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Advice Doctors Wish They Had Gotten During Med School

Discussion in 'Doctors Cafe' started by Mahmoud Abudeif, Dec 6, 2019.

  1. Mahmoud Abudeif

    Mahmoud Abudeif Golden Member

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    The clarity of hindsight about medical school allows senior physicians to reflect on their training and think, "If only I had known then what I know now." We asked Medscape's medical student advisory board to provide the next generation of physicians with the advice they wish they had been given back then.

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    Sarah Averill, MD: When I think back on medical school, I have to wonder: "Why did you have to take it all so seriously, Dr Averill?" I still ask myself that when I'm confronted with my tendencies to think, plan, and sometimes exhaust those around me. I ask the opposite, too: "Why didn't you take it more seriously?"

    It remains very tempting to think there is a secret to the perfect physician life that we've overlooked. Despite wishing I had studied even more, done more research, gone to more conferences, or networked more devotedly, I know my then self was ready to gag and needed to take some walks, get some sleep, and go to a movie.

    You may someday wish you had worked harder or differently, but when you face those feelings of regret, outright mistakes, or failure, those are your opportunities, your life lessons, and your chances to honestly assess your progress and make changes where you can and grow in new directions. Your physician life will unfold before you and become richer each month, each year, each decade. If you reflect and respond to your unique experiences along the way, you will become the physician that only you can become. It's your ride: You hold all the secrets and all the keys you need to make it through.

    Sarah Averill is a visiting associate professor of Radiology at the University of Iowa Hospitals and Clinics and staff radiologist at the Iowa City VA Health Care system. A writer of creative nonfiction, her essays can be found in various health humanities journals including the Healing Muse and Stone Canoe.

    Kendra L. Campbell, MD: When you look around at your fellow classmates, you may suddenly realize that you are no longer the top dog. Instead, you are now surrounded by people who were likely also at the top of their classes. Most medical students tend to be very high achievers and are also constantly comparing themselves with their classmates. Everyone is in a race to be at the top. The consequences of all this competition and the other stressors of medical school have been well documented and are related to the high prevalence of depression, anxiety, and substance abuse seen among medical students.

    One intervention that can be quite helpful is using mindfulness techniques. Mindfulness is defined as a mental state achieved by focusing one's awareness on the present moment, while calmly acknowledging and accepting one's feelings, thoughts, and bodily sensations. I think it's incredibly helpful to try to mindfully turn one's attention and focus away from a competitive stance, and instead focus nonjudgmentally on oneself in the present moment.

    At the same time, it's also helpful to remember that if you are struggling during medical school, you are far from alone. The non-advertised secret is that pretty much everyone around you is going through the exact same stress and is likely also comparing themselves with you and everyone else. Instead of judging and comparing yourself against other students, it can be immensely helpful to take a nonjudgmental, accepting, and compassionate stance toward yourself and everyone around you. This little med school secret may, in fact, be just what the doctor ordered.

    Dr Campbell lives with her family in rural Virginia and practices integrative and functional psychiatry. She believes in using holistic, mind-body interventions that focus on treating the whole person. In addition to being a psychiatrist, she is a mother, a blogger/writer, an entrepreneur, a free spirit, and an avid run-dancer.

    Shiv Gaglani, MBA : Medical and other health professional students should strongly consider the best ways to interact with their faculty. When you ask residents how they chose their program, a common answer is that they met an advisor or mentor whose shoes they could see themselves in. That advisor-searching can begin on day 1 of medical school. Some strategies for connecting with faculty members include the following:

    • Look up their research or other publications via PubMed or their faculty profiles and reading at least the abstract, if not the whole article . This helps set you apart because, when you email them or go up to them after lecture, you can ask them specifically about their work.

    • Do a summer or part-time project with them, ranging from a research study or case report to a less formal shadowing experience.

    • Introduce them to something interesting that could be relevant to their teaching, clinical, or research career . One reason they're teaching at your institution is that they generally like to connect with motivated and smart students like you.

    • Express appreciation to them both verbally and through cards. At Osmosis, we have a whole section on faculty appreciation now.
    Shiv Gaglani is the co-founder and CEO of Osmosis.org, a health education platform that educates millions of clinicians and caregivers. He's an avid writer who has authored two educational books and contributed to Forbes, Quartz, and the Annals of Internal Medicine.

    Molly Cooke, MD: Medical students are assaulted with what is known about health and disease. I'd encourage all medical learners, from students and residents to fellows and practitioners, to pay more attention to what we don't know.

    I would also encourage trainees to be curious about your patients, asking about their lives and their daily routines. I still like to start the social history with, "Where were you born? Where did you grow up? What did your parents do?" As a new intern at San Francisco General, I saw patients whose backgrounds were entirely different from mine and from the patients I had seen at Stanford. When a patient said that his sexual practices included "fisting" or that her drug of choice was "garbage can," they might as well have been speaking to me in Latvian. Just by being curious, without being judgmental, you can say, "I don't know what that is. Would you be willing to explain?" Your patients will (usually) fill you in.

    I also found that, especially with potentially unlikeable patients , asking them to tell me how they spent a typical day often gave me something that I could hang on to. I can't always find something to like, but I can almost always find something to admire, even if it is, "I wouldn't survive 12 hours living on the street like this person. How does she do it?"

    Molly Cooke, MD, MACP, FRCP, is a professor of medicine at the University of California, San Francisco, and coauthor of Educating Physicians: A Call for Reform of Medical School and Residency.

    Sara Cohen, MD: One important tip I used during medical school was using old exams to focus my studying. Everyone used their old exams to practice right before a test, but my secret strategy was that I also used to take the exams when I first started studying. In medical school classes, it often felt like there was an encyclopedia's worth of information to learn. If you started out by taking the old exams, you got a much better sense of what the professors thought was important, and you could then use that to focus your studying. It rarely led me in the wrong direction!

    My other tip is to study around other people, even if you're not studying together. In college, I always studied alone and felt like I couldn't focus around other people. However, when I got to medical school, I was studying so often that it became extremely isolating and depressing to study on my own. In med school, studying is one of the main social activities. Don't miss out!

    Sara Cohen, MD, is a clinical assistant professor at Tufts Medical School in the Physical Medicine & Rehabilitation Department and a staff physician at Encompass New England Rehabilitation Hospital.

    Daniel J. Egan, MD: I have a couple of key pieces of advice. The first is what I often tell students and residents when they are on rotations: "Early is on time, on time is late, and late is unacceptable." So much of what we do in medicine has to do with teamwork, sign-outs, and transitions of care. People rely on you to be present. It is important to make an impression with your reliability and accountability. Although it may not always seem like your team considers you an essential member, this is part of the process, and people will definitely notice if you are late.

    The so-called hidden curriculum has to do with the culture in a hospital and the interpersonal relations and interactions between people. You will witness conversations that may at times seem unprofessional and shocking. A good rule of thumb is to always take the high road and treat unprofessional behavior with more professionalism. You will always win.

    Also, be sure to take care of yourself. You will see things that many of your friends, peers, and family members will never see. Be sure to take time to reflect on these things and allow yourself to process them and to make meaning out of the work you are doing. The final goal is the awesome privilege of taking care of patients. It takes a bit of time to get there, but the prize is worth it in the end. Ask questions. Be inquisitive. Read about your cases. When it feels stressful or overwhelming, remember that this is about a patient who is trusting you with their health, their body, and oftentimes their secrets.

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