem with, and fix it among yourselves. Never humiliate anyone. Sadly, there are some people you can never seem to get along with. You can’t please everyone, and you will have to accept this fact. At some point, you will need to hurt some people to avoid a lot of pain in the future. At some point, you will need to call out the bullshit on your colleagues to make them better doctors.
  4. Have initiative. Clerkship is the best time to learn how to be a great doctor. Use all of your senses. Observe how physicians you admire communicate with the patients, and discard the bad behavior of those who do not. Ask questions (In a respectful way! In the right setting!), occasionally challenging your consultants. Read the patient charts, get to know their cases, read up on their disease. Update yourself on their clinical course. Take a look at the patients, politely examine them, talk to them, see them as people. I would have to admit that my best teachers were my patients. I learned how to do effective colostomy care from Ms. GO, how to act when suspecting a stroke from Mr. ME, how to analyze psychosocial conflicts from the AG twins. When I see a case, I see the patients I had the chance to meet. Meet as many patients and doctors as you can, and learn from them.
  5. Have a sense of urgency. This is a job where your actions can mean life or death, and a minute could be minute too late. I think it is best that when you are confronted with a task, assess its importance and urgency, and prioritize accordingly. The Eisenhower matrix is a good means for decision making in this setting, and I recommend you to study it as a guide.
  6. Endorse properly. Proper endorsement is an art that I admit I still need to develop. At first, you will endorse poorly, but over time, you will learn how communicate properly as a doctor to another doctor. There is nothing more irritating in the medical world than to receive an endorsement of a patient who is relayed to you as just a room number and the type of monitoring interval required. Go beyond that. Your goal is to make the patient be seen not as a case, but as a person. Also, it wouldn’t hurt to give written endorsements just to remove any further misunderstanding and make your instructions clear.
  7. Always consult with your superiors before doing any major interventions. At this point in time, you will be the grunt in the war, so you’ll have a lot of superiors breathing down your neck. Always inform them of the status of the patients, and if you have any interventions you plan to do, especially those concerning administering medications and any invasive procedures. You don’t have a license yet, so it is wise to ask, no matter how stupid the question may be; a life depends on it. Besides, your superiors have their own superiors too, and if you mess up, you’ll get them into trouble. Keep the peace and choose your battles wisely.

 Move Out!

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Waters off Palawan, 2015: Armed Forces of the Philippines board a landing craft air cushion

This year you will discover yourself. You will marvel at how you are able to stand without eating or sleeping for hours. You will marvel at your ability to go to work even when you’re sick. You will pull out creative solutions out of nowhere when everything seems hopeless. You will be frustrated for your mistakes and your failures. You will be burnt out and you will be depressed. You will feel like your life is not going anywhere, that you are stuck in the rut in the gears of life.

You will make a difference in the lives of other people.

You will become a great doctor.

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gettyimages.com

Never forget this year. This year, you are the grunt, at the bottom of the food chain. As much as it is hard to admit, the caring profession is unfortunately uncaring to those who practice it. There will be times when you will feel injustice done against you by other doctors, by the staff, by your colleagues. You will feel frustrated and disappointed in yourself, in others, and in your profession. You will feel anger and sadness at this reality. Discard their ways and use them as a guide on what not to be on your way to becoming a physician.

It is time to change the uncaring culture of Medicine, and it begins with you. This is the time not only to learn how to be a great doctor, but also to develop yourself into a decent human being. Become the doctor the world desperately needs: a doctor with a sharp and focused mind, gentle and caring hands, and a compassionate and understanding heart.

You will meet the best people and mentors this year. You will be inspired by their ability to keep calm under pressure, their unending vitality and vigor despite their lack of food or sleep, their warm and gentle guidance to you and to their patients. They will treat you as equals, and will listen to your opinions. They espouse the highest form of excellence and deserve the respect and love we give unconditionally. Use them as your guides towards progress and growth. Seek to become like them, and beyond.

I wish you all the luck and strength and wisdom for your fourth year! I will see you along the way.

Surviving Medical School: The Third Year

I write this entry with these people in mind: my unborn child, who [might] consider being a physician someday, for my future students [mwahahahahahaha!], and for myself, that I may be reminded ofwho I was as a student. This is the third part of the series. 

Third year medicine is, in my opinion, the “boss level” of your academic life. I have never worked as hard as I could until this year.

This year will sum up the discipline you’ve acquired throughout your years of formal schooling. This year will be a year of challenges, a year of great expectations, a year of tribulations. When it is finished, you will find that it will have also been a year of hope, a year of discovery, a year of vindication. By the end of third year, you will feel like a physician, at least in theory. By the end of this year, you will be one step closer to your dreams.

