2018 Recap

Coming to the end of residency in 2019. Just realized this is the second blog post of the year. It has been a bit of a blur.

Humanities

The last year, really every since returning to residency from pat leave, has been a low point in terms of writing/art production. I set a goal way back of 6 pieces a year and this is the first time I’ve fallen short of that goal. 2017 was a big year, so they average out, but still, I miss creating. A short poem about goals was published by CMAJ Blogs and a single page comic about treatment/testing burden in Annals of Internal Medicine.

I also presented on Storytelling in Medicine at the 2018 FMF conference. This workshop was based off my involvement in the humanities along with an enrichment activity in Narrative Medicine.  It was fun to share a bit of my journey as a writer, narrative medicine theory, use of story, listening/processing/sharing of stories, along with covering ethical issues related to medical narratives.  It goes by other names, but I call the last point ‘narrative stewardship’. The talk included a writing activity, but I was given a room without tables, so that made it a bit more difficult.

Mentorship

I haven’t said much about it previously, but I’ve been involved in mentorship for a number of years. It started with mentoring inner-city youth that had interest in science/medicine during my graduate studies and has continued to the present.

I have four mentees at the moment. This two of the medical ones entered clerkship (M3) this year. Both are doing very well. One is looking to IM, the other surgery. The third in medicine is a M2 and undecided on his direction. The fourth mentee is an interesting story. We met five years ago at a mixer for undergrads interested in medicine. We exchanged numbers and followed up afterward. She was being pushed to do medicine by her family. We talked about her interests, goals, etc. I mentioned there were many ways to achieve those goals outside of medicine.  Turns out I was the first person ever to tell her she didn’t have to be a doctor. She has completed a double major and is thriving in the bio-med industry.

In terms of my mentors. One is quite ill and wrapping up many of their projects. It is sad to see, but I’m glad I had the chance to connect and learn from them. I speak regularly with the other and value their input as I transition from residency to practice.

Exams

One of the reasons for my lack of writing this year was a focus on two big exams. The MCCQE 2 in May and CCFP in October. These was significant stress around the first exam. A lot of time management considerations in the stations, especially on ones requiring history and physical. During the exam there is a clock in the room, but it was generally poorly positioned to track your time. I also walked in a bit flustered as there was a wind storm the night before the exam. We experienced a 16 hour power failure due to the storm, thus, my laptop and phone were dead for any last minute studying.  In the end it worked out.

The CCFP went smoothly. I put in time and used the standard resources, O’Toole’s Family Medicine Notes, Dr. Kirlew’s podcast, the FM Study Guide app out of Western, and the SAMP Prep app (no affiliation with any of them). With my graduation date, I wanted to make sure I would not need to write again as there would be a gap after graduation and before I could write again, so I also took The Review Course. In the end, one SOO was blah, but otherwise no issues on the SAMPS or SOOs. Glad I had friends to practice the oral stations with as it isn’t a standard office encounter. I needed the practice to learn the marking scheme and an approach to make sure all the boxes were checked.

Certifications

Looking to the future I decided that it would be best complete number of certifications before entering practice. This was another reason for the lack of creative output.  ACLS, ATLS, NRP, and PALS. Completed initial/re-certification in all of them this year.  I also did a POCUS course, though it unfortunately didn’t give certification. The exam fees along with these courses were a huge financial hit. Next up registering for my license (another nearly $3k), total is easily >$10,000 this year…

Rotations

I completed all my required rotations by October, so the rest of my training consists of electives/selectives. To round it out I’ve done electives in a community health center, pain medicine, palliative care, and in 2019 addiction medicine and finally PMR.

Looking forward

As for the future. Today I worked through the twenty page application for my independent license. It is hard to plan with arbitration underway and no contract for five years in this province (cancelled then restarted within the last week…). Hoping there might be some clarity by the time I finish.  Still deciding on the exact nature of my practice. I found pain medicine and palliative care of interest, perhaps some focus in those areas.  Lots to think about with a young family in this transition.

On the arts side looking for an editorial position. I’ve picked up a drawing tablet and am watching tutorials to try some digital art/maybe a web comic. With the exams behind me perhaps I’ll be able to reengage with the creative side in the coming year.

