No, I didn't get an STD, I just spent the entire day reading about them. Seriously, I probably read 150 pages of information about STDs in preparation for working in STD clinic (which is the biggest clinic we have; it runs every morning).
In between articles and guidelines for STD treatments, I worked on other things, like my journal club presentation for tomorrow. Sure enough, on the paper to fill out to "guide our thinking" (read: questions we will be asked about), the last category was "impact on clinical practice". So I stared at that for awhile and then figured if I did something else, it would come to me. The article I chose was about how people order at fast-food restaurants when the calorie information is visible while they're in line, so I couldn't figure out what that would have to do with a clinical practice. When nothing came to mind, I asked Captain Peik (one of the interns) what I should put. After describing the results, he said "Oh. Just put 'require fast-food restaurants to post calorie information at point of purchase'." That's right, I can do that; this is preventive medicine. My 'clinical practice' has nothing to do with one patient, but rather one community (such as an Army base) and about making changes that would make everyone healthier.
And after I did that, it was back to STD reading.
Thursday, July 31, 2008
Latent TB clinic
Today was TB day in Preventive Medicine. After arriving at 7:30 and finding the office I share with the interns still locked (the lieutenant colonel who has the key forgot his Army ID at home, so when he got to the gate he had to turn around and get it and was a bit late), I sat in the conference room for awhile reading from the epidemiology textbook I have to get through this month. After my room was unlocked, I logged onto the computer and spent the next three or so hours reading the TB materials in the Preventive Medicine database. It would have gone faster, but I spent a lot of the time laughing with one of the interns, which somewhat impeded both our abilities to get work done.
Once I got those out of the way, I spent some time flipping through the various public health and preventive medicine journals we have in the office, trying to find an article for journal club on Friday. Journal club isn't nearly as much fun as it sounds--pretty much, the lowest people on the totem poles (so in this case, me and the residents) pick articles, describe the research methods and the results, discuss whether or not it's applicable to our current situation (so in this case, for preventive medicine in the Army), and point out the flaws in the research and reasoning. Then after we present that, the higher people on said totem poles (the attendings, and in my case, the residents) ask all sorts of questions and pretty much make me feel like an idiot. I couldn't find anything all that exciting in the journals, so I finally settled on an article on visibility of calorie content on menus and purchasing decisions in fast food restaurants in New York City. The conclusion: when people can easily see the calorie contents of the food, they're more likely to buy things with fewer calories. Subway was the winning restaurant on making those visible to the customers.
Anyway, back to TB... the afternoon was latent TB clinic, which is people who had a positive TB skin test, but don't have symptoms and don't have any findings on chest x-ray. They come to us, and we decide 1) if we believe the positive TB test, 2) if we want to treat them, and 3) what to treat them with. There's no requirement to be treated for latent TB (unlike active TB, which you not only have to be treated, but they have to see you take your medicine), so part of #2 is the patient's preference. If they decide to be treated, and we decide that's a good idea, they get isoniazid (also called INH) for nine months. They can't do this if they have abnormal liver function tests, are pregnant, take other medications metabolized by the liver, or can't go nine months without drinking. I didn't do much in clinic today; I pretty much shadowed one of the residents and watched closely to learn how to document things in AHLTA, the DoD's electronic medical record system.
I have no idea what I'm doing tomorrow, but I'm guessing it will involve reading from my textbook, preparing my journal club presentation, and researching my scoliosis project.
Once I got those out of the way, I spent some time flipping through the various public health and preventive medicine journals we have in the office, trying to find an article for journal club on Friday. Journal club isn't nearly as much fun as it sounds--pretty much, the lowest people on the totem poles (so in this case, me and the residents) pick articles, describe the research methods and the results, discuss whether or not it's applicable to our current situation (so in this case, for preventive medicine in the Army), and point out the flaws in the research and reasoning. Then after we present that, the higher people on said totem poles (the attendings, and in my case, the residents) ask all sorts of questions and pretty much make me feel like an idiot. I couldn't find anything all that exciting in the journals, so I finally settled on an article on visibility of calorie content on menus and purchasing decisions in fast food restaurants in New York City. The conclusion: when people can easily see the calorie contents of the food, they're more likely to buy things with fewer calories. Subway was the winning restaurant on making those visible to the customers.
Anyway, back to TB... the afternoon was latent TB clinic, which is people who had a positive TB skin test, but don't have symptoms and don't have any findings on chest x-ray. They come to us, and we decide 1) if we believe the positive TB test, 2) if we want to treat them, and 3) what to treat them with. There's no requirement to be treated for latent TB (unlike active TB, which you not only have to be treated, but they have to see you take your medicine), so part of #2 is the patient's preference. If they decide to be treated, and we decide that's a good idea, they get isoniazid (also called INH) for nine months. They can't do this if they have abnormal liver function tests, are pregnant, take other medications metabolized by the liver, or can't go nine months without drinking. I didn't do much in clinic today; I pretty much shadowed one of the residents and watched closely to learn how to document things in AHLTA, the DoD's electronic medical record system.