Keeping up the Pace

ECG

pinterest.com

A medical student is a marvel of creation. We are a juxtaposition of contrasts. We feel dumb, but we can answer (some) questions our consultants throw at us. We feel sleep-deprived most days of the week, but we manage to pull through our examinations. We are caffeine-laced junkies, but we can fall asleep on command. We feel like robots in a daily grind, yet we feel compassion and empathy when we talk to our patients. We feel stupid most of the time, but for some reason, our patients and our relatives believe in our abilities. (If you’re my child, I’ll probably be bragging about you to everyone.)

It is essential to keep in mind that taking care of yourself is your first priority. Eat a well-balanced diet, exercise often, go on dates or parties, don’t neglect your personal hygiene, and sleep adequately. There will be lots of times when you will feel burnt out. You’ll try to force yourself to keep going, but you won’t likely be productive if you do. I’ve done that many times, but I would just be frustrated and miserable after.

It is important to know yourself this year. It is important to accept that you are only human, and you will probably not be able to read everything or practice all your skills. It is equally important that you believe you have what it takes to be a doctor. It is important that you discover in yourself the grim determination that will spur you to face your fears.

The greatest challenge this year is not really the tons of material, the gaggle of paperwork, or the physical exhaustion, but the lack of motivation that will sap your strength and affect everything else. Keep up the pace. You’ll get there.

From a Marathon… To a Triathlon

Ocean

zarmeenk.wordpress.com

When I first started third year, it felt like being dropped into the ocean. Initially, you’ll feel the unforgiving chill, you’ll thrash about helplessly, you’ll be brought down by the endless waves.

Up to this point, I’ve treated medical school like a marathon, where all you had to do was to keep placing one foot in front of the other. This year, you will need to be faster and stronger and wiser. You will find that you have less time to study because you have to do a lot of paperwork and projects on top off trying to live like a normal decent human being with a social life.

The greatest skill you must master this year is time management. There are many ways to become productive, but the one I’ve always found useful is to divide your day into a pie. Allot 8 hours of rest and 8 hours of lectures everyday, and probably an hour or two for personal hygiene and eating. This will leave you with 6 hours to choose between studying and not studying. How you use those 6 hours is up to you.

If you’re like me, the internet is a bad distraction. I remember looking at a clock and saying: “Hey, I’ll just surf the net for half and hour.” When I look at the clock, it’s jumped by 6 hours. Try to remove distractions from your life and focus on getting to where you want to be.

Smart is the Way to Go

Tactics

forum.ea.com/uk

Studying smart is the norm for third year. You can try to read all the material, but it’s no use if you don’t understand it. I’ve applied new tricks to keep up with the material, some of which are:

  1. Strengthen your basic knowledge by brushing up on your past lectures. I’ve found that having a good background on pathophysiologic processes will allow you to quickly understand material, as well as allowing you to reason logically when confronted with a case you’re not familiar with. An example would be how you’d suspect leukemia in a patient presenting with anemia, easy bruising, and frequent infection. You’ll even know what type of leukemia it is just by recalling your basic knowledge. If you don’t understand what you’re reading, I strongly suggest going back to the basics. If it seems too tedious, know that ultimately, you’ll work faster as you master the basic sciences.
  2. Know the common diseases, their diagnostic criteria, their treatments, and their quirks. Staple cases would be lifestyle diseases such as hypertension, diabetes, and obesity. Infections and antibiotic treatment are also frequently discussed topics. How would you know what the common diseases are? Listen to your lecturers! Or if you really need to sleep in class, at least list down what they’re talking about and just go back to them later.
  3. Simplify! I would suggest using a small index card to take note of the important characteristics of a disease, as above. It will force you to put only the essential information, and it doesn’t hurt how writing helps integrate these into your memory. Another way to simplify is to consider how diseases can be grouped according to their core pathophysiologic concept and directing treatment accordingly. The Integrated Management of Childhood Illnesses (IMCI) chart is a good example of this. Find such material, or develop them yourself.
  4. Use mnemonics, use humor, enjoy the material! Think of funny ways to remember diseases. I remember Takayasu disease being a “pulseless disease” because you can’t “Takaya-pulse”. Or how to memorize the order of CT scan radiodensity: “be sure where fart arises” (bone-soft tissue-water-fat-air). Medicine has a lot of information, so you might as well find humor in it.
  5. Put in your hours everyday. Third year is the worst time to cram. Try your best not to fall into this, as the material this year is not only voluminous, but also requires time and effort to understand. By breaking up huge diseases into simpler concepts, you’ll have a finer understanding and appreciation for the material, as well as the luxury of good sleep during the exam weeks.
  6. Be a team player. Did you forget about the paperworks you’ll have to do already? Because there are a lot of paperwork. Our team created rotations schedules to guide those who are decked to interview patients. This ensures that we all get to hone our skills, as well as getting some respite. Now, don’t be that team member who hogs all the skills, nor be that team member who is just dead weight for the group. You are going to be a doctor, and how you behave with your team will reflect the kind of doctor you’ll be in the future.

