A Matter of Life and Death

“We're all human, aren't we? Every human life is worth the same, and worth saving.” 
― J.K. Rowling, Harry Potter and the Deathly Hallows

There have been a few times in life where I found myself asking "what is the value of life? how much is life actually worth?" and "to what lengths would I go to protect and keep a good quality of life?"

The more I study medicine and begin to mentally prepare myself for being on the wards and interacting with patients,  I can't help but to think how common these questions may or may not be to my future patients and ones that I may be asked when discussing the management and treatment of their condition(s).

During my holiday breaks, I tend to reconnect with the practical part of medicine by shadowing Physicians. Over the Christmas break, I was afforded the opportunity to shadow a very knowledgable and exemplary doctor and was granted the opportunity of seeing both the private and public advantages and disadvantages of medicine.

Overall, the main theme I noticed was what is the worth of a good healthy life. There were days during my shadowing opportunity where I sat across the table from ill patients, went on rounds and performed respiratory, cardiovascular and abdominal examinations and every patient asked the same question at the end of the examination "Doc! When will I be well enough to go home and how can I get better?"

It was hard not to realize that each patient, regardless of their personal diagnosis showed their determination to fight and to prove that life is worth fighting for and always sought to
ask ways in which they could improve their current prognosis. It was also encouraging to enter a room to have a patient exclaim how they were so proud because they were using the spirometer regularly (and the difference was heard in their lung sounds which was remarkable after completing Respiration course) and wanted us to watch as she demonstrated. It made me appreciate my health all the more, and gave me the sense of obligation to help these patients on their road to recovery although I was just shadowing.

As I prepared to begin this new semester in January, I made a few notes as to ways that I can improve my views on what things are worth, specifically life and how I can shape my thinking that will be beneficial for patients of the future.

WAYS TO VALUE LIFE TODAY

1. Spend Time Helping Others 

You may not agree with me, but there is a certain level of joy to be attained when you spend some time helping someone other than yourself or even a family member. 

Get involved in organizations at school, work or church that plan outreach events and functions where the community benefits. It will allow you to meet new people and be introduced to a new way of thinking and how you can serve others in small ways. 

When I help someone, I am usually reminded of the minute things I take for granted such as the opportunity of being educated in a foreign country and able to experience another culture. 

2. Take Time Doing Something That Makes You Happy

This is vital to mental health and balance. At times we all take on the "mommy role". You know where we tend to overwork ourselves and ensure that everyone is taken care of except ourselves. This can be damaging to one's psyche because we're not taking time to care for ourselves.

Make it a habit to take at least one day or an hour or two just to spend time with yourself doing something YOU enjoy.

Remember that song by Heather Headley- "Me Time?" (Don't worry go ahead and youtube it). Pencil that in your planner, and make it a habit to have a little me time regularly. Sure people may think you're crazy because you're kind of taking a day to date yourself, but who cares what they think, right?

Take time to read a new book, watch a movie, explore a new restaurant, take a day at the spa to be pampered, and the list goes on. Try it! The people you help will be thankful as well.

3. A.S.K. 

Taking a lesson from Matthew 7:7-8. Simply asking oneself and others what is life worth will give you an idea of how you and others view life.

By asking, we're opening the door to be educated and to allow ourselves to dig deeper in understanding how we can make our lives and that of others worth living. 

I encourage you to take a listen to the podcast entitled  "Worth" which got me to delve into the questions "what is the value of life?" and "how do we value the life of another?" and also read the following article that was published on KevinMd entitled  "Being a patient made me a better Doctor and Physician Leader" . They both highlight the concept of worth and how as humans and even more so future physicians we should aim to treat others with the thought center that all persons deserve equal and fair service and that all life is valuable despite the preconceived notions and prejudices we may be exposed to or possess. 

Share your thoughts on the podcast, the article and on the value/worth of life. 

Image found on Piccsy posted by Wonders of the younger.