I have no idea what I'm doing tomorrow, but I'm guessing it will involve reading from my textbook, preparing my journal club presentation, and researching my scoliosis project.
Wednesday, July 30, 2008
Computer training
Today, I had the fun and exciting (that's sarcasm) experience of training on the computer systems used around Madigan. We were to report to the classroom at 0800, and expect to be there until 1600. We were less than thrilled with the idea of eight hours of sitting in front of computers learning what buttons to push to see lab reports.
Fortunately (or unfortunately; I haven't decided yet), I didn't have to be there for the first hour, which was training on Essentris, the inpatient system (I don't see patients in the hospital in preventive medicine; it's a bit too late to prevent anything at that point). I've also used Essentris at OSU, so I already know the system. The unfortunate part was that they didn't tell me this until I had already arrived in the morning, so I missed out on what could have been an extra hour of sleep. So I figured I'd use the time to go to the PX and buy some stuff I needed (such as a black backpack, green highlighter, pens that fit in my ACU pen pocket, etc). Well, I learned after walking across the Madigan parking lot, driving across base to the PX, and walking across that parking lot, is that the PX doesn't open until 0900. Sigh. Such is life.
After returning to Madigan empty-handed, I sat in the computer classroom for a couple of hours before lunch break, which was really too long considering the hospital cafeteria was right there and there was nothing else for us to do. So we occupied space in the cafeteria and talked for about an hour, likely to the annoyance of other cafeteria visitors. Then back in the classroom for more training. It didn't take as long as scheduled--we were out around 2:30--so I hit up the PX (which was open), went shopping, and headed over to Rachel and Jason's to hang out, hear about Tennessee, and listen to Jason's stories about Iraq (and eat their food, of course :)).
Pretty chill day, which will not be the case tomorrow. I have to review the CDC's guidelines on TB in the morning to prepare for TB clinic in the afternoon, while hopefully getting started on my project. We'll see how that goes.
Fortunately (or unfortunately; I haven't decided yet), I didn't have to be there for the first hour, which was training on Essentris, the inpatient system (I don't see patients in the hospital in preventive medicine; it's a bit too late to prevent anything at that point). I've also used Essentris at OSU, so I already know the system. The unfortunate part was that they didn't tell me this until I had already arrived in the morning, so I missed out on what could have been an extra hour of sleep. So I figured I'd use the time to go to the PX and buy some stuff I needed (such as a black backpack, green highlighter, pens that fit in my ACU pen pocket, etc). Well, I learned after walking across the Madigan parking lot, driving across base to the PX, and walking across that parking lot, is that the PX doesn't open until 0900. Sigh. Such is life.
After returning to Madigan empty-handed, I sat in the computer classroom for a couple of hours before lunch break, which was really too long considering the hospital cafeteria was right there and there was nothing else for us to do. So we occupied space in the cafeteria and talked for about an hour, likely to the annoyance of other cafeteria visitors. Then back in the classroom for more training. It didn't take as long as scheduled--we were out around 2:30--so I hit up the PX (which was open), went shopping, and headed over to Rachel and Jason's to hang out, hear about Tennessee, and listen to Jason's stories about Iraq (and eat their food, of course :)).
Pretty chill day, which will not be the case tomorrow. I have to review the CDC's guidelines on TB in the morning to prepare for TB clinic in the afternoon, while hopefully getting started on my project. We'll see how that goes.
Tuesday, July 29, 2008
First day at Madigan
Today I began the fun and exciting adventure that is a 4th year HPSP student on Army rotations. For the first time ever, I put on my ACU (Army Combat Uniform) in its entirety (when I went through Officer Basic Course, we were still in the old BDU, or Battle Dress Uniform). Of course, I had a brief panic attack thinking that I had the flag on the wrong arm, but it was all good.
I left really early from Ann and Norm's to give myself enough time to get a visitor's pass and get through the gate... that was a mistake. After more than half an hour at the main gate, they finally called my number and I handed over my proof of sale and proof of insurance for the car. The lady at the counter looked at it, and then told me that if I have temporary tags, I don't need a pass, I can just show my ID and get in. That would have been helpful half an hour before! So, I ended up being five minutes late for in-processing. What a great first impression.
Fortunately, I in-process with the Graduate Medical Education people, not the Preventive Medicine people, so they'll never know. There were three of us who are doing the rotation without orders (called non-ADT, or non-Active Duty Training), so we filled out our papers pretty quickly and then were done, so we went and got our hospital ID badges and white coats. I won't wear my coat (they don't wear them in Preventive Medicine), but it was an interesting novelty to check out a long white coat, instead of the short med student coat that I've been using for the last three years (we aren't allowed to wear the coats from our schools while on rotations in Army hospitals). Anyway, after that, it was back into the car to drive to the Madigan Annex, where the PM department is located (it's in the old hospital, not the main hospital).