For You, Only the Best

Heart

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I believe that a medical student should strive to be the best physician they can be. There will be many times when you’ll be tempted to just breeze through the material and pass the exams. There will be times when you’ll feel lazy and just read through previous exam review questions and hope those concepts will come out of the test. These things have happened to me. But now I have to brush up on cervical cancer because I know squat about it, and OB-Gyne will be my first rotation this April. I’ve learned how each concept you slack off from will bite you back someday.

Third year is the time to think about the future. When you’ll be in the clinics, patients won’t come to ask how you did in an exam; they’ll ask if you can help them. What good is knowing that secondary amenorrhea is caused by polycystic ovarian syndrome 80% of the time when you don’t know what the diagnostic criteria are, or how to treat it? You have to learn these diseases well enough so that you can spot them in the clinic, diagnose them, and treat them accordingly.

In the end, it will all boil down on how much you care about your patient. If you care sincerely enough, you will see all the exams and papers you’ll do as essential steps to become the best physician you’re meant to be. You will grumble and fret, but take each day at a time, and before you’ll know it, you’ll be where I stand now – at the brink of clinical clerkship, anxious and excited at the same time.

I hope this year will be good to you, and I hope to see you along the way.

Majesty

Mt. Pulag It was on a day like that when my father’s notion of the whole being greater than the sum of its parts moved from my head to my heart. The view from my sycamore was more than rooftops and clouds and wind and colors combined.

It was magic.

And I started marveling at how I was feeling both humble and majestic. How was that possible? How could I be so full of peace and full of wonder? How could this simple tree make me feel so complex? So alive.

Flipped by Wendelin Van Draanen, 2003 December 20, 2014. Sunrise on the summit of Mount Pulag, Northern Philippines

Surviving Medical School: The Second Year

I write this entry with these people in mind: my unborn child, who [might] consider being a physician someday, for my future students [mwahahahahahaha!], and for myself, that I may be reminded of who I was as a student. This is the second part of the series. 

It’s a Marathon, not a Race

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I wrote earlier that going to medical school is like running a seemingly never-ending marathon. In the second year, you will feel out of breath, out of strength, and out of willpower. This is normal, and you’ll experience it every once in a while. But if you took my advice and took care of yourself and your studies, you’ll be very surprised at what I have to say.

The Parable of the Snowball

I will never forget the advice told to my college roommate by his uncle, a medical doctor:

Take the basics seriously.

I was told how his uncle regretted not taking the first year subjects seriously, and how he struggled with catching up on the higher subjects. I would have to say that this advice is one of the best I followed, and I wish to emphasize this with a parable.

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On a mountaintop, a boy rolled over two snowballs. One snowball rolled downhill and became larger in size. It unfortunately slowed down when it hit some rocks, and stopped completely when it hit a tree. The other snowball rolled resiliently, and despite opposition from jagged rocks, it accumulated more snow and turned into a mighty avalanche that carved the mountainside a path of destruction.

Moral #1: Avalanches are bad for your life.

Moral #2: During the second year, I’ve found out how Medicine is like rolling a snowball on top of a mountain. When you begin the path towards becoming a doctor, you start out as a tiny little snowflake. During the first year, you accumulate the language and grammar of medicine, just as a snowflake rolls over more snow and turns into a snowball. Eventually, this turns into a powerful avalanche  that becomes unstoppable.

A practical illustration would be that during a subject you will take in second year, Pathology. This subject builds upon the knowledge you have of Histology and Physiology, and some Biochemistry. If you don’t know what a kidney looks like under the microscope, and you don’t know the three phases of renal physiology, you will have a difficult time understanding why a kidney looks weird in a case of renal failure.

Practical Tips Section

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I realized that my posts up to this point aren’t really about practical stuff for medical school. Hehehe. The reason is that no two medical students learn the same way. These are some techniques I’ve come up so far to learn medicine effectively and efficiently. My disclaimer is that I’m more of a visual-kinetic learner, but I’ll put in some feedback from audio-learner friends:

