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.

 

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Trauma Team Pearls

A few  practical tips from a trauma team elective:

  • Just walking down the street ‘minding my own business’ seems to be an independent risk factor for being assaulted, stabbed and/or shot.
  • If you are cleaning your shotgun, for your own safety and those around you, please make sure it is unloaded.
  • If you like to run or bike alone please have some form of identification on you or information to contact a partner or family member.
  • If you are working at heights, wear and use your gear.  Hook in and be safe.
  • Buckle up when you are driving.  A bruise from the seat belt is much better than being ejected from your car.
  • If you have a trauma in the winter your Canada Goose jacket will be destroyed  during the primary survey, sorry.
  • CT-A is very useful, but isn’t perfect.  There can be surprises, a patient’s retained clothing or the collar can compress vascular injuries.

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.

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.

Review of Year 2

Year 2 has come to a close.  This marks the end of our pre-clinical training and brings with it a lot of excitement to begin wading into the hospitals and clinics.  It also marks a point of stress for many.  Application of the knowledge and skills we were to have acquired and perhaps the realization this is our final summer off.

This year was quite similar to the first year, continuing our march through the systems of the body, working our way towards a more complete and integrated understanding of the medical system, diseases, treatments and people.  Our skills in examining and interacting with patients was also tested and consolidated to make sure we are ready to start clerkship.  Approaching this quick summary as last year:

What did we study?

  • Digestion
  • Endocrinology
  • Reproduction
  • Musculoskeletal anatomy/physiology
  • Emergency Medicine (1 week)
  • Family Medicine (1 week)
  • Neurology
  • Psychiatry
  • Ethics (Pt. II)
  • Healthcare Systems

Was second year difficult?

I found second year more challenging than our first year and believe that was the general feeling.  Some subjects were memorization heavy such as neurology and anatomy, requiring a lot of effort for those not familiar with the material. This year many of us took on leadership roles or projects that made large demands on our time and on our minds that may have been another contributor to the perception of difficulty.

It has been great seeing classmates grow since we started.  I’m sure it happens in every class, but we have had a few engagements in the class.  Some children, some weddings.  It has been interesting watching friendships grow and relationships evolve over 2 years.

I’m trying to enjoy my final summer and the time I have with family close by, so I don’t expect to blog much over the next 2 months.  Once clerkship starts I’m sure I will have many experiences that will leave a lasting impression and may be posted or linked.

Review of Year 1 (Part 2)

Some things stick with you more than others.

Christening

The first time you scrub in, you’re not sure what you’ll be able to do in the operating room.  My first time was rather uneventful, until a clamp wasn’t placed quite right:

photo 2-18

Another important lesson, don’t wear nice shoes in the OR.  This was what hit me below the gown, of the whole team I got it worst.  The clamp was quickly adjusted and the patient is fine. “Welcome to surgery!”

The Vasovagal

If you’ve every jumped up from the couch too quickly, you know the feeling.  Flashes, narrowing field of vision, weakness. Not things you want to have happen when you’re helping a patient.  Everyone has a trigger it seems.  For some it was the cadavers, others an amputation, for me it was seeing an ER doctor drill into a patients shin to get a line in. I had to leave the room, nobody really noticed.  I felt embarrassed, supposed to be able to handle everything and my first day in the ER I nearly fainted…

The doctor reassured me and after a short break I rejoined the team.  It’s normal, it happens to everyone.  You always remember the first time.  I was advised to make sure to eat and have some fluids before going to the ER.  (What I saw was the use of an EZ-IO device, for placing a line into bone rather than a vessel.  This is another route to the circulation called intraosseous and I shall post more on it in the future.)

Movember

Our class and the school was very enthusiastic about Movember.  We had some amazing mustaches in the class and raised a good deal of money for prostate research.  Some of the class has a bit of a facial hair deficit, so they dyed what they had.  I participated as well. Was great to see the enthusiasm of the class for a cause.

photo 1-18

Review of Year 1 (Part 1)

The first year of medicine was interesting. We recently received our final grades, having been warned not to leave the country until their release… seems an appropriate time take a look back.

What did we study?

  • Introduction to Medicine
  • Blood
  • Infection & Immunity
  • Cardiology
  • Respirology
  • Nephrology/Urology
  • Dermatology
  • Epidemiology
  • Population Health
  • Leadership
  • Physical Exam/Interviewing
  • Patient Centered Care Integration & Application

That’s quite a bit of material to cover in 10 months. It is surprising how much of it has stuck, far more than in undergrad. My previous training made some topics easier than others. Having little previous anatomy definitely made certain subjects more difficult. Additionally, our anatomy is taught piecemeal; only those areas relevant to the system under study are covered. This leads to a lot of confusion in understanding the relations of the systems of the body. Some other schools cover the whole of anatomy prior to engaging each system, perhaps this is a better approach, but I’m sure it has its own shortcomings.

Was first year difficult?

This is an interesting question. Yes and no. There is a ton to know, but it isn’t hard to pass. There was definitely a lot a material, but it was not that conceptually difficult. The main issue I found was devoting enough time to studying while trying maintaining a balance in life. At the same time, despite the volume of material, with the pass/fail system you can scrape by. You are harming your future self as you will have to know the material in the future, but it can and is done by some.

Another aspect was that the lectures were not sufficient to become comfortable with the material. I used a number of other resources to complement what was taught. I found that a good overview early in a block was very useful, for example skimming Toronto Notes or USMLE Step 1 prep material. These gave the larger picture, allowing the material taught to be put in context. For certain clinical aspects videos on YouTube were of great help and I found books outside those recommended that better fit my needs. Thus, the lectures formed a framework and introduced the material, but I felt other resources were very useful in setting the context of the material and consolidating the information.

The above may seem like a lot of extra work, but it was worth it. This made the material easier to understand and organize; hopefully establishing a strong base to build from in the coming years.

(A few resources: Future Teaching Physicians – http://www.youtube.com/user/tomiwa007, Dr. Najeeb – http://www.youtube.com/user/DoctorNajeeb, Students of Medicine – http://www.youtube.com/user/StudentsOfMedicine, First Aid for the USMLE Step 1, Toronto Notes 2012)