Since I haven't been trained on the computers yet (that's tomorrow, all day), there wasn't a whole lot for me to do, so they gave me a tour of the place and introduced me to the interns, one of whom I met last February at the American College of Preventive Medicine conference, and then I started researching my project for the month (picking a recommendation from the US Preventive Services Task Force and describing the recommendation and the evidence behind it; I think I'm going to do scoliosis screening for adolescents, which is actually NOT recommended by the USPSTF). I also met some of the third year residents, one of whom is an OSU grad--go Bucks! I did have the misfortune of informing him that Dr. Stang, one of our former associate deans, passed away about two months ago, which was hard for him to hear. Dr. Stang was a mentor to him, as he was to many OSU grads.
After a longish day of not doing much, I decided my boots weren't all that comfortable, so I went to the uniform shop and bought myself a new pair of boots, which are very nice. I think I've had more uncomfortable tennis shoes. Anyway, tomorrow is eight hours of computer training through the Graduate Medical Education office, and then we'll see what PM has in store for me after that. I think it's going to be a good month.
I left really early from Ann and Norm's to give myself enough time to get a visitor's pass and get through the gate... that was a mistake. After more than half an hour at the main gate, they finally called my number and I handed over my proof of sale and proof of insurance for the car. The lady at the counter looked at it, and then told me that if I have temporary tags, I don't need a pass, I can just show my ID and get in. That would have been helpful half an hour before! So, I ended up being five minutes late for in-processing. What a great first impression.
Fortunately, I in-process with the Graduate Medical Education people, not the Preventive Medicine people, so they'll never know. There were three of us who are doing the rotation without orders (called non-ADT, or non-Active Duty Training), so we filled out our papers pretty quickly and then were done, so we went and got our hospital ID badges and white coats. I won't wear my coat (they don't wear them in Preventive Medicine), but it was an interesting novelty to check out a long white coat, instead of the short med student coat that I've been using for the last three years (we aren't allowed to wear the coats from our schools while on rotations in Army hospitals). Anyway, after that, it was back into the car to drive to the Madigan Annex, where the PM department is located (it's in the old hospital, not the main hospital).
Since I haven't been trained on the computers yet (that's tomorrow, all day), there wasn't a whole lot for me to do, so they gave me a tour of the place and introduced me to the interns, one of whom I met last February at the American College of Preventive Medicine conference, and then I started researching my project for the month (picking a recommendation from the US Preventive Services Task Force and describing the recommendation and the evidence behind it; I think I'm going to do scoliosis screening for adolescents, which is actually NOT recommended by the USPSTF). I also met some of the third year residents, one of whom is an OSU grad--go Bucks! I did have the misfortune of informing him that Dr. Stang, one of our former associate deans, passed away about two months ago, which was hard for him to hear. Dr. Stang was a mentor to him, as he was to many OSU grads.
After a longish day of not doing much, I decided my boots weren't all that comfortable, so I went to the uniform shop and bought myself a new pair of boots, which are very nice. I think I've had more uncomfortable tennis shoes. Anyway, tomorrow is eight hours of computer training through the Graduate Medical Education office, and then we'll see what PM has in store for me after that. I think it's going to be a good month.
Monday, July 28, 2008
Half-marathon and beginning rotations
Kit and I ran a half-marathon (13.1 miles) in Camas this morning. It wasn't too big of an event--only a couple of hundred people, as opposed to some of the other races I've done, with 10,000+ runners. Not too bad, although it did rain for the first six miles or so, and there was a massively huge hill at mile 12 (I walked up it--I'm a wimp, and was a tired one at that). In the end, I came in at 2:02, which is about nine minutes slower than my best, and Kit came in at 2:23. Not bad for a first half.
He was less than thrilled with me, as I'm sure you can tell.
How I'm able to smile after this is beyond me.
He was less than thrilled with me, as I'm sure you can tell.
How I'm able to smile after this is beyond me.Anyway, that was pretty much all I've done the last few days. The parents went to Spokane for LeMaster and Daniels 100th year anniversary, and Alex left for Seattle on the 23rd (to get ready for the Olympics), so I had the house to myself until Kit showed up Saturday morning. I did a lot of reading, and that's about it.
Well, all lazy vacations come to an end, unfortunately. After dinner tonight I headed up to Tacoma (University Place, technically), where I'm staying with Ann and Norm for the month while doing a rotation in preventive medicine at Madigan. I in-process at 7:30 tomorrow, which means I need to leave here by 6:30 so I can be sure to get to Ft. Lewis, get through the gate, drive to Madigan, park, and get to the medical education office by 7:30. Fun, fun.
Thursday, July 24, 2008
The new car
As promised, here are some pictures of my brand-new Volkswagen Jetta:
Yup, that's the odometer when I picked it up... 7 miles. A little bit insane. It's the basic model, but that has pretty much everything I want/need: cloth seats (with heated seats in the front), all sorts of airbags and safety features like that, telescoping steering wheel, climate control, CD player, a port for my iPod, duel transmission (which I doubt I'll ever use but Alex had a fun time playing with), cruise control, heated windshield (that'll be nice when I wake up to an inch of snow/ice on my car in the winter), and some other stuff I can't remember right now. I'm pretty excited about it, which is good, because I'll be paying for this until I finish residency.