Lessons from Spotter Exam

“The only real mistake is the one from which we learn nothing.” 
― Henry Ford

Most times, I'm usually well prepared for my "spotter" examinations, especially those at the end of the shorter blocks. For those of you reading who may not be familiar, a spotter examination is a laboratory based exam specifically over Anatomy and Physiology in the first 6 blocks of medical school and strictly Anatomy in the last semester of second year.

There are jars, radiographs, histology slides, micrographs, models, laboratory instruments, wet specimens and plastinated specimens that are all fair game for the examination. Questions range from simple identification of a pinned or labeled structure and give a feature or function of it, to naming the innervation of and vasculature of the pinned or labeled structure. Seems easy enough right? Well try doing that in a minute knowing that at any second a loud clock is going to sound, signaling time is up for that question and you need to move onto the next.

To date, how I prepare for these examinations have changed drastically from reviewing jars and writing out the function, innervation, vasculature of every pinned structure in every jar we covered in lab, to simply reading lecture notes, reading my textbooks and looking at the jars and the notes at the same time to familiarize myself with the anatomical layout of every organ covered in the five systems covered thus far. I must say, the more school progresses, and the more anatomy I learn, the easier it's becoming to see how each system is integrated with the next. I am now appreciating the curriculum's structure and embracing my education as simply adding more floors to the foundation which is these first two years of medical school.

For this spotter examination, I found myself waiting until the weekend before the exam to really concentrate on the fine details covered in lab and I must say I began to panic which didn't help my situation at all but made me waste a lot of time trying to motivate myself to study hard and effectively. This wasn't my best choice for preparation, but I was glad that I accomplished everything and had a thorough review (believe it or not) of all of the anatomy that was to be tested.

I would NEVER recommend last minute preparations for any examination, because the amount of pressure I felt had me on the fence contemplating throwing in the towel and just going to bed and studying hard for the final. Well you better believe I did no such thing, rather I had moments where I needed to take a break, regroup and sweep that overwhelming feeling aside and tough it out. After all I had no one else to blame but myself for my poor time management especially since during Carnival I had two days free where I could have just studied for Spotter.

Here are five things that worked for me during my last minute study sessions and what Spotter has taught me over the blocks on time management and effective studying.

1. Write It Down.

When you're faced with a lot of things that just must be done, it's vital to your sanity and overall productivity to write everything down that you must accomplish and then to rank them based on their priority. 

2.  Set A Timer.

Based on that priority list, set a timer to ensure you are making the most out of the short time you have to complete your list. There are all kinds of study apps out there to chose from such as Pomodoro timers for both iPhone and Android to Study Helper which allows you to set timers for your different tasks and to even schedule short bathroom breaks to lunch breaks and to create charts to gauge your most productive study days/weeks and months.

To prepare for my spotter a few weeks ago, out of the six lectures we had for the block, I missed one lecture, and so I reviewed all of the lectures I attended first. This worked for me because I was able to recall different points that were discussed in class and didn't have to spend a lot of time clarifying things I didn't understand as I had made notes post lecture. For the lecture and lab I didn't attend, it took me a little longer to get through the material because everything was new, and I had to reference my atlas and textbook as I read the lecturer's notes. By doing this I was able to cover all of the material from the lecture and from lab and then to spend a day just with slides and jared specimen while making the connection with the material I had read.

Whenever I study for spotter's now, I try my best to imitate the exam conditions by either testing myself and allotting a minute to answer or by reviewing the jars and coming up with my own questions based on spotter exams I've previously survived. 

3. Do NOT Multitask.

This relates to number 2, in that what you didn't get done during that timeframe will have to wait until you're finished with everything else.

For me this is a hard pill to swallow because if I don't accomplish what I had set out to do in a certain timeframe I find it very difficult to move onto the next task without thinking about what I did not complete. However, by moving on and tackling something else you are able to cover more ground. Crazy how that works right?

Whatever you do, do NOT  try and split up your time for one thing to work on two things at once. This can lead to confusion, false sense of accomplishment and understanding and it can very well be a waste of your limited time.

Focus on one thing in a certain timeframe and move on to the next when the time is up. 