  • Take care of yourself: body, mind and spirit. This is the foundation that you will build your character as a professional.
  • Know what you don’t know: I’ve once ploughed through a chapter of a book without understanding a single word of it. Never again. I’ve learned that when I don’t understand something, stop, look for the concepts that I don’t understand, review those concepts, then continue learning. It’s no use reading the different mechanisms of diuretics if you don’t know the renal pumps.
  • Write stuff down!
    • For processes (such as the RAA cascade or the fetal circulation), you can use flowcharts to illustrate how things are interconnected. This really comes in handy during Pathology, where you can see the disease processes simultaneously. Also works great for Pharmacology, for learning the modes of actions of drugs.
    • For info-overload subjects, use tables! This especially comes handy for Pathology, where’ you’ll be asked to compare the different types of cardiac failures (Left vs. Right, Systolic vs. Diastolic) and the different types of cancers (the bane of every medical student).
    • For memory-retention, use index cards. This is especially useful for information that requires one to memorize numbers *shivers* such as equations for Epidemiology, Pediatrics, and Medicine. I also use index cards to summarize some chapters from Harrison’s such as “Approach to a Patient with Rash”, writing the important points to be found when faced with a patient with a rash (Number one: watch out for meningococcemia!)
  • Say concepts aloud: my audio-learner friends tell me that in order to learn, they sometimes talk to themselves aloud to get aural feedback. They also said that they like listening or talking to people about the information they need to learn.
  • Realize that there are a ton of material that can help you learn!
    • YouTube, and other Video sharing sites: can’t understand a concept? Look for videos! I learned the intricacies of the renal countercurrent exchange mechanism *puts nerd glasses up* that way.
    • Board Review Series, “Dummies” books, etc.: I remember in Biochemistry that I understood nothing reading up on the Central Dogma on the prescribed text *puts nerd glasses up*. So I read a simplified book on Biochemistry. When I attempted to read the prescribed text again, I understood it. Disclaimer: simplified books are no substitute for the big books but are a great place to start if you have any difficulty.
    • Your colleagues: this includes your medschool friends and your teachers. A medical student is not a John Rambo cutting through the vast forests of medical knowledge. A medical student is a part of a community that works together for the advancement of medical knowledge.  It’s better to look like a fool asking a question than doing a foolish action that could cost someone’s life.
  • Practice makes perfect: Throughout second year, you’ll learn skills that will help you diagnose disease. Skills are attained through constant practice. I practice my physical examination skills by checking up on my father every other semester; to my unborn child, I’d be willing to be your dummy.
  • Expose yourself to experiences and opportunities: During the second year, you’ll start doing paperwork (at least in the medical school I’m attending), which, while it adds to the workload, exposes you to the drama of the human condition. There are some things that my patients taught me that aren’t in the books. There are also conventions and medical missions you can participate in to hone yourself further.
  • “See one, do one, teach one”: This is a tenet of Surgery, in which one progresses from being a passive observer, to an active learner, to a teacher when learning surgical skills. The ultimate form of learning is teaching. Help others understand a concept that they have a difficulty in. After all, our professional oath exhorts us: I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.”

Learn to be a Doctor, not Study to be one

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There’s a fine line between studying and learning. Studying, according to the MW dictionary is “the activity or process of learning about something by reading, memorizing facts, attending school, etc.” Learning, on the other hand is “to gain knowledge or skill by studying, practicing, being taught, or experiencing something.” On these definitions, one can discern that the former is a passive process and the latter an active one. Strive to be the latter.

Let’s face it: medicine is a competitive profession. In pursuit of good grades and high marks in order to secure good training programs, I’ve seen how the pursuit of knowledge becomes a rat-race in which only one person wins. Medicine should not be like this; it is a profession where teamwork is of utmost importance. The foe of an aspiring doctor is not the subject matter; it can be learned. The foe of an aspiring doctor are not the marks of his peers; it won’t affect him in any other way anyway. The foe of an aspiring doctor is the self.

It’s quite existential, but second year is a continuation of the struggle against yourself. You see in your everyday medical school life forks in the road that diverge into paths that you will never cross again: “Will I spend 2 hours discerning the intricacies of the protozoa, or will I spend 2 hours playing this awesome video game?” “Will I go out this weekend or will I use it to learn the difference between the different types of cardiac drugs?” I’m not saying this to tell people to become hermits, only to emerge into medical prodigies without a social life (read the first post again); I’m asking you, a future doctor, to make choices. “To be a doctor, will I study, or will I learn?”

Keep going towards your dream! I’ll see you along the way.

Concept

ConceptJonas hesitated.

“I certainly liked the memory, though. I can see why it’s your favorite. I couldn’t quite get the word for the whole feeling of it, the feeling that was so strong in the room.”

“Love,” The Giver told him.

Jonas repeated it. “Love.”

It was a word and concept new to him.

The Giver by Lois Lowry, 1993

March 31, 2009, in a messy room

What I Want in a Teacher

I’ve always wanted to be a teacher. I’d be a Social Sciences Professor who’d rave and rile my students into opinionated individuals. My dream is not but a passing melancholy; one day I will be a teacher.

I’ve had the honor of being under the tutelage of great teachers in my life. I write this entry while I am a student that I may never forget what qualities such great people had. I aspire to be such when I realize my dream. This list is in no particular order.

1. Competence in the Field

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I think the foundation of successfully teaching is knowing the subject matter itself. This is what differentiates a teacher from any other individual. Someone may be nice, good natured, and kind, but that’s just the base where one adds other qualities that make the person stand out, or in this case, a professional.

When I speak of competence, I do not only desire a teacher who knows the inner workings of the mitochondria (the “powerplants” of cells) ; I want a teacher who applies such knowledge clinically in all aspects. I once had a teacher who always made my jaw drop when she explains those tiny details you miss but are very crucial for patient care.