Yup, that's the odometer when I picked it up... 7 miles. A little bit insane. It's the basic model, but that has pretty much everything I want/need: cloth seats (with heated seats in the front), all sorts of airbags and safety features like that, telescoping steering wheel, climate control, CD player, a port for my iPod, duel transmission (which I doubt I'll ever use but Alex had a fun time playing with), cruise control, heated windshield (that'll be nice when I wake up to an inch of snow/ice on my car in the winter), and some other stuff I can't remember right now. I'm pretty excited about it, which is good, because I'll be paying for this until I finish residency.Tuesday, July 22, 2008
It's done!
After a month of whining and complaining about how much I have to study for step 2 of the boards, it's done! I left the house at 8 this morning and drove to Portland (not so far in that I had to deal with rush-hour traffic), and was seated at a computer, which became my home for the next seven and a half hours. It was a joy.
Here's pretty much what happens: I go in, check in, make sure everything is in the computer correctly, listen to the rules, and follow one of the proctors to my computer. This is just at a testing site, not specific to the USMLE, so there are people there taking other exams--for example, I saw at least four family medicine doctors there for their recertification exams. So after signing in, there's a ten minute "orientation" on the computer, pointing out what each of the buttons on the screen means. Then the test begins. There are eight blocks of 46 questions, with an hour given for each block. There's also 45 minutes of break time to use at any point between the blocks. Any time that isn't spent answering questions goes toward the break time--you don't get more time on the next section if you finish one early. I'm a fairly fast test-taker, so I had time left over after each block, so I signed out and walked around the courtyard for a bit, cleared my head, and went back in. By the end, the proctors were very used to seeing me coming up and signing in/out. I did four blocks, broke for lunch, went for a bit of a walk (since I had so much break time built up already) and came back for my last four. By the sixth block, my brain was fried and I was doing all that I could to just read the questions each time instead of clicking a random answer, but I made it through. The score for this one will come in about six weeks.
In other news, I bought a car yesterday. It really wasn't planned. When Alex and I picked up the parents at the airport, Mom suggested going in and test driving some cars so I have an idea of what I'm looking for. Well, before I knew it, I was signing the paperwork for a 2008 Volkswagen Jetta. We're picking it up tomorrow, so pictures will probably appear sometime after that.
Here's pretty much what happens: I go in, check in, make sure everything is in the computer correctly, listen to the rules, and follow one of the proctors to my computer. This is just at a testing site, not specific to the USMLE, so there are people there taking other exams--for example, I saw at least four family medicine doctors there for their recertification exams. So after signing in, there's a ten minute "orientation" on the computer, pointing out what each of the buttons on the screen means. Then the test begins. There are eight blocks of 46 questions, with an hour given for each block. There's also 45 minutes of break time to use at any point between the blocks. Any time that isn't spent answering questions goes toward the break time--you don't get more time on the next section if you finish one early. I'm a fairly fast test-taker, so I had time left over after each block, so I signed out and walked around the courtyard for a bit, cleared my head, and went back in. By the end, the proctors were very used to seeing me coming up and signing in/out. I did four blocks, broke for lunch, went for a bit of a walk (since I had so much break time built up already) and came back for my last four. By the sixth block, my brain was fried and I was doing all that I could to just read the questions each time instead of clicking a random answer, but I made it through. The score for this one will come in about six weeks.
In other news, I bought a car yesterday. It really wasn't planned. When Alex and I picked up the parents at the airport, Mom suggested going in and test driving some cars so I have an idea of what I'm looking for. Well, before I knew it, I was signing the paperwork for a 2008 Volkswagen Jetta. We're picking it up tomorrow, so pictures will probably appear sometime after that.
Saturday, July 19, 2008
A few thoughts on The Boards
Since the second half of the second part of the lengthy process commonly called "The Boards" is quickly looming (we're down to 36.5 hours), I decided to post a few of my thoughts about taking multiple choice tests to determine whether or not we know how to treat patients. Here are thoughts numbers 1 and 2: 
It's a soul-sucking process of sitting in front of a computer clicking little bubbles all day, and to study for it, you sit in front of a computer and click little bubbles all day. Ugh. It could be worse, though; it used to be sitting at a desk with a number two pencil, filling in bubbles all day.
Yeah, I just happened to find that when Googling for the other comics, so it was added.
So there you go; my thoughts on the evilness of The Boards. Oh, and if all this nonsense weren't enough, here's anything fun fact: each part of The Boards costs $480-$1000. So yes, we are paying for the privilege of being tortured like this.
The countdown:
CK: 36 hours, 2 minutes
Obviously, when faced with real patients, they don't come with charts that say "What is the appropriate next step in treating this condition? A) Chest x-ray. B) Chest CT. C) FAST scan. D) Emergent laparotomy. E) Transfer to surgical ICU. F) Draw blood for type and cross." In fact, in many situations, multiple things are happening at once, and it really is impossible to determine which one is happening first. For example, when you have a trauma patient come in, they are getting IVs put in, fluids running, blood drawn for type and cross as well as cell counts and electrolytes, someone is listening to the lungs while someone else is examining the legs, etc. In multiple choice tests, you only get to pick one next thing that is happening.