4. Unplug From The World.

I learned this the hard way.

Whenever I sit down to study, like seriously study, I have to turn off my wireless connection on my phone, computer and iPad to avoid distractions. Then the door sign goes up, to ensure NO ONE disturbs me during my focus time.

I have found that being unplugged from the world and social media allows me to be more efficient and to get through my list of things to do in a timely manner and limits my multitasking. 

5. Keep It Real, And Plan.

I tend to set unrealistic goals and have high expectations whenever I find myself in a procrastination pickle, trying to do a mountain of work in a short time. This contributes to panic and my initial poor execution of tasks. So, I have to keep it real with myself and plan what will be done over the span of time I have. I literally have to allot the various tasks to specific timeframes, and pencil in what textbooks or notes I will need to get through the task, especially if I won't be studying at home (I tend to overpack and have to tug a bag full of books that I don't use whenever I don't do this). Once I set realistic goals I am able to focus on one task at a time and find it easier to check things off of my list. 

Time management is one thing you will learn from the inception of year 1 is vital to success in medical school. 

Try to work on it during your holidays, learn to rise early and to be effective during the morning hours. You will find that this will pay off during the semesters and you will be amazed at how much you can get accomplished during less hours and reduce the amount of time spent procrastinating. 

Let me know how you make your studying effective after long bouts of procrastination. 

Life as a D.O. Student

“Desires dictate our priorities, priorities shape our choices, and choices determine our actions.” 
― Dallin H. Oaks

I can recall a quote I've seen a number of times as I studied for my clinical laboratory science degree which said "you don't have to be a doctor to work in a hospital". True indeed. Even more true is that you don't have to  attend a traditional  medical school to be a very good or great doctor either. Depending on where you live in the world you apply, enter and graduate from medical school and attain an M.B.B.S, or you can attend a naturopathic school and attain an N.D. or attend an Osteopathic Medical School and attain a D.O. I hope you enjoy this post as  Morgan a current D.O. student and blogger at Heart Work sheds some light on the similarities and differences between a D.O and an M.D. as well as sharing with us some of her most memorable moments in her journey thus far in a Q & A styled interview. 



TNO Chronicles: Why did you choose a DO school over an MD one?
Heart work: For a couple of reasons….

I was first exposed to “DOs” when my cousins started DO school while I was still in high school. So, I knew quite a bit about DO school from them before I applied, just watching them go through the process and talking with them about their experiences. I liked the holistic approach to medicine that’s at the core of the osteopathic philosophy. We’re taught that “the body is a unit” and therefore everything is interrelated. That mindset, in addition to the manipulative treatments that we learn, just made sense to me. Ultimately, as I researched the profession more, and shadowed physicians, I knew that training as a DO would turn me into the kind of physician I hoped to become.

I was also a “non-traditional” medical school applicant. I majored in English literature and minored in biology as an undergraduate. Generally, Osteopathic schools are more accepting of those types of applicants, and I felt I was more competitive for the osteopathic application process. 

TNO Chronicles: What was the application process like for a DO school compared to that of an MD one?
Heart work: This was a while ago so some of the specifics I am a little vague on, but the processes are very similar. Both use application services; for MD schools its AMCAS and for DO schools its AACOMAS. Some schools may require you to send in additional letters or fill out an additional application form, but that varies. I sent in my primary application with AACOMAS, had my letters of recommendation submitted, and then waited to fill out secondary applications for individual schools and get invited to interview.

Regarding the undergraduate course prerequisites, the requirements are the same for DO and MD schools. The MCAT is also required. 

TNO Chronicles: How does DO schools differ from medical schools, or are they the same?
Heart work: DO schools follow the same syllabus and curriculum as MD schools. The difference lies in our osteopathic manipulative medicine training, or OMM. DOs, or osteopaths, spend additional time studying how to manipulate and treat the body with noninvasive techniques that range from simple soft tissue to adjusting bones! There really isn’t an area of the body we don’t know how to diagnose and treat.

