What did I do during M1 summer?

The summer is coming to a close and M2 starts next week.  Over the summer, I went on vacation to the Caribbean, which was a very relaxing time.  I went jet skiing, swimming, sat by the pool, went kayaking, ate a lot and slept a lot.  I left for the islands just after school ended, and it was one great week.  After returning, I had one week to get my things together again to move back to school, as I was about to start a summer research project with my medical school.

During this project, I would collect data some days at a clinic, and then do some reading, data entry, etc on my own time.  In addition, I had plenty of time to watch a whole bunch of movies, catch up on TV shows, and sleep some more.  I didnt do any studying for a good part of the summer.  I would drive up to see my family and friends almost every weekend.  I even went on a mini-vacation to Dallas for a couple of days to meet with friends and spend time with family.  But, for the most part, I spent it just relaxing and working on the research project.

I did start studying a little during the middle of the summer.  I would read a chapter in my biochem lippincotts book, or in the big Costanzo Physiology book.  I would make some flashcards of things that I found hard to remember, so that I have them ready if I ever needed them for M2 year.  I studied Behavioral Science from the BRS series, as this subject was taught all over the place during my M1 year, and wasn’t very cohesive.

I made a list of books (and bought some of them) for my “Step 1 box” in which I store the materials I’m going to use to study for boards.  I read up on the actual exam, what’s involved, and also looked through First Aid for the USMLE Step 1 book, to get an idea of the depth of material.  This usually keeps me on my feet and emphasizes the amount of work I will need to put into M2 year to learn the material.

Currently I’m in the process of moving to my new apartment.  The summer has been great for the most part, especially because I just took it easy.  I’m slowly getting into the mental state for next year.

Mobile Me

I recently got an Apple Mobile Me account, and its great!  I can add events like exams, meetings, group study sessions, etc on my computer, and it automatically sends it to my phone and the web, without any need for wires and cables.  I find it very useful; I believe it also syncs your notes, email and contacts. It took a little bit to set up, but after that, it works like a charm.  I highly recommend it.

iReason Rx: High school redux

Yup, that’s what medical school is all about, in social terms.  You will feel like you are in high school, and that pretty much sums it all up.  It all starts with orientation week, when you get to know people during the ethics lectures and the professor introductions.  Then, in the evenings, there are gatherings held at various bars on and around campus for a “social hour.”  During this period is when you will notice the nicest things about your classmates.  You will enjoy every moment of it.

Then, the grind starts.  You are in class 8-4, study from 6-11, lose track of your college friends, become frustrated that your family doesn’t understand why you can’t come home more often, start sneering at people in the hallways, start hitting on fellow classmates, rumors spread, exams hit hard, and before you know it, you are walking around smelling like formaldehyde, cutting corners to avoid certain people in the hallways, eyelids drooping while clutching your physiology notes, eating junk food and attending class at the crack of dawn with zombies fatter than you.

Due to all this stress, people need to vent somehow.  It happens through the spread of rumors and talking about people.  Since all you do is study and attend class, you will find that the majority of your conversations will center around exam material, about your classmates, and where the next drinking party is at.

The “high school” part stems from the conversations about classmates – one person says something to another, then that spreads to 4 people, and following this, you have exponential growth.  This really does happen – and most of the time, the actions that set off the rumors would never be considered a big deal if there wasn’t so much stress.  Let me give you an example.

In my class, there are roughly 5 groups of people – 2 of them are large groups of people, another group is rural/urban medicine program folk, still another is the MSTP students (MD/PhD), and finally the random creepy kids who hang out alone and are hardly present.  These are the cliques of our class.  It formed during the first few weeks of school, and has stuck ever since.  See someone from one group speaking to another, and BAM – there’s something to talk about over dinner.