I once took care of a baby with Biliary Atresia. Children like them have bloated abdomens (ascites). When she asked how my patient’s breathing was, I was stunned. I didn’t consider that fact. She explained that the condition can cause difficulty in breathing because it can mechanically compress the lungs when the child is lying down. So the best move would be to put the child in a side-lying position to ease the breathing. Bam. Competence at its finest.

Competence is a dynamic quality that must be constantly developed. I want a teacher who maintains competence by practicing the profession, taking continuing education courses, keeping up to date on the literature, and those things I’ll *probably* be complaining about in the future.

2. Ability to Communicate Well

Communication

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All knowledge is for naught if a teacher is unable to communicate ideas effectively. In retrospect, the best teachers I had were those who had the ability to make me understand things I didn’t want to understand.

Communicating ideas is in a way, selling these ideas. Communicating effectively requires getting the attention of the student, stoking the flames of interest, and leaving the student craving for more.

The best ways I find effective in communicating ideas from great teachers are:

  • Providing Analogies. Instead of saying that a heart attack occurs secondary to a block in the coronary arteries by an emboli, a teacher can liken it to a bad traffic jam (or a pile-up) that disrupts the flow of supplies. From that concrete image, a student would be able to translate it into an abstract thought.
  • Telling stories. I had a Psychiatry professor notorious for this. She would tell the natural courses of the diseases of her patients, and through these vignettes, I was able to understand the diseases better than reading the prescribed texts.
  • Analyzing and Correlating. An adage I picked up through the years: “Analyze, don’t memorize; correlate, don’t reiterate.” It is one thing to provide facts, but it is another to transform these facts into tools one can use. Besides, I think that it is by analysis that one can discard useless information and better “memorize” concepts. Learning is further strengthened by correlating ideas with one another, which forms a “web” of concepts that mutually strengthen each other.

3. A Person of Noble Character

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I mentioned awhile ago that being “nice, good natured, and kind” are the base where other qualities and abilities are added. Nobility far exceeds these aforementioned traits. It is hard to define what a noble character is – so I will just describe what a noble charactered teacher made me feel.

These are teachers, when I meet them, I feel that I can trust. When I approach them, they welcome me and  take time to hear me out. When they answer, it is with equal curiosity as to the manner I inquired; they are not condescending. When out of the classroom, they smile and greet their students, a great bonus if they know our names. When I think about them, I want to be just like them. When we part ways, I feel afraid, but incredibly inspired to be better.

I guess for my future self, the closest concept would be the Golden Rule. Do that which ennobles the self and others.

4. Strives for Excellence

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A teacher becomes outstanding when the students feel that they are  in school to become better people. It’s one thing to treat teaching students like a factory, and another to help every student maximally achieve their potential.

I want a teacher who continuously grows and becomes better, and who doesn’t accept mediocrity from the students. I want a teacher who says bluntly: “You’re not living up to your full potential. I know you can do better, but you just don’t want to.”

And lastly, on the flip side…

5. Never Forgets What it Means to be a Student

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Often I find teachers who act all high and mighty with their students. They forget that they, too, were those same scared clerks who didn’t know the difference between that crumdumgeon Nephrotic and Nephritic Syndrome (it’s the spelling. DUH.) A teacher always remembers their roots, and accept, that they too, are students who are also learning and making mistakes.

I remember one instance when I  taught a strict professor a lesson. She was then helping a classmate of mine collect a urine sample from a bedridden old lady in the ICU. After all preparations were done, I noticed that they didn’t drape the cover curtain around the patient, so I just walked over and closed it for them. I heard her saying “Oh yeah… [we forgot that detail].” Mind you, I love that professor, but boy, was it sweet.

Those who can, teach!

5 Lessons Learned From Jogging

The more I learn about Medicine, the more I’m becoming a hypochondriac. I guess that’s a good thing though, since I’ve started jogging again. Here are 5 lessons I’ve learned from jogging.

1. Set Goals

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I don’t know who said it, but he or she said that “a goal set is half the work done.” To set the intangible goal is as important as attaining the tangible product. This is a fact that is often overlooked by people, who in their zeal, just plow right into the fray without asking themselves the what’s, the why’s and the how’s of what they’re doing.

Before I began jogging again, I spent the first day on a walk around the path I’d be running. The walk took me about an hour. I began to feel the vastness of the distance I’ll be running, and doubt began to shake my resolve to even start jogging again. So I divided the course into parts, which were “marked” in my mind, and I resolved to conquer, a run at a time.

When I did a “test run”, where I would just run and stop whenever I felt like I couldn’t run anymore, I found that I finished less than half of the course, panting heavily and sweating profusely. It was a good start.

From that baseline, I began to increase my jogging distance with each subsequent run, and now I find myself running farther than I have ever ran before.