TNO Chronicles: If you could go back to the application process for DO schools, what would you change, keep the same or modify and why? 
Heart work: I followed my pre-med advisor’s advice and cast a very wide net by applying to a lot of schools. Most successful applicants, from what I was told, apply to about 10-15 programs. I think I applied initially to around 17 – probably a little too many! However, I did not fill out all of those secondary applications. I submitted secondary applications to eight and interviewed at 4 schools. I don’t know if there is anything I would change, per se, but I could have been a little more selective at applying to schools.

TNO Chronicles: What advice would you give to someone wanting to apply or attend a DO school?
Heart work: Shadow a DO! And especially shadow a DO in the field(s) that you find interesting. The DOs I shadowed practiced family medicine, internal medicine, and emergency medicine. Different specialties lend themselves to osteopathic medicine differently. So it was nice to see how each physician tailored their osteopathic training to their practice.

I’d also recommend reaching out to current DO students, especially if you are about to apply and have questions about the application process, or questions about life as a medical student in general.

TNO Chronicles: To date, what is your most memorable medical school experience? How has it impacted your life?
Heart work: My most memorable experience this far was my first “real patient” encounter. Before that we just practiced on standardized patients (actors). The real thing was very different. (I am proud to say the first thing I ever did for a patient while wearing my white coat was catch vomit in a bed pan!) But it reminded me why I’m working so hard right now, and what all of this studying is for – which can be a difficult thing to remember when its 3am and you’re trying to make sense of glycolysis for the seventh time. ;)

TNO Chronicles: What is the COMLEX and how does it differ from the USMLE?
Heart work: The COMLEX is the DO board exam, the DO equivalent of the MD USMLE. Both exams test the same material – the curriculum covered during the first 2 years of medical school. Additionally, the COMLEX tests the OMM techniques and principles that we study as DO students.

However, as a DO student, we are still allowed to take the USMLE if we want to. For example, if I wanted to pursue a residency program that only accepted the USMLE, as some of them do, I would be allowed to take the USMLE in addition to the COMLEX.

TNO Chronicles: How are you planning on studying for the COMLEX and what advice would you give to others preparing to study for the USMLE?
Heart work: Since the step one (USMLE) and level one (COMLEX) both test the curriculum that we study during the first two years of medical school, doing well in school and trying your best to really understand and make sense of the material is the best preparation. With that being said, like anything, if you don’t use it, you lose it. There are topics I covered my first semester as a first year that I don’t really remember (anatomy of the human foot, for example). That’s where board prep programs come in – and there are a lot of them!

I chose DIT (Doctors in Training). My friends ahead of me in school used it and were happy with their results. I sat through the DIT spiel when they came to my school’s campus and their program seemed like a good fit for me. I’m using it right now to study for my board exam in June and so far I’m very pleased with my choice.

Kaplan also has a good prep program and I know a lot of other people use Boards Boot Camp.

Some of my classmates got hung up on choosing the “wrong” program, but I don’t think there really is a “bad” board prep program – if it didn’t produce results it wouldn’t last! I think that you’ll get out of it what you put into it. If you apply yourself and study hard, boards are conquerable. (Or so I’m told!)

What is absolutely essential is to use a Q bank (question bank). This really is imperative and statistically the more questions you do the higher your score is. I’m using the COMLEX Q bank (COMBANK) and the USMLE Q bank (U World). My goal is to get through the COMBANK at least twice (there are 2,000 questions total, just to give you an idea), and the U World Q bank once (also 2,000 questions). 

TNO Chronicles: What apps or websites do you find most helpful as a student?
Heart work: Every med student has their particular study tools they swear by, so this will vary from person to person. My favorites are:

Firecracker – an online question bank that lets you flag topics you’re currently studying. It’s a little pricey, but they usually have discounts at the beginning of the semester and it really is worth it if doing questions and seeing things repeatedly is how you learn. They have a website and an app, bonus. They have a free trial month that I’d recommend looking into.