Within my group of friends, a few of them decided to organize a little trip to the nearest large city, but decided not to tell others in our group.  Normally, this would not be a big deal as there probably were certain factors to consider (for example, car space, luggage, lodging accommodations, etc.).  However, in medschool, its a different story.  People starting scathing each other with their glares, sparks flew across dinner tables, thumbs frantically began dancing on cell phones, and an iron curtain was drawn between the two sides.  Now, there were 6 cliques in my class.

The funniest thing of all was that even though there was so much commotion regarding the subject, whenever members of the two groups were forced to be in the same area (example: anatomy lab), it was so silent that I swore I could hear the cadavers chuckling.  Nobody ever confronted the other as to why they weren’t invited, or anything of the sort.

In medical school, egos clash.  Conversations break. Friendships sink.  Unless you actively seek ways to do something about them.  You have to dissolve your ego in some situations and just accept a mistake when it wasn’t your fault.  You have to find ways to talk better to people, instead of saying things about them in their absence.  You have to confront people (nicely) and directly converse with them about a perceived issue.  You really should try. Medical school is tough as it is – but being good to people under stress is tougher.  Something tells me it’s not going to get any easier once rotations, then residency, begin.  The last thing you want to do is snap at your superior, or even worse, a patient.

What you make of your medical school experience is really up to you.  I wasn’t the greatest at interacting with people, but I’ve learned a few things about how to handle or dissolve certain situations I find myself in.  I hope to use this as I move on to M2 year.

Administering the survey

After the IRB application, training, approval, and pre-research preparation (see previous post) has been completed, it comes time to collect data.

This involved, for me, sitting at a desk in a clinic waiting room, with a small sign that encourages volunteers to approach my desk.  When someone does stop by, I would briefly introduce myself and the project to them, then hand them an informed-consent form and a survey.  Most people took about 5 minutes to complete it, and the majority were enthusiastic about filling out the survey.  Occasionally, people would frown and walk away.

The hardest part is to get people interested in your project and approach the desk.  The staff members in the department I was working were supposed to suggest to their patients to visit my desk and fill out a survey.  However, it doesn’t always go according to plan – those staff members become extremely busy, and patients don’t approach you.  My project did not involve any type of remuneration for participants as I did not have funding of that magnitude.  This made it exceptionally hard to attract people to your project.

Imagine walking into a clinic for an appointment – you are worried about your health, you are worried whether or not insurance will cover the visit (or the results of the visit), you have taken time off from work/school to make this doctor’s appointment happen.  The last thing on your mind would be to find out what that person is doing at the extra desk in the waiting room, let alone help with the survey project.  So, for those who did approach me (the minority of the participants), I am thankful.

For the rest, although I am still thankful, it came with a little bit of effort.  I had to strike up a conversation with those sitting closest to me, waiting to see a doctor.  I would try to steer the dialogue to favor their interest in my purpose in the waiting room.  This is how I would get the majority of participants – make small talk with them, establish rapport, give them a little background information about myself, and request five minutes of their precious time.

Collecting data is one thing, but analyzing them is the interesting part of the project – its what all scientists are most interested in – What are the results? How can we synthesize our findings into the current working body of knowledge? To what extent will these results be useful, and to what end?

I’m a couple of weeks away from starting my analysis, and will write about that experience as well, when the time comes.

Preparing to administer a survey research project

After IRB approval has been obtained, the next step is to set a starting date.  After this, a little preparation is required to start administering the survey at the chosen location.

First, copies of the actual survey needs to be made, along with copies of the informed-consent forms, letters to the staff of the department where the survey will be administered (so all the staff know what you are doing in their waiting room), and copies of the flyer to advertise.

In addition, you have to prepare a small sign to set on your table to attract people to your desk in the waiting room.  You will also have to obtain a couple of clipboards and a dropbox with a lock/key, where patients can deposit their surveys.

Next, you will have to attend a meeting with the hospital manager, the physician you are assigned to, the head nurse, and the research coordinators of the program through your college of medicine.  Here, you discuss how you will approach patients, what days and times the survey will be administered, where your desk may be placed in the waiting room, and the like.

