These
6 weeks have went by pretty quick. General consensus was that it was pretty
chill, but there was more work than I expected. On Friday we presented a
SOAP note (write up of history/physical/assessment and plan for a specific
problem) to one of the doctors at Cleveland clinic, which was pretty laid back.
We will be doing a lot of presenting cases on the island. Next week we have one
day at the cardiology clinic, OSCE final (practice for step 2 cs) and our final
exam on Thursday. I’ll stay in Miami for a couple days then it’s back home to
Bakersfield to start rotations at Kern Medical Center. I’ll be beginning with
family medicine.
Only
a week and a half left of IMF. Our typical schedule is 2 days of clinic
days, usually from 9-5. Most of that time is spent studying or talking
with classmates. On a lucky day we’ll see 4 patients, but usually
only 2-3 per day. This is because we generally only see the new patients,
as we are taking a complete history and physical. Otherwise the clinic is
very busy, and the doctor wants to go through the routine check-ups quickly by
himself.
The
good thing is that we are able to see pathologies that typically wouldn’t be
seen or heard in a primary care clinic. We’ve hear bruits, murmurs, seen
abnormal ECG’s, and abnormally high BP. I’ve also learned how to use the
electronic medical records system.
Las
Olas in ft. Lauderdale has an art fair 2 times per year. Artists from around
the country come to show off their work from woodworking to ceramics to a lady
who was literally selling toy frogs glued onto shells (that one confused
us).
One
artist was led a team of engineers, managed rental properties, and took classes
at university. In addition to this she created beautiful oil paintings, one of
the pieces took her 4 hours just to complete one of the eyes. I asked when she
found the time and she responded that she just doesn’t sleep much because she
feels a need to make time for all of her hobbies.
Starting
off in cardiology has been a good first rotation. We get to hear a lot of
pathologies such as bruits of the carotid artery, mechanical valves,
pacemakers, extra heart sounds, aortic stenosis, mitral regurgitation. So many
things I wouldn’t be hearing on a daily basis in another clinic. It’s
definitely a trial by fire event. Last week I got chewed out for not presenting
the patient in the manner our doctor prefers or reporting the wrong
finding on auscultation of the heart. I prefer an environment like this,
as I’d rather make these mistakes now before I’m the doctor of these patients.
The transition to clinical thinking has been more difficult than I
anticipated. It is no longer, just memorizing a mechanism of action, but
figuring out which symptoms correlate to how the patient is presenting and how
to ask questions in a manner to get that information from the patient.
For example, rather than asking if they feel shortness of breath, I
should ask how long do they walk before the feel short of breath and if that is
any different from before the precipitating event.
One
of the patients in our cardiology rotation stated that he keeps himself strong
by hittting himself on the arms vigorously. The 80 year old man
demonstrated by pounding his triceps with vigor. He also stated that
whenever he felt tired or sore he would throw himself on the floor then pop up
immediately. This man was full of energy, so whatever he was doing was
working, but probably not anything that I will try in the near future.
One
of the patients in our cardiology rotation stated that he keeps himself strong
by hittting himself on the arms vigorously. The 80 year old man
demonstrated by pounding his triceps with vigor. He also stated that
whenever he felt tired or sore he would throw himself on the floor then pop up
immediately. This man was full of energy, so whatever he was doing was
working, but probably not anything that I will try in the near future.
The
first week of IMF felt like a bunch of well intentioned, but mostly forgetable
lectures delivered from 8-5. It was tought to transition back to sitting
in a classroom for that long. Especially since I thought that many of the
orientation lectures could’ve been condensed into a powerpoint sent via e-mail.
I feel that a structured schedule can be bad because it leads to the
prolonging of the delivery of information. For example, if a speaker is
given 1 hour but only has 15 minutes worth of information to deliver they will
usually fill that extra time with fluff instead of ending early.
The
second half of the first week and second week was much more engaging. It
has been more work and reading than I had expected based on talking to previous
students. But it is a nice change of pace to actually be dealing with
patients on the cardiology rotation.
This
is an overdue post, but I passed the step 1 exam! 7 sections of 44 questions,
and 45 minutes of break is over. It was such a relief to be done and have
the freedom to not be studying or feel like I need to get back to studying.
There were definitely some questions that had me thinking I was sitting
down for a radiology or pathology specialty board exam rather than an exam for
second year med students, but I just mentally marked those questions as
experimental. This only worked for so long, as there’s no way half of a session
on the exam is experimental lol.
The
test didn’t seem that long, maybe because of the adrenaline or because of the
many practice questions I had done. I passed with a modest score of a 210,
which was a little lower than I hoped for but close to averages for family
medicine residencies, which I am hoping to match in. So overall I’m pleased,
and my score went up quite a bit from the first NBME practice exam that
correlated to a failing score.
After
spending months studying for the step, I decided to… surprise… do more
studying. But this time it was mixed in with some fun. I stayed
with a Spanish speaking family for a week and took 6 hours of class studying
Spanish in a town called Heredia in Costa Rica. The Sunday I arrived, we
took a trip to a beautiful volcan, Volcan Poas, which was a volcano in the form
of a crater. My host parents were a sweet 73 year old woman, her 79
year old husband who still worked near a waterfall. Everyday she would
cook breakfast consisting of tropical fruit and eggs or oatmeal. Then I
would take private classes with an instructor. Our sessions were fairly
casual, discussing verb tenses one moment and our shared disdain for Trump the
next moment. Then I would return home to chat and eat dinner with my host
family.
Over
the weekend, I visited a hostel near Jaco beach called, Riva Jaco. It was
a decent hostel, with bamboo tents and mattresses outside and bunk beds inside.
Most people staying there were Germany, a couple form Austria, a couple
of women from Costa Rica, and one person from Oregon. One couple from
Germany rode their bike much of the way from Southern California to Costa Rica
over the course of months. I couldn’t imagine riding my bike more than a few
miles, let alone through Central America, but they were the type of people you
immediately exude an adventurous personality. That weekend we went
clubbing and I did some surfing, and a lot of falling, at Jaco beach. I
returned to my host family for a day, then it was time to go back and prepare
for the trip to Miami for IMF.
I
started the day with a short run, prayer, and some sweet potatoes and eggs.
Then I was off to begin the most important test of my life. I
walked into the test room and attempted to suppress the pressure that
accompanies a test of this magnitude. Questions of what would I do if I
don’t pass, are you prepared enough? I changed my thoughts to thoughts of
how far I’ve came to get to this point, how much I’ve studied, and how I’m
proud of the effort I’ve put in prior to the test. I would be able to
live with any result I get whether favorable or not.
The
test is composed of 7 blocks with 44 questions each and 45 minutes of break
time (could be up to 15 min. more if you skip through the tutorial).
After opening the tutorial, I started to jot down some equations of the
“whiteboard” provided instead of scratch paper I wrote some of the epidemiology
questions and the “qiss qiq siq sqs” mnemonic then proceeded to the first block
Some in the blocks seemed like as if I was just doing another practice
exam, others contained images or content I wasn’t familiar with. It was
definitely a beast, but I feel like I passed it. I’ll find out in a
couple of weeks.
Once
I finished it was a relief just to be done with studying for a while and
putting an end to the anticipation. I then proceeded to pack for my week
long trip to Costa Rica.