And now for a nerd moment. Physiologically, the body releases a chemical called Dopamine, a  chemical that is released whenever we accomplish something. This “feel-good” chemical makes us happy when we’ve eaten that cake – on the flip side, it also makes us happy when we finish our “Rocky” training montage of a day. By application, setting a goal, even a small one, like running the extra 5 meters makes one feel satisfied.

In the greater scheme of things, I find that setting goals (and gradually achieving them) helps me stay more motivated. When the run seems long and arduous, you can always take satisfaction that you ran an extra mile each time.

2. Consistency is Key

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Consistency should be a lesson taught to everyone at a young age. We’re taught to be honest, to be kind, to be diligent, but in a weird way, not so much on being consistent. Consistency is that virtue that creates powerful habits that break equally (if not more) powerful vices.

Nerd moment number two. The brain is an organ that is complex, but very stubborn. It is an organ that knows its potential yet feels very snug in the status quo. To challenge the brain with change will be met by strict opposition. Who hasn’t had the experienced of making a New Year’s resolution, then breaking it the next day? And who cringed at the obvious grammatical error of the previous sentence? That is the brain screaming at you to comment on my bad writing.

In jogging, being consistent made me get up from bed (the hardest part) and run. It was an internal voice that nagged me to run. It was the voice that told me: “Hey, you ran this far yesterday, so you can run further today.”

In life, consistency allows one to create habits. As of this writing, I find myself automatically putting on my jogging shoes every other day and just running. Mind you, in the past, the thought of going out and jogging was met with: “But I just wanna sleep/watch a movie/read!”

It turns out, I have the ability drag my sorry butt out of bed and make me do things that matter.

3. Everything in Moderation

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I usually jog alone. During jogging, there are two conflicting voices that battle in my mind: the “Keep Running!” voice and the “Hey, I’m tired. Ugh, your body hurts. Hey, let’s just watch a movie.” voice.

The experience made me realize that your greatest foe is also your greatest ally: yourself. We are limited by what we limit ourselves, and conversely, we can achieve as much as we want to achieve. Now, I don’t mean it in a way that says “I am an invincible being! Feel my wrath!”

I mean it in a way that says: “we should see limits as frontiers of what we can do, and of achievement as a gradual process of breaking limits.” That said, in jogging, you don’t just plot a course and run through it all – you might overexhaust yourself.

The two voices in my head are two sides of the same coin: the “Keep Running!” voice is a whip that inspires me, yet if I listen to it alone, I might destroy my body. The “Hey, I’m tired… blablabla” voice obviously, will keep me lazy if I listen to it exclusively, but it also has the wisdom of telling me to not kill myself in the pursuit of health.

Nerd moment three. The body is well made to handle stress. Take the lungs for example. During exercise, it is able to oxygenate the blood adequately, such that even during times of severe exercise, blood is close to a 100% saturated with oxygen. Then take the heart. It has the ability to pump blood to meet the demands of the tissues, and has several fail-safe mechanisms to keep it running under various conditions. Then take the muscles. Muscles have the ability to keep contracting and contracting as long as it’s ordered to. In fact, it still has enough energy to contract despite seeming tired. The one that limits the body then, is the brain, which feels pain and fatigue – but it doesn’t contract or do any of the work the lungs or the heart or the muscles do. But it’s an important organ that tells you not to kill yourself in the pursuit of health.

As I began to jog more consistently, I began to discover that I should listen to the two. In essence, there will always be two voices in your head – the angel and the demon. You need to listen to both – not just one.

4. Ditch the Distractions

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I’ve tried running with earphones on. Bad idea, in my opinion. For one, your safety will be compromised. You can’t hear a brakeless car heading your direction with the “Final Countdown” song blaring at your ears. It’ll also be too late when you feel your leg being gnawed on by a dog you didn’t hear chasing you. Second, it’s a surefire way to destroy that electronic equipment, especially if you sweat profusely. Third, it robs you of the experience of feeling and appreciating  your body.

The last statement may be due to my habit of running alone. It is during jogging that I get to commune with my body, feeling my heart beating faster, my lungs breathing deeper; my feet striking the ground and my muscles tightening.

Sometimes, before I jog, I latch onto one idea – it may be an experience, a problem, or a thought, and think about it during the run. Or, since this number has to have a nerd moment, I also ruminate on a concept in my studies when I run. I find that after running, I become enlightened on that idea I meditated upon.

5. The Last Stretch Syndrome

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In this post, I defined the “Last Push Syndrome”. The Last Stretch Syndrome is the opposite of that. It is when a person, in his desire to finish a goal, burns himself out in the process. These are periods of extreme zealousness that causes one’s downfall.

I usually feel this when I’m at the last mile of my run, when I see the electric post that marks my “finish line.” In the past, when I saw the post, I would make a mad dash towards it. Most of the time, it would lead to my downfall – I would tire out and stop at the sidewalk, and feel disappointed and confused.

I was *this* close. When I realized what I was doing, I began, at first, to look down when I saw that finish line. To achieve is a tempting thing, and it can cause one to lose focus. Over time, I managed to rein myself enough to keep the pace and finish the course.