Finally, someone from the hospital department where you are conducting your research will give you a tour of the facilities and the staff.

Once these responsibilities have been met, the survey administration can start.

Navigating the tangles of the Institutional Review Board (IRB)

For my summer (my last official one ever) between M1 and M2 year, I designed a clinical research project where I try to get a better understanding of why or why not, patients tend to exercise. My argument was that understanding this would enable healthcare providers to find different and more effective ways of conveying the benefits of exercise to their patients. It would essentially enable healthcare workers to address concerns that some patients may not necessarily feel comfortable asking, while gaining insight as to why some patients don’t exercise regularly. Arming oneself with this information can help the clinician convey the importance and value of regular excerise to patients, instead of simply asking them to pay a visit to the gym for health reasons.  Also, clinicians can gain a better idea of why patients who exercise do so, and incorporate this advice into conversations with other patients.

This is my first clinical research project, and I’d like to inform you of the process that’s involved, starting with the arduous task of fulfilling the mountain of IRB requirements.  IRB stands for the Institutional Review Board.  There is usually an IRB established for each institution that conducts research, and their main goal is to make certain that fair and ethical protocols are followed in the use of human research subjects.

IRB application involves a long, boring application that asks you to detail how you plan to collect data and secure patient confidentiality, the length of the project, and other details like available remuneration, etc.  It also demands an informed consent form designed by the investigator (the researcher), which details the rights and responsibilities of the subjects and the researcher.  Basically, IRB wants to make sure that the patient knows exactly what they are getting themselves into, the reasons why, the benefits and risks involved, and the like.  If deception is an integral part of the project, then IRB needs to make sure that the benefits from deceiving patients temporarily outweighs any harm that is caused by the deception.  IRB exists to make sure that research projects like the Tuskeegee study does not happen again.

After this initial application is submitted, it goes through a pre-review.  A member of IRB reviews your application to make sure it’s filled out properly, with all the required information, along with suggestions for improvement.  This process goes back and forth a few times, after which your application is ready to undergo official review by the IRB board.  You cannot start your project until and unless you get the final approval letter after this review process is complete.

How long does all this take? About 4 months for a simple project involving human research subjects taking a 5-minute survey (not involving any drug administrations or hospital stays, which I’d assume takes longer and is a more cumbersome process).  So, if you are looking to conduct research during your M1-M2 summer, you need to have submitted your project to IRB by early March.  Don’t forget it takes some work to fill out the application and design the study prior to seeking IRB approval.

Further, the approval process cannot proceed until and unless you finish the IRB required training, and provide the review committee with certificates of completion.  This includes a handful of IRB training modules that takes a few hours to read and complete, and a HIPAA training that is required to help maintain patient confidentiality.

After the IRB approval letter was granted, it took me a week to prepare before starting the project.  Since my project is pretty simple, I’d imagine it could take longer to prepare for a more complicated project.

What’s involved in preparing to conduct a survey research project?  That’s the topic of my next research-related post.

Is lecture helpful in medical school?

There’s the age-old debate among medical students, whether lecture is useful or a waste of time. Below, I present the major points of both schools of thought, after which I provide my personal experience with the matter.

“Lecture is useful” – People who religiously go to lecture do so, because they either find some benefit of attending, or they want to get the most out of their tuition fees. Others like the tradition of having a professor teach the material to the student, while giving the student a chance to directly interact with the professor.

“Lecture is a waste of time” – These people prefer to learn on their own; they don’t require formal instruction from professors to be able to master the material. They rely primarily on the lecture notes and slides posted online, using textbooks and boards-review books to supplement their understanding.