Reading/Movie List

Been a while since I posted a list. A few things over the last year.

Books:

  • Life Studies & The Union Dead – Lowell
  • Realm of Hungry Ghosts – Maté
  • Enchiridion & Moral Discourses – Epictitus

Movies/TV:

  • The Iron Giant
  • Cargo
  • Baki (Netflix)
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Readings

Since returning to residency my reading and creative output has slowed.  New rotations every 1-2 months, studying for and passing the MCCQE 2, and a lot going on at home with the 3 kids…  Some recent books:

  • Out of Your Mind – Watts
  • How It Is – Beckett (audiobook)
  • Cutting for Stone – Verghese
  • A Grief Observed – Lewis

Also, I recently figured out what the title was of an old comedy series I caught a few episodes of years ago: Only When I laugh.  Watching an episode here and there while studying for my Family Medicine exam in the fall.

Moments You Can’t Get Back

Paternity leave is a less common request for residents, but for Kevin Dueck, MD, the time off was invaluable for bonding with his three young children. Dr Dueck, now 33 and a resident in the family medicine program at McMaster University in Brampton, Ontario, Canada, knew early on that he didn’t want to wait until after medical training to start his family.

The first of his three children with his wife, Kim, was born 6 weeks before he started medical school. The second was born in his third year of school. This year, his third child was born in July, when Dr Dueck was supposed to start residency. He decided to arrange paternity leave for more than 6 months, beginning in January, and pushed back his start date until August. His program was very supportive, he said, adding that senior faculty told him, “I wish that had been available when I had young children.”

Dr Dueck says he gets congratulated for taking time off, and he’s uncomfortable with that because women don’t often get the same congratulations. Time off should not be seen as unusual for either sex, he says. The delay put him off cycle, so he will need to find work to fill a 4-month gap after graduation if he wants to pursue fellowship training.

He acknowledges that there has been little time for social activities outside those with family, and he has had to learn to say “no” to some professional projects and meetings. However, he says that’s a small price to pay for quality bonding time, to fully celebrate his children’s birthdays, ride bikes, take family excursions, and spend time at home with his family, before medical responsibilities compete for his attention. “Those are moments you can’t get back,” he says.

He adds that his experience as a young father helps him as a doctor. “Taking leave and having a family has helped with connecting with patients, especially those expecting or with young children. I’ve found having that lived experience to be an asset in clinic,” he said.

Excerpt from Marcia L. Frellick. Taking Leave in Residency: Tips and Traps – Medscape – Dec 08, 2017 [LINK]

Staying Organized

I recently posted on Twitter about setting up for 2018 and was asked about staying organized.  As mentioned previously in my Medical School Tips staying organized is essential, especially with multiple projects on the go, deadlines, and other responsibilities.  I’ve used to-do lists all through graduate school and my medical training.  For a while it was simply scraps of paper and a calendar on my phone.  Over the last few years I’ve tried different planners/pocketbooks and incorporated elements of bullet journaling. Thought it might be time to talk about to-do lists and staying on top of things.

With so much going on at times having a system to keep things organized is needed.  Over time I’ve come to prefer the analog systems.  There is something satisfying about checking a box or crossing off a goal.  They are also nice to look back on and see progress or many little accomplishments.  I use a dash for events, a dot for to-do lists. Items range from gymnastics for our oldest to dental appointments and keeping up with my N95 fit tests and ACLS certification. I enter major events on the monthly calendars and use each Sunday to jot down a weekly list of important items. In the dotted section at the back of the Hobonichi I keep a list of books read, movies watched, publications, etc.

I tried using a Hobonichi in 2016 and enjoyed the set up, the quotes, and compact nature of the planner.  It was thin and didn’t bleed with fountain pens, so it was fun to use.  The positives were having a page a day, a yearly calendar, monthly spreads, and some fun facts in the back.  For 2017 I used an A6 Midori MD lined planner.  It gave a lot of freedom and I used it as a bullet journal.  For 2018 I planned to use a couple grid Midori A6 notebooks, but they got lost in transit, so I ordered a 2018 Hobonichi Techo to use for the new year (the grid notebooks did arrive after ~2 months).