In life, there will be many opportunities when goals seem to be in one’s grasp. However, one must not lose sight that it is the journey (or the run), and not the achievement, that makes us the better people we are today.

Nerd Moment Five: Jogging improves your cardiovascular health.

Surviving Medical School: The First Year

 I write this entry with these people in mind: my unborn child, who [might] consider being a physician someday, for my future students [mwahahahahahaha!], and for myself, that I may be reminded of who I was as a student.

The Question: Why go to MedSchool?

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Before we get down to business, there’s something that one must consider first before embarking on the journey of extended adolescence: why should I go to medschool? In my experience, there are two broad categories of people who go to medschool. The first group are the ones who go in it without the desire to be there in the first place. Such people are the ones who were “coerced” by their parents or peers, those who are in it for the title or the money or the respect that the profession gives. The second group are the ones who go in it and hunger to be there. These people literally saved up money from their past profession just to continue in their pursuit of medical knowledge. These people are crazy, but passionate in their intentions.

I can say that I am part of the second group. I can say to people: “I chose to become a doctor.” I’ve also met like-minded people who say the same statement, and we are all in a consensus that darn it, Med School is hard! If it’s hard for us who want to study Medicine, how much harder would it be for those who don’t? I’ve had many times when I asked myself: “What am I doing with my life? I could be [insert long list of things given up for medschool]…” But at the end of the day, my passion to learn sustains me. Talking to people of the first group, recurrent themes of surrender keep popping up. Not that we of the two groups differ in aptitude; we are of the same playing field, but what differentiates us from one another is that tiny little sliver of passion continuously urging us forward.

In my opinion, aptitude isn’t the prime determinant of a successful physician. No matter how high one’s grades were in college, what titles one may have acquired, and what grades one has during the course of the year, it will all fall to dust without the right attitude.

So take a breather. Which group do you belong to? If you belong to the first group, you may want to rethink your decisions before committing. Medical school is expensive, and it will have multiple trade-offs that might make you miserable in the long run. If you belong to the second group, rethink your decision. This decision will cost you five years of your life in study alone, and more years for specialization. Given my current status as a medical student, I am not in a position yet to say if it will be worth it. Talking to someone who is already a physician may be more helpful in this regard. Maybe I’ll write about it in the future.

Ready…

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Going to medical school is akin to running a marathon. A marathon that seemingly has no end. It’s easy to get burnt out if you don’t take care of yourself. I know, since I’ve burnt out lots of times already, for reasons I would like to share. There are areas in your life that you might neglect, thinking to yourself: “Meh, I’m studying to be a doctor. Those things can wait.” This is a big mistake, and doing so can cause you to have a 180 degree paradigm shift.

1. Take care of your health

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One of the greatest paradox of the health professions is that we fail to take care of ourselves. In my studies, I’ve learned that health is wealth, but I haven’t been practicing what I preach. The ability to learn becomes more effective if the body is strong. The link  of the body to the mind is complex, and while people say that things can be taken “mind over matter”, the body can only take so much. In the course of my studies, I’ve learnt that you can’t cheat your body – the stomach will grumble, the eyes will droop, and the muscles will fatigue.

So, do things that keep you healthy – eat right (and regularly), exercise (regularly), sleep adequately, and keep clean. Energy is in short supply in medical school, and getting sick, among other things, will sap that vigor.

Besides the maintenance of physical health, you must also consider your mental health. One of the best (and worst) things in becoming a doctor is becoming a hypochondriac, and you tend to become more careful with yourself. So you’ll know in yourself when you’re turning into a sociopath. Just don’t.

2. Network

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If it takes a village to raise a child, the same can be said for training to become a physician- it is not a battle fought alone, but a concerted effort by you, your family, your friends, your colleagues, and your patients. Support in the form of having someone to cry on, having people to party with, and people to help you learn is needed. Otherwise, you’ll go crazy.

3. Rest

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Did I mention that you need to sleep? Yeah, I did. You also need to rest every once in a while. That is not equivalent to sleep, by the way. By rest, I mean that which Stephen Covey defined poetically as “sharpening the saw” in one of his seven habits. Do something that you enjoy, may it be video games, going on dates, reading [non-medical] literature. Otherwise, you’ll go crazy.

Get Set…

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Hep! Before you take off, it’s important to know this: your progress in medical school will be uncertain. You will meet many hardships, and you will fail and you will succeed. But there is a way to succeed more, and fail less.

Sun Tzu, in his Art of War, once said: “If you know your enemies and know yourself, you will not be imperiled in a hundred battles; if you do not know your enemies but do know yourself, you will win one and lose one; if you do not know your enemies nor yourself, you will be imperiled in every single battle.”