My experience with lecture – I have ventured out to both sides of the spectrum. I started off by going to lecture, but decided that I was so drained by the end of the day, that I had no motivation to study in the evenings. So, I came to the realization that I could squeeze more study-time during each day if I skipped lectures entirely, and study on my own. This strategy worked for me until the material started getting harder toward the end of first year. By that time, the amount of material we were responsible for increased, and the lecture notes and slides began to show much more detail than before. As you can probably imagine, I was having a hard time memorizing all the tiny details, and more importantly, I was having problems recalling all that information. I decided to start attending lectures again.

I found that professors would use very detailed slides during the lectures, but they would pinpoint on the screen, which material was high-yield and which was not. I started marking things that professors would refer to as “important” or “key” or if they use the blackboard to manually illustrate a topic on the powerpoint slide. I pleasantly found that this helped tremendously during my studying after lecture. I was able to focus my studies onto the major concepts and then fill in details if necessary. Further, I was able to mentally recall pictures, words, and descriptions that professors used while presenting the material – this gives your memory a boost while trying to remember some boring pieces of information.

You’re probably wondering how I am now able to study after lecture, but before I wasn’t able to. There are a few reasons for this. After taking a few exams, and understanding the level of detail we need to know for exams, along with the workload involved, I’m able to structure my studying along these lines, after lecture. This is much easier than trying to memorize everything thrown at you. Memorizing key points and facts, and understanding major concepts is more useful than memorizing everything on the lecture slides. Also, going to lecture helps draw a larger-picture for the day’s material, so when I sit down to actually study, I already have a framework to add onto.

For some classes though, I do not find it helpful to go to lecture. For example, I did not find attending Anatomy lectures useful all the time. The same with embryology lectures and histology lectures. I did go to a few, but I mostly studied on my own. You will find a balance between going to lecture and not, once you start medical school. Some classes will be very helpful, while others you can study for on your own. My advice is that you start by going to all of your lectures, and slowly cut out the ones you don’t have to go. Another word of advice: if you do go to lecture, make sure you’re not sleeping; be alert and awake because you don’t have even one hour of precious time to lose.

Things I wish I knew before starting medical school

1. Rankings don’t really matter unless you’re very serious about research

2. The need to apply earlier than I did (my AMCAS was submitted in August)

3. How expensive the application process would be (cost me close to $3G)

4. How time-consuming the process is (I could have taken an lighter course-load that semester)

5. Applying to your state school (in-state tuition!) should be done first

6. How long it would take to put together the final personal statement (took me 2 months!)

7. More about health-care politics

8. How to overcome procrastination

9. Getting into medschool is not the end-goal; it’s just the beginning.

10. How much material was really coming my way

11. There’s always bigger fish in the sea

12. How much drama there’ll be in the class!

13. Discipline to exercise regularly and eat a balanced diet

14. How to spend money and time more efficiently

15. How people’s perception of you change once they know you’re a medical student

16. How disturbed and sad I’d feel, looking at pictures in lecture, of individuals suffering from various diseases

17. Some material being learned pushes the brink of knowledge in that particular subject – professors don’t always have the answers

18. How professors treat you as though you’re their colleagues, rather than upholding the barrier between teacher and student (a pleasant surprise)

19. How useful my iPhone would be!

20. How creative I would need to become to mentally store and organize information

21. How quickly a day can pass by when you are focused on your work

22. How quickly you get hungry after your previous meal, while studying!

23. How much money I’d spend on Jamba Juice

24. How people’s personalities change under heavy stress

25. How sleeping at least 6 hours per night is important to maintain focus the following day  (unlike college, where I could get away with 4-5 hours a night).

Those darn pre-med requirements – are they really necessary?

When I was in college, I could never understand why I needed to know where to draw the little arrows and dots for the Baeyer-Villiger reaction mechanism in organic chemistry, or why I would ever need to know circuits or hydrostatic pressure from physics.  After all, I wanted to practice medicine one day, and I couldn’t see the reason why these were requirements to get into most medical schools.