Thought number 3:
It's a soul-sucking process of sitting in front of a computer clicking little bubbles all day, and to study for it, you sit in front of a computer and click little bubbles all day. Ugh. It could be worse, though; it used to be sitting at a desk with a number two pencil, filling in bubbles all day.And now a little Calvin and Hobbes:
Yeah, I just happened to find that when Googling for the other comics, so it was added.So there you go; my thoughts on the evilness of The Boards. Oh, and if all this nonsense weren't enough, here's anything fun fact: each part of The Boards costs $480-$1000. So yes, we are paying for the privilege of being tortured like this.
The countdown:
CK: 36 hours, 2 minutes
Friday, July 18, 2008
Plane tickets and such
I just spent $2800 on my plane tickets from LA to Port Moresby, Papua New Guinea, for my internation rotation from Dec. 27-Feb. 11. Yikes. I still need to get the tickets from Portland to LA, as well as from Port Moresby (the capital of Papua New Guinea) to Baimuru Station, from which I'll take a boat to Kapuna, the village the where the hospital is located. My credit cards are definitely going to be getting a workout in the coming months. On the plus side, I did just get approved for funding through OSU, which pays $2500 of my total cost.
All in all, it's going to be a busy year as far as travel. Here's the tentative plan:
July: okay, I'm not going anywhere in July, I'm just hanging out here in Camas
August: Madigan for most the month, with a conference in Albuquerque, then I'm driving back to Ohio at the end of the month
September: Washington, DC (well, Silver Spring, MD, but it's all the same)
October: I'll be relatively stationary in Ohio, but driving back and forth between Columbus and my rotation site (which is not Columbus)
November: Tripler, in Hawaii
December: Columbus, then flying home to Portland, then taking off for Papua New Guinea
January: Papua New Guinea
February: Papua New Guinea to LA for a conference, then up to Portland, then possibly to wherever I'm going to be doing residency to find a place to live, then back to Columbus
March-April: I'll actually be in Columbus for 2 whole months
May: moving my stuff to either Washington, DC or Tacoma
June: back to Columbus for a weekend to get hooded (med school graduation), then back to DC or Tacoma
July: start internship in either DC or Tacoma
So fourth year will be busy
All in all, it's going to be a busy year as far as travel. Here's the tentative plan:
July: okay, I'm not going anywhere in July, I'm just hanging out here in Camas
August: Madigan for most the month, with a conference in Albuquerque, then I'm driving back to Ohio at the end of the month
September: Washington, DC (well, Silver Spring, MD, but it's all the same)
October: I'll be relatively stationary in Ohio, but driving back and forth between Columbus and my rotation site (which is not Columbus)
November: Tripler, in Hawaii
December: Columbus, then flying home to Portland, then taking off for Papua New Guinea
January: Papua New Guinea
February: Papua New Guinea to LA for a conference, then up to Portland, then possibly to wherever I'm going to be doing residency to find a place to live, then back to Columbus
March-April: I'll actually be in Columbus for 2 whole months
May: moving my stuff to either Washington, DC or Tacoma
June: back to Columbus for a weekend to get hooded (med school graduation), then back to DC or Tacoma
July: start internship in either DC or Tacoma
So fourth year will be busy
Wednesday, July 16, 2008
Back in Washington
I arrived back from LA at about 10:30 last night, so I was home by 11 (I really enjoy being so close to the airport). After pretty much collapsing into bed last night, I was up again this morning for the same old routine: breakfast, run, shower, second breakfast, read cardiology, read practice cases, do practice problems, lunch, do more practice problems, go the gym, do more practice problems, dinner, and then contemplate doing more practice problems (which is the step I'm at right now).
I have learned a value lesson the last week or so: doing practice problems while sitting out on the deck enjoying the sunshine is probably not the best study technique I've ever come up with. First of all, I do much worse on the problems. Second, I never to think to put on sunscreen, so I'm getting some pretty interesting tan lines. Still, it's hard being cooped up in the house all day.
Good news: the dishwasher guy came this morning, and all is better again. Turns out it wasn't that big of a deal; for some reason, the detergent foamed up more than usual (I know I didn't add too much; it's hard to mess up on measuring an Electrosol tab), which hit some sensor in the dishwasher and blew the breaker. At any rate, it's working again, so I don't have to wash dishes by hand.
USMLE countdown:
CK: 5 days
I have learned a value lesson the last week or so: doing practice problems while sitting out on the deck enjoying the sunshine is probably not the best study technique I've ever come up with. First of all, I do much worse on the problems. Second, I never to think to put on sunscreen, so I'm getting some pretty interesting tan lines. Still, it's hard being cooped up in the house all day.
Good news: the dishwasher guy came this morning, and all is better again. Turns out it wasn't that big of a deal; for some reason, the detergent foamed up more than usual (I know I didn't add too much; it's hard to mess up on measuring an Electrosol tab), which hit some sensor in the dishwasher and blew the breaker. At any rate, it's working again, so I don't have to wash dishes by hand.