The knowledge of oneself is as important as knowledge of the torrential material that one will pore over in the course of medschool. Sun Tzu’s adage made me realize how jumping gung-ho into the fray cost me. I’d like to share what I’ve learned:

1. Know thyself.

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With regards to this element, it is important to answer the following questions:

  • How do I learn?
  • What are my study principles?
  • Woooh! Time for a reward!

How do I learn? There is no general method of studying that will be successful for everyone. Everyone is unique, and what may work for one may not work for another. Consider first what kind of learner are you. Are you a visual learner, an auditory learner, or a kinesthetic one? Doing so will allow you to adapt yourself to the material in the best way possible. The following link can help you determine what your predilection to learning would be.

Next, know when you work best. Some people are morning larks; others are night owls. What’s important is syncing the time of your best energy output to productivity. This means also knowing in yourself when to call it quits. In my experience, studying further than what my energy would allow not only deprived me of precious rest, but were also material that I tended to forget anyway. But there’s a [legal] workaround with that, by studying smart.

What are my study principles?  Stephen Covey’s suggestion to stick to one’s principles has been a life-changer for me. Not only has it made me into a better person, but it has also stirred me in the direction of growth. I’ve extended his suggestion towards learning, and I’ve come up with three principles for myself that I adhere to:

  • Put in my 20 miles per day – a friend referred me to a link that made me realize the value of putting in productive work. The article discusses the triumph of consistency over brute force. I’d recommend that you read it.
  • Simplify everything – the human body is nothing but simple. I have a hard time memorizing, so it helps me when I simplify stuff. Some stuff I’ve learned along the way is writing diagrams and flowcharts for long paragraphs. Thus, the blood supply of the upper extremity can be “simplified” into a two-page flowchart.
  • Integrate and correlate – the good thing about studying Medicine is that recurrent themes tend to pop up, and recognizing these patterns will help you a long way in decreasing the volume of material you’ll need to commit to memory. For example, knowing the way blood flows in the heart not only strengthens your knowledge of cardiac physiology, but also of the anatomy of the heart.

Woooh! Time for a reward! Finally, you should know what kind of rewards make you happy. Let loose every once in a while. Knowing that you put your back into your work makes those rewards sweeter, and spurs you on.

2. Know thy enemy

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In medschool, you have but one enemy: yourself. Your dreams only go as far as how much you’re willing to put into it.  I’ve thought before that my enemy was the pressure of time or the mountains of knowledge that had to be conquered.  The greatest enemy of the medical student is the self.

 

This is the double edged blade of Sun Tzu’s adage – besides knowing your abilities, you should also know your weaknesses. I personally have the bad habit of procrastinating, and it has led me to cramming stuff I could’ve not crammed. I would always ask myself: “Why did past me not [insert things past me would’ve done]?” and say, “never again.” And proceed to blow it off the next exam. I also know in myself that my performance really sucks if I’m not well rested or if I’m hungry. Knowing these weaknesses, I compensate. For my procrastination, there’s my habit of putting in my 20 miles a day. For those physical limitations, I accept them and take care of my body.

 

The medical student will also face lots of frustrations along the way. There will be (many) days that you feel like you studied hard for an exam, but will fail. There will be times when you will feel overwhelmed with the work you’ll have to do. There will be lots of times when you will be tired and sick and fed up with the intangible dream of being a doctor. There will be days when you will be defeated. Yet there will also be small victories: when you learn the topography of the heart by heart, when you meet friends who share your burdens, when you discover the inner workings of pathology, when you have that first party after the first exam, when you lay your head to rest knowing you did your best. I’ve had many times that I was frustrated with myself. But I bounce back, knowing that despite every loss I’ve suffered, I’m still up and kicking.

 

The medical student is not a stranger to competition. The environment in medschool is competitive. There will be pressure to succeed.  To this, I would just like to quote: “The race is not always to the swift, but to those who keep on running.” I always like to think that spending time on thoughts such as envy or greed saps the brain of its much needed power. Better to use those energies for productive work than mulling over things that are negligible in the grand scheme of things.

Go!

As you set out on your first year of medical school, you’ll notice three things about yourself. First, you’ll crack jokes that won’t be understood by anyone. The stress will make you turn to humor and to your beliefs to keep you sane. Second, you’ll have a penchant for food. As I write this I feel hungry already. Third, you’ll feel like an idiot all the time. If you don’t, then you’re not studying smart enough.

 

So go! Go after your dreams to become a physician. I’ll be seeing you along the way.

Purpose

I see a beautiful city and a brilliant people rising from this abyss. I see the lives for which I lay down my life, peaceful, useful, prosperous and happy. I see that I hold a sanctuary in their hearts, and in the hearts of their descendants, generations hence. It is a far, far better thing that I do, than I have ever done; it is a far, far better rest that I go to than I have ever known.

– Charles Dickens’ A Tale of Two Cities, 1859

November 24, 2011. Returning home from a day’s work. Brgy. Libato, San Juan, Batangas

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    For people who love to think.

    Jian Carlo R. Narag, MD

    2005-2017