As an first-year medical school war veteran, I can now understand to a certain extent, why these pre-med classes were important, and why so much emphasis was (and continues to be) placed on the undergraduate science GPA.  I thought I’d share some thoughts with you on the matter, concerning first-year material that I have come across.

Physics – Circuts and hydrodynamics are extremely important in understanding the basic physiology of the human body.  Circuts are important in appreciating cell physiology, where it’s comparison to cell membranes is highly valuable.  This includes setting up resting membrane potential, ion fluxes, and the Nernst Equation.   Hydrodynamics is essential in understanding cardiac physiology.  When they say “measure blood pressure,” you will come to understand that there are many different blood pressures, and depending upon how the catheter or monitor is positioned in a given stream (of blood?), the measured pressure can differ.  There’s so much more involved in understanding cardiac physiology: velocity, gravity, the individual’s height, wall tension, wall thickness, viscosity, flow, flow lines, pressure curves, etc. to name a handful.  In addition, renal physiology requires an understanding of fluid dynamics.

Organic Chemistry – Biochemistry in medical school has a lot of information.  There are many organic reactions that take place in our bodies, and without having heard terms like “aldol condensation” and “oxidation/reduction”, I would have had a very tough time in medical biochemistry.  Organic chemistry, even though I hardly remembered much at the time of graduation, exposed me to such terms before medschool – even though I didn’t remember much, I knew they existed, and I’ve seen these terms before…giving me some morsel of confidence.  Although I have not experienced M2 year yet, I gather that Pharmacology requires some understanding of the chemistry behind the drugs you will one day prescribe patients.  I walked into a seemingly empty classroom one day, hoping to find a place to study; but I had accidentally walked in on a TA reviewing Pharmacology with some M2 students – he was pushing arrows and dots on the blackboard.  I almost fainted.

Genetics – This was a required class in my pre-med curriculum.  I knew that genetics was important, but little did I know how much would be covered in biochemistry and the level to which we delved into such material in our Medical Genetics class.  We learned that cancer, inherited diseases, mutations, forensic uses, etc were some of the applications of genetics.  You will have to understand how small RNAs work, what SNPs and Snurps are, what the genetic mechanisms are behind diseases like Huntington Disease, different types of cancer, Phenylketonuria, etc.  You will have to understand the genetics behind how B-cells rearrange certain genes to produce their receptors.  All these, among other things.

In conclusion, I sincerely believe that those “ridiculous” science classes in undergrad will serve to benefit you once you start medical school.  Try to learn as much as you can now, so you’ll have an easier time learning the basic medical sciences.  You will also find it MUCH easier studying for the MCAT if you work hard now – in college coursework – to understand physics, general and organic chemistry.

Food for thought: If those pre-med requirements are useful in understanding normal physiology and biochemistry, imagine the level and extent of knowledge you would need when things go wrong with the human body.  Medicine is about fixing human beings whose bodies deviate from the normal workings of life – only if you have a solid framework in the normal basic sciences can you think about how to revert things away from the abnormal.

Is research important?

Many of you wonder if research is important in applying to medical school.  A lot of people will tell you YES, it is important, while others will tell you that you should only conduct research if you find it interesting.

Below is my experience and advice regarding research and its importance.

I was a research assistant during undergrad for one semester, where I helped do some minor lab work like labeling plates, plating cultures, and screening colonies on plates with bacteria.  This experience, regardless of how insignificant it seems, helped me conduct the independent research project I would eventually conduct as a senior undergraduate student.  When I was interviewing with the lab’s Principle Investigator (lab head) for the independent project, I was able to show her that I had some experience in sterile technique, and now that I’ve had a lot of classes in cellular and molecular biology, I was ready to begin a supervised research project.