USMLE countdown:
CK: 5 days
Tuesday, July 15, 2008
USMLE Step 2 Clinical Skills
Yay! My step 2 CS is over!
After an abbreviated night's sleep on the world's most uneven mattress, I got all dressed up in my professional clothes and white coat and grabbed a taxi to the testing center. I ended up getting there about 7:15, so two of my fellow test-takers and I wasted some time by getting some breakfast and coffee (the breakfast was me, coffee was them). Then at eight, the whole thing started. Here's how Step 2 CS works:
So in all, twelve standardized patients, of which ten count (but we don't know which ten). We're graded on English speaking skills (which includes the ability to explain what we're doing in lay-person English), ability to elicit a complete history, physical exam skills, and differential diagnosis and ordering the appropriate tests. It's this magical, confusing process to come up with a grade, which I don't understand, but supposedly, in a couple of months, they'll let me know if I'm one of the 93% of US medical students who passes.
Because we're told to plan for the exam taking until 5 pm (you never know what kinds of delays might occur), my flight isn't until 8:40 tonight, so in the meantime, I'm hanging out at the USO at LAX, enjoying their free internet, free food, and the company of a whole bunch of 18 year old Marines playing video games.
USMLE countdown:
Last night I flew down to LA and stayed at just about the most sketchy hotel ever. Here's a picture of the room:
Yes, that's a giant painting of parrots. Anyway, I was only there for about eight hours, from 11 pm until 7 am, because the stupid shuttle took about an hour after I called to come pick up and take me to a hotel five minutes away. I was not in a happy mood by the time I arrived.
After an abbreviated night's sleep on the world's most uneven mattress, I got all dressed up in my professional clothes and white coat and grabbed a taxi to the testing center. I ended up getting there about 7:15, so two of my fellow test-takers and I wasted some time by getting some breakfast and coffee (the breakfast was me, coffee was them). Then at eight, the whole thing started. Here's how Step 2 CS works:
8 am: orientation ("use the otoscope to look in the standardized patient's ears"...)
8:45ish-11:15: see five standardized patients. For each, there is fifteen minutes to get a history and physical, including history of present illness, past medical history, family history, social history, review of systems, and focused physical exam. Then there's ten minutes to write up a note, come up with a differential diagnosis, and "order" up to five tests to try to diagnose the patient. Then it's time for the next patient.
11:15-11:45: lunch (catered sandwiches with way too much mayo. Yuck)
11:45ish-1:45ish: four more standardized patients
1:45ish-2ish: break
2ish-3:30ish: last three standardized patients
So in all, twelve standardized patients, of which ten count (but we don't know which ten). We're graded on English speaking skills (which includes the ability to explain what we're doing in lay-person English), ability to elicit a complete history, physical exam skills, and differential diagnosis and ordering the appropriate tests. It's this magical, confusing process to come up with a grade, which I don't understand, but supposedly, in a couple of months, they'll let me know if I'm one of the 93% of US medical students who passes.
Because we're told to plan for the exam taking until 5 pm (you never know what kinds of delays might occur), my flight isn't until 8:40 tonight, so in the meantime, I'm hanging out at the USO at LAX, enjoying their free internet, free food, and the company of a whole bunch of 18 year old Marines playing video games.
USMLE countdown:
CS: done
CK: 6 days
Sunday, July 13, 2008
Still here
Yup, I'm still here... and still doing more of the same. See, when I told you the life of a med student wasn't that exciting, this is what I'm talking about.
Kit came down this weekend (showed up Friday about noon), so that was a little bit of change from the usual nothingness. We had a barbecue on Friday night with Andrew and Megan, which mostly consisted of us putting burgers, corn on the cob, and salmon on the barbecue and wandering off to do other things. We're going to have to find a more efficient way to grill corn and salmon--both took about an hour and a half. After everyone was done eating and whatnot, I loaded up the dishwasher, started it, and went off to bed. Then Saturday I got up, headed down to the gym for my cross-training (swimming, exercise bike, and elliptical) and came back. When I opened the dishwasher to grab a bowl for my breakfast, I noticed there were bubbles everywhere. Very confused about this, I tried unsuccessfully to get the dishwasher to rinse again. That was about the time Kit wandered up to the kitchen and noticed the giant puddle that had been sitting on the hardwood floor probably all night. So, to sum it up, the dishwasher was clogged, water went everywhere, floorboards might be permently a bit warped, and there are very few places around here that repair Bosch dishwashers. Supposedly, someone is coming out on Wednesday to take a look at it. In the meantime, it's washing dishes by hand, something I loathe deeply and fortunately haven't had to do much of since the apartment I lived in first year.
Other than the dishwasher fiasco, it's been same old, same old, like I said earlier. Just a lot of studying. Kit and I were briefly considering going to a few car dealerships and test driving some cars, just to see what I like, but that didn't happen because I, again, started to panic about the fact that both of my exams are coming up way too quickly. In fact, I'm flying down to LA tomorrow night for my clinical skills exam... yikes!
