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

Dangers

I wrote about an encounter with a nurse that was attacked by a patient, an event that stuck with me.  I tried a different style to keep focus away from the doctor and on the patient and their sense of responsibility for the attack.  It was recently accepted and posted by CMAJ Blogs.  Check it out: Link

See Publications for more medical narratives

The Final Push

Only 6 weeks of clerkship left.  Time has flown by.  Some of the 2-week selectives seem to barely start before you are shipped off to another service.  Quite a year of experience and learning, a welcome change after 2 years in the classroom.

Starting clerkship last September electives and CaRMS seemed so far away, now they are on the horizon and quickly approaching.  The AFMC Portal that was to streamline the elective application process has been something of a bust in its first year.  Half the schools opted out, some had dual application streams, in the end I’m sure there was a lot of frustration for students, administration and programs.  For many it resulted in a feeling of helplessness since after submitting an elective application there is silence, sometimes for 4 months of more.  Unsettling.

For now I’m focusing on finishing my core rotations strong and going into my electives well prepared.

Holding Hands

It is hard not to be touched by patient stories. Stories of illness, loss, struggle, abuse, and more. I am often been moved by them, at times feeling tears build only to blink them away and maintain my medical persona. For a time I felt that I should not let these emotions show. Last fall a friend shared a concept with me call moral injury. It is used with veterans that are experiencing long standing psychological consequences of combat exposure. As expounded by Dr. Jonathan Shay this involves the transgression of moral norms in a high stakes environment by someone in authority. He also talks of the need to share ones story as a path to healing. I immediately saw the applicability to medicine.

No veteran will every trust you if you conceal yourself behind a neutral, non-reactive ‘professional’ facade. If you want to weep; weep. If you want to vomit; vomit. The veterans will regard that as a sign you are listening and that you are hearing what they are saying. Dr. Jonathan Shay Link ~6:20

Hearing this was validating.  It helped overcome the hesitancy to be moved deeply by patients. While respecting boundaries I have held many hands and listened to patient’s stories, and I believe they can tell I’m present both intellectually and emotionally. What I’m doing isn’t out of the ordinary, but I’ve had a number of patients thank me and appreciate their stories and concerns being heard. These connections have made clerkship far more rewarding than simply an accumulation of knowledge.

Halfway

Seems like it was New Years a second ago and now February is ending. This marks the halfway point of our clerkship training; hard to believe.  Internal Medicine is out of the way and Family Medicine starts on Monday.

My IM rotation ended with strong feedback from the attending. A nice way to end a block.  I’m sure I’ll feel somewhat lost for the first few days of the next one: learning the EMR, way they enter orders/present cases, etc.  Good to end a block on a positive note to transition into new territory.

IM ended with six weeks of CTU.  This was split between an adult in-patient unit and one focusing on those over 75 years-old.  It was nice to see care in the adult and elderly population and learn to deal with different issues, from endocarditis and liver cirrhosis to CHF and palliation for metastatic cancer.  It was quite a range and required a good deal of study/review at home.  This was also the first rotation where we were given responsibility for everyone on the floor when on call.  During pediatrics a resident was always present to cover floor issues, here we did consults in the ER and covered the floor.  Terrifying the first couple call shifts, especially since we can’t order anything.  A combination of responsibility and powerlessness that can be quite unnerving. Over time I learned to prioritize, which questions to ask when paged and paired up with one of the residents to co-sign orders.  Very stressful, but I also learned a lot.

Off to a rural family medicine placement tomorrow.  Going to be quite a change.  I’m hoping the experience in IM gives a good foundation for it.  Working with 4 different doctors in a group clinic, will be a change.  Family Medicine is an option I’m considering for residency, so the next few weeks should aid in that decision.

Fall Review

With the New Year coming and the move into the clinics this fall an update is in order.

The last few months it has been quite a change.  I took the summer easy, spending a lot of my time with my family and a few projects including those mentioned here.  In early September the class had a short orientation then was dispersed to hospitals and other practices.  Finding a balance between studying for each rotation, time for my family, myself and other projects hasn’t been easy.  The call shifts especially have been difficult; all you feel like doing afterwards is eating greasy food and sleeping.

This year is the move from theory to application.  Over the year we will all cover the core specialties: Internal Medicine, Surgery, Family Medicine, Psychiatry, Paediatrics and Obstetrics/Gynaecology.  A lot to take in and many times learning is divided into 2 week blocks, so just as you begin to feel comfortable you must move on to a new area.  A few practical tips are summarized here.

Since September I’ve covered Paeds, OB/Gyn, and am in the middle of Medicine.  Like many I felt a bit lost at first, part of this was related to knowledge, but much of it was the practical aspect of medicine (writing a progress note, dictating, presenting a case, consulting another service, the materials needed for a procedure, to cut knots too long or too short…).  These practical and communication related aspects took time and were not well covered in pre-clerkship.

Time on the wards has also afforded many opportunities to learn from those more experienced, most of the residents I’ve worked with have been eager to teach.  It takes some time to be comfortable heading down for a consult or reporting an acute ER case to a senior, hoping you’ve covered all the relevant information.  I’ve learned the hard way a few times, been harshly criticized and tried to take it in stride.  There are also some very positive encounters with patients.  Knowing people rare want to be in the hospital I listen and do what I can to help.  I’ve had a few patients/families thank me for the little I’ve done.

Looking forward the next few months are a time of making decisions.  Next fall we do electives in order to learn skills and make good impressions in the hopes of landing interviews and ultimately the residencies we desire.  The portal for applications is now up, a new service this year that attempts to simplify applying for electives across Canada.  It still has some bugs, but a way to make the process more streamline is great.  With all that, we must narrow down our career paths, some already knew coming in, many changed their mind, but it is still a stress.  I have ruled out a few, but am still on the fence. Soon I’ll need to make a few choices, like many in my class, and then see where my journey in medicine leads.