During my independent supervised project, I had the opportunity to create a design and plan experiments ‘1 on 1′ with the Principle Investigator (PI).  Further, I slowly read about lab techniques for various procedures, read the protocols available in the lab, etc.  While carrying out these experiments, I would read more about the science behind it in select textbooks (recommendations from the PI) and pertinent journal articles.  I started becoming competent as to how to read these scientific articles, and assess them for validity and experimental procedure.  I had to become very familiar with calculations regarding units such as millimoles, micromoles, microliters, milliliters, liters, ampheres, volts, etc.  At the end of the project, I was able to write a paper describing the research using sections such as the introduction, materials and methods, results, conclusions, graphs/data.  I was able to explain my research in layman’s terms (which is very hard to do for a beginner student).

At the end of the year long project, I had a better understanding of western blots, southern blots, chip assays, gel electrophoresis, PCR, bacterial cloning, restriction digests, and a whole bunch of other techniques.  I essentially had private tutoring from a PhD in the cancer department of our school.  Further, I developed an appreciation for the effort, time, and hard work it takes to develop a study design, execute it, analyze the results, modify the projected track, and conduct more experiments.

Yes, I was scared in the beginning, as I didn’t know if research was right for me.  I was afraid that I would mess up – which I did, multiple times, and on a few occasions, had to start the whole (sometimes 3-days-long) experiment all over again.  But, in the end, I got a small sample of how the material in our textbooks got there in the first place.  Without research labs and research folk, we won’t know as much as we do today.

That being said, let’s address how research can help you in the medical school application process.  You will have something to put down in the Research/publications section of the AMCAS.  And believe me, if you have research, it looks good.  It used to be that you will stand out, but these past few years, medical school admission has become so competitive that some programs may be surprised that you don’t have any research experience at all.  Something is surely better than nothing.  However, be prepared to talk about your research as you may be asked about it during interviews.  Also note that admissions interviewers who do ask you about your research can see right through you if you are bluffing or making stuff up.  Review your research before you go into your interview so you can talk at least semi-intelligently about it.  They don’t expect you to be an expert in the field; just show them you knew some of the science, what you got out of it, and what its implications are in the larger realm of things.

Research is important and medical schools and residency programs are stressing them more and more as the years go by.  Some residency programs now have required research components built into the program.  Others offer additional years during your residency to take time to do concentrated research.  Our medical school encourages us to do some sort of research during our summer between M1 and M2 years (our last summer off, ever).  This way you can show your residency interviewers that you didn’t sit around during the summer, and that you were actively involved in learning.

Probably the most important area where having conducted research as an undergrad was useful, at least for me, is applying to research programs for my M1-M2 summer.  There are a plethora of research programs targeted specifically at medical students where the program gives you a stipend to come to their school/program for about 2 months in the summer to go thru a research-training experience.  These are highly competitive, and is very similar to applying to medical school all over again.  The process requires personal statements, program-specific essays, demographic information, 2-3 letters of recommendation from medical school professors, a letter from the Dean, AND a resume-like questionnaire (with a space for prior research experience).  Having this prior research experience was useful in securing a position because they can see that you are sincere about research, and that you know what you are getting yourself into, during your last summer break.  During one of my interviews for one of these summer research internships, the interviewer concluded by saying, “Okay, from our little meeting, I can tell you are serious about conducting research, and that you have the critical thinking skills needed for designing and executing your own study.  You probably received that from your prior research experience.”  As you can see, he pretty much told me what he was looking for in potential candidates.

So, is research important?  I do believe so.  It has so many advantages that you cannot go wrong with any research experience you get.  If you are scared about the prospect of research, just talk to a few of your professors and see if they are willing to meet with you to give you some advice.  They may even take you into their labs and give you some beginner experience that way, to sort of feel it out.  If you really are interested in their research (or another PhD’s in your school), be bold and contact them.  They love it when people show interest in research.  They are willing to help; they know how you feel because these professors and scientists were in your shoes one day not too long ago.

If you have specific questions about research, feel free to leave a comment or e-mail me! ireason9@gmail.com