Pathoma – this really is awesome. Seriously, almost everyone in my class uses it and loves it. Dr. Sattar, a pathologist from University of Chicago has put together videos on the highest yield path topics. If you’re having a hard time making concepts stick, this really is a valuable tool. It is also one of the ways I’m reviewing for boards. Also a little pricey, but the subscription lasts for a while, plus it comes with a book of notes.

I also use the Lange pharm flash cards and a set of medical microbiology flash cards by Rosenthal, which I find very helpful. The “Made Ridiculously Simple” series is also pretty good depending on the topic. I have the clinical neuroanatomy and clinical microbiology text that are solid resources in addition to my textbooks.

YouTube – this sounds dumb, but its absurd how many helpful videos that are out there! For example, today I watched a quick video on liver blood supply while I was studying liver path. I’m such a visual learner that being able to see things is extremely helpful! There is one video about drawing the brachial plexus in 10 seconds or less that I have probably watched about 20 times. There are also some really great anatomy review videos by Dr. Preddy from Touro University.

Those are the ones that I’ve found helpful! I also know a few people from my class who use Picmonic, which is a visual aid study tool that uses different pictures to help you remember facts about various topics. They have a free trial and it is something to at least look into.

TNO Chronicles: What are some of the things you do in your free time, other than study?
Heart work: Bake! I’ve become a little bit of foodie and love baking. Plus, there’s no better way to make friends at the library than to bring snacks. Hungry med students love people who feed them. ;)

I also work out when I can. I love being outside so running and hiking are favorites. And I’m addicted to Netflix just like the rest of the world and love being lazy while watching endless TV or movies.  

TNO Chronicles: What is a valuable lesson you've learned as a student thus far? 
Heart work: Medical school is very challenging. I remember everyone telling me that when I was applying – friends, advisers, and current medical students. So while I was “expecting” it to be challenging, it still came as a shock. There is just so much to know.  That old metaphor that gets thrown around comparing medical school to drinking out of a fire hose is completely true. So, I guess what I’ve learned is to lower my expectations a bit. Not the expectations I have of myself – to work really hard and commit to doing my best to master all of the concepts. But the expectations I have concerning things like my GPA. I am not a straight A med student. I’m just not. I work hard and pass all my classes, but I do not have a 4.0. And that’s ok. I think ultimately it has come down to me being at peace with what I accomplish when I know I’ve done my best, and not comparing my results to anyone else’s.

TNO Chronicles:  What motivates you to stay positive during your studies?
Heart work: This is such a good question and an important thing to get a handle on when you start medical school. It doesn’t take long to figure out that one thing med students are really good at is complaining. It’s shocking. There are people in my class I actively go out of my way to avoid because every time I run into them they’re miserable! And I get it. You’re studying all day –stressing out the only way med students can – and it’s easy to get in a “funk.” But still, don’t be that person! Find things that make you happy, and make time to do them!

I am blessed with a solid support system of friends and family back home. If I’m having a rough day, or even if I’m not, I make time to call the people who have always supported and encouraged me. I also have solid people in my med school circle I can commiserate with. ;)

There is also nothing like a good post workout high. So getting to the gym and moving those muscles we learn so much about (origin, insertion anyone?!) is another way I stay positive. Gotta love those endorphins!

But the biggest thing that helps me is my faith. I’m a Christian and I find so much peace knowing that God has gotten me this far and He will continue to see me through any and all trials that life brings. The verse that always winds up on my heart before every big exam is Psalm 94:18-19 “When I said ‘My foot is slipping,’ your love, Oh Lord, supported me. When anxiety was great within me, your consolation brought joy to my soul.”

TNO Chronicles: If you could sum up your medical school experience thus far in three words, what will they be?
Heart work: Oh boy, here it goes: challenging, consuming, rewarding.


I hope you all enjoyed Morgan's contribution as much as I did. I learned a lot of things I didn't know before regarding D.O.'s. Feel free to comment and post your questions. I'll be happy to hear your thoughts. 

-Morgan is a second year DO student who blogs over at Heart Work and who took the time to answer a few questions regarding her journey thus far as a student. I'd like to thank her for taking the time to be a guest blogger and to enlighten us about the DO path.