Monday, November 06, 2006

Fun Month, or School of Ineptitude

It's 9:52 am, and I'm sitting in my school's computer lab, blogging. At noon, I'll give a talk to the future surgeon's club in exchange for free food; at 1:30, I'll give a tour to a visiting potential student. Then I'll go home, finish the last remnants of the laundry, beat my husband into helping me clean the apartment, and hopefully head to the gym.

Why am I telling you this? And what happened to medical school? Surely, a busy third year student shouldn't have time to do all these things. She should be running around the hospital, doing scut and "saving lives".

This year, my school enacted the "fundamentals month", aka "Fun Month", during internal medicine. The orientation power point described the objectives of fun month as follows:

  • Acquire, record, organize and analyze patient data.
  • Independently identify key problems of patients
  • Application of this knowledge and formulation of an appropriate differential diagnosis
  • Perform focused interviews and physical exams on standardized
  • Reflect on the ethical and professional boundaries of patient care.
  • Demonstrate understanding of ethical and professional issues in patient care.
  • Identify basic EKG conditions.
  • Understanding and application of therapeutic options for thee diseases including any related issues of pharmacology.
  • Understand pathophysiology of all disease processes you encounter.

What this actually translates into:

  • Attending 5 lectures on "clinical reasoning", where I wrote a brief paper on CHF, a briefer paper on treatment on high blood pressure and cholesterol in diabetics, and a rough draft of what questions I'd ask a patient with shortness of breath
  • Attending 1 lecture on "Diabetes", where we "learned" how to prescribe insulin
  • Taking an EKG baseline exam, on which I scored 62%
  • Reading Dubin's "Rapid Interpretation of EKG's"--useful. Amazingly, I do actually feel that I understand some of the principles behind EKG interpretation now. It makes me feel so smrt.
  • Attending 2 lectures on EKG's, which reiterated the reading materials
  • Reading "Cecil Essentials of Medicine"--I've gotten through about 6 chapters
  • Attending 3 ethics lectures, including discussions of HIV confidentiality, US healthcare system, Doctors Without Borders, and How to Break Bad News--somewhat useful
  • Attending 4 standardized patient encounters, where I pretend that their complaint is valid in the face of their entirely normal physical exam. My grade on the first one, where the patient said I did "great": 77%. My grade on the second one, where I forgot more stuff, had to ask the patient to sit up and lie down 3 times (he had "abdominal pain"), and misdiagnosed his pancreatitis as a perforated gastric ulcer: 87.5%. I think I'm going to be a better doctor because of this.

Note that only the material I specifically marked as "useful" is actually useful.

What I've actually done with my "Fun Month", since all of the above amounts to less than 2 hours at school per day:

  • Contacted a personal trainer at the gym, meeting once a week. More on this later.
  • Worked out at least every other day
  • Done mountains of laundry
  • Taken up a new hobby: jewelry making. I'm being cheap for Christmas!
  • Watched weeks of TV. I've probably watched 20 episodes of Mythbusters on my first two weeks of Fun Month.
  • Donated blood
  • Got a flu shot and a PPD (totally flat! No TB here!)
  • Cuddled with my husband a lot
  • Taken my dog to the dog park at least 3 times so far
  • Getting my oil changed this week
  • Went out to lunch and shopping with a friend and her baby
  • Got a massage

Obviously, I'm using this time to my best advantage.

Why does Fun Month make me mad? After all, I'm basically on vacation this month. I get up at 7:30 or later, I'm working out a lot, I'm getting some basic stuff done that I can't really do when I'm on rotations. The reason it makes me mad is that I'm not supposed to be on vacation now. I'm supposed to be working my ass off. I was ready to work, not ready to vegetate. I'm a little worried that next month will hurt more because this month was so easy.

I'm also mad because they changed the format of third year for our class. They took 2 weeks off OB/Gyn and 2 weeks off Psychiatry to give us 1 month of Neurology during the third year. Ugh, I hate Neurology. Anyway, they took a month out of what might be useful rotations to add Neurology. Internal Medicine has traditionally been 3 months long, with 1 month at the county hospital, 1 month at the "nice" hospital, and 1 month spent in a subspecialty. This year, they took off the subspecialty to add Fun Month. So, they cut other rotations which might have been useful to add Neurology, but they took a whole month out of Medicine to allow me to vacuum my apartment more often. If the subspecialty month of medicine was so useless, why didn't they cut it to add neuro? One reason I heard they added neuro was that it's an early match, so people need to see it during third year. Well, now it's NOT an early match--it just joined ERAS. Most of the internal medicine subspecialties don't match until after residency, so there's no real trade-off here. My only concern about losing subspecialty month is that we're losing exposure to some of the variety of internal medicine. They might not get us a whole lot of test questions on the shelf exam, but the subspecialties provide us a break from "standard" internal medicine. Not to mention, many 4th years I talked to said the subspecialty month provided plenty of time to read Cecil's.

Giving me a whole month to read Cecil's has translated to my reading almost nothing. I work best under pressure. I also know that I won't be taking the shelf exam until the end of February. I don't even like to read too much 1.5 months in advance of the exam, because I forget it all and have to go reread it, let alone 4 months in advance.

But TS, isn't the point of third year to learn how to be a good doctor? Shouldn't you read Cecil's just because you should? Probably. If I were a better student, and more self-motivated right now, I probably would read Cecil's. But I'm not. I learn better when I'm faced with a patient and I have to go look up the appropriate therapy than when I'm reading about abstract concepts in a book. I would also like to point out that the book chosen is 1216 pages. This is both too long and too short. Too long is obvious. Too short because Cecil's is a little too concise. Harrison's Principles of Internal Medicine, or "the Bible", is 2607 pages. Of course, I'm not reading it, either, so it's a moot point.

The big point here is that I'm lazy, and this month is allowing me to feed my laziness. The only useful thing I'm getting out of this month is how to read EKG's, which didn't require a whole month with nothing else to do to learn.

How dare they give me time off. Which wasn't necessarily the school's intention, but it is the (predictable) result. Bastards.


barbie said...

yer dare they remove a month of USEFUL rotations to bring neuro. egh, neuro. no one needs neuro. they are just quacks. all of them. USELESS!
i must say that pedi neuro and neurosurg are still early match.

Jenn said...

well, by god, we should add plastic surgery and ophtho rotations to third year too, since they match early as well!

actually, it sounded bad, but i was more trying to say they cut time off rotations for neuro, but left a month in internal medicine for "fun month". why didn't they take this month for neuro? but my hatred of neuro bled through into what i was trying to say...

The MSILF said...

Try Davidson's medicine book - it's better than Cecil and longer, but way more manageable than Harrison. Also the beginning of each section has how to do the physical exam for that system and what the results mean, and has a DD/workup by symptom. I love that book!