The Hobonichi has a lot of great features, but there as some shortcomings:

  • Despite using Tomoe River paper like the Seven Seas journal I’ve used previously, it seems to dry even slower. This makes it harder to quickly jot down entries if carrying it with you all day or having to use some blotting paper to sop up ink.
  • Some days only need a few lines for events or to-do items.  With a page per day space feels wasted.
  • There is no weekly to-do section

Along with the Hobonichi my set up includes an A6 pocketbook for notes on the wards.  At the end of a block I transfer notes from the pocketbook to a simple notebook of tips/tricks, clinical teaching, and step-by-step instructions for procedures.  A set of practical notes to complement the textbooks/lectures.

I’ve mentioned journaling before and for 2018 I wanted to do something different.  Instead of a lined A5 journal as I’ve used before I decided to use a larger A4 blank journal.  I hope to do more doodling and enjoy the greater flexibility in my entries.  I have 4 pens chosen for journaling and will alternate between them.

Trying my best to stay organized in 2018 balancing home life with my training.  Going to be a busy one as I transition to my final year of Family Medicine, write 2 large exams, and need to make many decisions about my future.

Hobonichi Techo in Midori MD paper cover

IMG_4652

Midori MD A4 blank, Hobonichi Techo, and Leuchtturm1917 A6 softcover.

Year in Review – 2017

Finished my last shift for the year doing consults in the Emergency Department and even had enough time to grab a coffee and use the bathroom, so not too bad…  Today we enjoyed Christmas as a family and tomorrow we head off for a large family gathering.

This last year was unique as I took over 6 months of paternity leave before returning to residency in August.  It was great to have that time with my family and some time for myself.

Back in February a call went out from in-House for reflections on the first year of residency and I thought being on leave was something different, so I wrote a short reflection.  It was well received and has since been reposted to KevinMD and lead to my being interviewed on a CanadiEM podcast along with a Medscape article (free registration required for full article).  Glad to see people are receptive to my perspective on taking leave and making family a priority.

This year I also became more involved in the Health Humanities.  From February to October I was the Humanities Intern at CMAJ and was involved in peer review, development of a rubric for evaluating submissions, and help to develop the new Graphic Medicine section. In addition, I had a short comic published on in-House, my poem Handsome Cat was published, and a number of older pieces of writing found venues for publication.

The time off also gave me a chance to do some reading, some mentioned in a previous post. I also took a few courses including a Joule self-awareness/leadership course and a few continuing faculty development courses through U of Toronto (mentorship, teaching health humanities, etc.).  These would be far more difficult to fit into my schedule during residency or when in practice, so it was nice to explore some of my interests during the break.

After many months at home and family time including trips to Niagara Falls, I headed back to residency in the fall and joined the incoming R1 cohort. As expected I was a bit slow the first few days and found that my DDx was narrowed.  Things have gone well since and I’ve completed blocks of Hospitalist, ER, OB/Gyn, and just started my block of General Internal Medicine.  With my being off schedule my R2 year of Family Medicine starts in a few months and have 2 large exams in the coming year.  Still not sure if I will do a +1 year, but am trying to arrange things to continue my involvement in the medical humanities.

Thanks everyone that has followed my journey in medicine via the blog and my Twitter @AbootMedicine over the last few years.

 

Back

Last week I headed back to the world of medicine. The time off passed quickly, especially with packing and moving to a new place in the spring.  Was great to be home and spend time with my family.  This summer we have enjoyed a few family trips and had some visitors. I may do a longer review at some point of my pat leave, but put simply I’m glad I had the opportunity to spend the time at home.

The first week back was a lot to take in. My home clinic was happy to see me, nice to catch up with the staff. I’m a bit rusty and slow seeing patients, in part because the EMR there was updated recently. On top of that I’m starting my first hospital based rotation and learning their EMR and they way they like things done. Got through the first week and even had a few kind comments from patients.

The Hidden Curriculum Narrative

During an interview for residency I was asked about my previous article about the hidden curriculum. I spoke of the lessons outside the textbooks and lectures; lessons of hierarchy, role modeling, and more. The interviewer then asked about if there were positive aspects of the hidden curriculum. I told a story from clerkship and recently made a comic about that experience. It was recently published on in-House and is my first attempt at graphic medicine. Enjoy: Lessons