USMLE countdown:
CS--2 days (well, 37 hours)
CK--8 days
Kit came down this weekend (showed up Friday about noon), so that was a little bit of change from the usual nothingness. We had a barbecue on Friday night with Andrew and Megan, which mostly consisted of us putting burgers, corn on the cob, and salmon on the barbecue and wandering off to do other things. We're going to have to find a more efficient way to grill corn and salmon--both took about an hour and a half. After everyone was done eating and whatnot, I loaded up the dishwasher, started it, and went off to bed. Then Saturday I got up, headed down to the gym for my cross-training (swimming, exercise bike, and elliptical) and came back. When I opened the dishwasher to grab a bowl for my breakfast, I noticed there were bubbles everywhere. Very confused about this, I tried unsuccessfully to get the dishwasher to rinse again. That was about the time Kit wandered up to the kitchen and noticed the giant puddle that had been sitting on the hardwood floor probably all night. So, to sum it up, the dishwasher was clogged, water went everywhere, floorboards might be permently a bit warped, and there are very few places around here that repair Bosch dishwashers. Supposedly, someone is coming out on Wednesday to take a look at it. In the meantime, it's washing dishes by hand, something I loathe deeply and fortunately haven't had to do much of since the apartment I lived in first year.
Other than the dishwasher fiasco, it's been same old, same old, like I said earlier. Just a lot of studying. Kit and I were briefly considering going to a few car dealerships and test driving some cars, just to see what I like, but that didn't happen because I, again, started to panic about the fact that both of my exams are coming up way too quickly. In fact, I'm flying down to LA tomorrow night for my clinical skills exam... yikes!
USMLE countdown:
CS--2 days (well, 37 hours)
CK--8 days
Friday, July 11, 2008
Still studying...
I know, I've been a bit lackadaisical about my blogging again lately, but in my defense, nothing new has happened. My life consists of running, studying, going to the gym, eating, and sleeping. That's it. But I did decide to include a picture of what I've been doing:
Yup, those are a couple of my books. The top one is my cardiology text, the bottom one is the CK cases book. They're getting progressively more and more colorful (each colored highlighter means something different, don't worry), but I'm not sure how much of what I'm highlighting is getting absorbed. I'm scoring slightly higher on my online practice problems, but not in the "wow, you're so great, everyone will want to offer you a residency position" range.
My USMLE countdown:
Clinical Skills: 4 days
Clinical Knowledge: 10 days
Yup, those are a couple of my books. The top one is my cardiology text, the bottom one is the CK cases book. They're getting progressively more and more colorful (each colored highlighter means something different, don't worry), but I'm not sure how much of what I'm highlighting is getting absorbed. I'm scoring slightly higher on my online practice problems, but not in the "wow, you're so great, everyone will want to offer you a residency position" range. My USMLE countdown:
Clinical Skills: 4 days
Clinical Knowledge: 10 days
Sunday, July 6, 2008
Studying, studying, and more studying
In case you couldn't tell from the title of the post, all I've been doing is studying. Well, not all, but it sure seems that way. Here's a brief run-down of my day:
-wake up, breakfast, etc
-long run (about 10 miles)
-shower, get dressed, etc
-read chapter about heart failure in the cardiology text
-read 3 cases from the USMLE CS Complex Cases text
-a set of practice problems (25 questions)
-lunch
-work on my personal statement for my residency applications
-read 15 cases from the USMLE CK Cases text
-2 more sets of practice problems
-submit my abstract for the American College of Preventive Medicine conference in February
-discuss my personal statement and studying for CS with Adrienne
-dinner
-1 more set of practice problems
-writing in my blog
I know, it's terribly exciting.
-wake up, breakfast, etc
-long run (about 10 miles)
-shower, get dressed, etc
-read chapter about heart failure in the cardiology text
-read 3 cases from the USMLE CS Complex Cases text
-a set of practice problems (25 questions)
-lunch
-work on my personal statement for my residency applications
-read 15 cases from the USMLE CK Cases text
-2 more sets of practice problems
-submit my abstract for the American College of Preventive Medicine conference in February
-discuss my personal statement and studying for CS with Adrienne
-dinner
-1 more set of practice problems
-writing in my blog
I know, it's terribly exciting.
Home
Okay, I am home now, and have been since Tuesday afternoon (the day, not the Moody Blues song), I've just been too busy/lazy to post anything.
After all our big plans of going hiking while on our cross-country drive, the first time we actually found somewhere to hike was Beacon Rock, which was about twenty minutes from the house. Oh, well. It was a good idea in theory.
During the drive, the fuel door on my car was getting progressively more and more difficult to open and shut, until it finally reached a point where it wouldn't close all the way. I resigned myself to the fact that I would have to put some money into fixing this, and made plans to go to a Nissan dealer after arriving back in Washington. Well, after our hike and about fifteen minutes from the house, my brakes started squealing, which just made me laugh, and I added it to the list of things that they had to look at when I took it in. So Wednesday morning, Mom and I took the car into the dealer, told them the situation, and then walked over to the mall to shop for things we didn't really need. A couple of hours later, we call the dealer and find out what the deal is. It was quite the list. 1) Some of the paneling/hinges on the fuel door were warped, and the whole assembly would have to be replaced. This is a custom job. Price: $390. 2) Leak in the oil pipe/tank (I was only half paying attention). Price: $140. 3) Leak in the power steering. Price: $160. 4) Front and rear brake pads are worn and would have to be replaced. Price: $440. Needless to say, I was a bit shocked and not all that happy about hearing that my car had over $1000 worth of necessary repairs, so I told him I needed some time to think about it, and we went back in to pick up the car and go home. Well, when we got there, he explained that most of the damage (brakes, leaky pipes, etc) were due to the excessive amounts of rust in the undercarriage due to 12 Ohio winters, where they salt the roads. So the car didn't have $1000 worth of repairs; it was actually much higher. So now I'm shopping for a new car. I'm going for a compact sedan, if anyone has any suggestions for which one I should get.
Other than the whole car debacle, not much has been going on around here. I'm actively (in theory) studying for the boards, step 2 of the USMLE (there are three steps; step 2 has two parts). I'm taking the clinical skills portion in LA on the 15th, and the clinical knowledge (multiple choice written exam) in Portland on the 21st, so most of my time these days is spent reading my cardiology textbook, my case books, and doing practice problems online. It's quite intimidating, and I don't feel ready for it at all.
After all our big plans of going hiking while on our cross-country drive, the first time we actually found somewhere to hike was Beacon Rock, which was about twenty minutes from the house. Oh, well. It was a good idea in theory.
During the drive, the fuel door on my car was getting progressively more and more difficult to open and shut, until it finally reached a point where it wouldn't close all the way. I resigned myself to the fact that I would have to put some money into fixing this, and made plans to go to a Nissan dealer after arriving back in Washington. Well, after our hike and about fifteen minutes from the house, my brakes started squealing, which just made me laugh, and I added it to the list of things that they had to look at when I took it in. So Wednesday morning, Mom and I took the car into the dealer, told them the situation, and then walked over to the mall to shop for things we didn't really need. A couple of hours later, we call the dealer and find out what the deal is. It was quite the list. 1) Some of the paneling/hinges on the fuel door were warped, and the whole assembly would have to be replaced. This is a custom job. Price: $390. 2) Leak in the oil pipe/tank (I was only half paying attention). Price: $140. 3) Leak in the power steering. Price: $160. 4) Front and rear brake pads are worn and would have to be replaced. Price: $440. Needless to say, I was a bit shocked and not all that happy about hearing that my car had over $1000 worth of necessary repairs, so I told him I needed some time to think about it, and we went back in to pick up the car and go home. Well, when we got there, he explained that most of the damage (brakes, leaky pipes, etc) were due to the excessive amounts of rust in the undercarriage due to 12 Ohio winters, where they salt the roads. So the car didn't have $1000 worth of repairs; it was actually much higher. So now I'm shopping for a new car. I'm going for a compact sedan, if anyone has any suggestions for which one I should get.
Other than the whole car debacle, not much has been going on around here. I'm actively (in theory) studying for the boards, step 2 of the USMLE (there are three steps; step 2 has two parts). I'm taking the clinical skills portion in LA on the 15th, and the clinical knowledge (multiple choice written exam) in Portland on the 21st, so most of my time these days is spent reading my cardiology textbook, my case books, and doing practice problems online. It's quite intimidating, and I don't feel ready for it at all.
Tuesday, July 1, 2008
Cross-country drive, day 3
Ugh. I am tired of the car and the constant sitting in it. We started before 8 again this morning and finished up Wyoming, a little bit of Utah, and into Idaho. Mom was in the passenger seat for both state crossings, and managed to get the signs in the picture, but from a distance, so they're pretty small, but she's making progress with the camera. I was laughing at her because the pictures Shane and Dayna posted from Danelle playing with their point and shoot camera turned out better than the ones Mom was taking. I'm too lazy to pull my camera out of my backpack and download the pictures, so they're not getting posted.
The nice thing about the states we crossed (and are still crossing) is that the speed limits were all 75, so we were moving, which makes the drive seem slightly less long and monotonous, even with the scenery never changing (with the exception of random construction zones, complete with signs and cones and closed lanes, but no construction workers). We did have a dust storm in Idaho while I was driving, which Mom also attempted to take pictures of, and that was pretty much the extent of our excitement.
Tomorrow we'll be home (finally!).
The nice thing about the states we crossed (and are still crossing) is that the speed limits were all 75, so we were moving, which makes the drive seem slightly less long and monotonous, even with the scenery never changing (with the exception of random construction zones, complete with signs and cones and closed lanes, but no construction workers). We did have a dust storm in Idaho while I was driving, which Mom also attempted to take pictures of, and that was pretty much the extent of our excitement.
Tomorrow we'll be home (finally!).
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