MD/PhD Year 4: Uff Da

Uff Da is a phrase commonly said in Minnesota to signify exhaustion, weariness, resignation, and overwhelm. As I look back at all that I have done in my first 4 years as a MD/PhD student, this is the word that comes to mind. Yet, as I live day-to-day, it doesn’t seem that bad. In fact, I LOVE what I do, and I am so excited for what’s to come!

You may have noticed that my blog posts have severely dropped off as I’ve progressed through this program. Why? It’s hard to write about things that are so drawn out! I started this blog to help undergraduates survive the med school application process and learn about MD/PhD programs. I’ve written a decent amount about my med school application process, but this was so long ago I dare not write much about it anymore! As for sharing about MD/PhD programs, I feel that I have settled into a routine over the past 4 years such that I don’t really have that many new and exciting things to talk about.

I could tell you all about the failed experiments or few successful ones (I ran a gel today! Just like yesterday!) But I don’t because I’d rather wait to tell you the full story of my research that gets published (whenever it does). Furthermore, classes and teaching are such a normal part of my life that they don’t really stand out as something to write about (beyond how to do well in anatomy). I have done a few other pretty cool things that I’ve wanted to tell people about (like some mentioned below), but I’ve had enough other things to rush off and do immediately after that I haven’t committed time to do them justice.

I really want to share what I’m doing and connect with others to learn about the cool things they’re doing as well. I’m glad that new people continue to find my blog and value its resources. It really warms my heart to hear that my writing has been of help! I promise I will continue to write when I can. 🙂

So, to make up for a year of silence, here’s some of the cool things I’ve been up to during the past year:

I planned a conference!

I didn’t realize how much time this took up until the conference was over and I was back to doing deep cleans and organizing in lab. I wondered to myself, “Why haven’t I been doing this? How did I let it get this bad?” And I realized that I’d normally be sending emails during that time!

Of course, I didn’t do it alone. In April 2016, my good friend and fellow MD/PhD student at UIUC, Mariam Camacho, and myself were elected the Events Chairs for the American Physician Scientists Association (APSA). APSA is a national trainee-run organization for physician-scientist trainees that holds an annual meeting with the Association of American Physicians and American Society for Clinical Investigation each spring. It was our job to oversee the planning from the APSA side of things, including inviting speakers, coordinating the planning of panels, and taking care of all of the nitty gritty details that are required for planning a conference. I am happy to say it was a success!

33553616713_69a36e79b0_z
Source: American Physician Scientists Association

There were many other great people that helped us with this endeavor including Alex Adami, Jillian Liu, Allyson Palmer, Lillian Zhang, Jason Siu, Michelle Caunca, Teddy Mamo, Jeremie Lever, and the staff at McKenna Management. We couldn’t have done it alone!

Events Committee.jpg
2016-2017 American Physician Scientists Association Events Committee. Missing: Michelle Caunca

APSA is a wonderful organization for physician-scientist trainees! If you’re a trainee (whether in medical school or undergraduate) and you’re interested in becoming a physician-scientist, check them out!

I finished my first year of medical school!

And it only took 4 years!!! As my peers who started medical school with me were graduating and preparing for residency, I was taking my last exams of my first year of medical school. We have a unique MD/PhD program at UIUC where we gradually integrate the first year of medical school curriculum into our PhD training as to not greatly hinder our research time. To help you better understand how this works, I’ve listed my schedule for M1 courses:

Year Fall Spring
2013-2014
  • Immunology
  • Brain, Behavior, and Human Development
2014-2015
  • Physiology I
  • Physiology II
2015-2016
  • Anatomy
  • Cell and Tissue Biology I
  • Embryology
  • Anatomy
  • Cell and Tissue Biology II
2016-2017
  • Biochemistry
  • Foundations of Clinical Medicine I
  • Medical Genetics
  • Microbiology
  • Biochemistry
  • Foundations of Clinical Medicine I
  • Medical Statistics
  • Neuroanatomy and Neurophysiology

I presented my research and traveled across the country

Literally. In November, I gave a talk at the AASLD Liver Meeting in Boston, Massachusetts.

AASLD Talk

At the End of March, I flew to the other side of the country and presented a poster at the American College of Physicians (ACP) Internal Medicine Meeting in San Diego.

San Diego.png
Instagram: @MDPhDToBe

In May, I went to Washington, DC to advocate with the ACP as I have done in 2014 and 2016.

Screen Shot 2017-08-12 at 7.15.32 PM.png
Instagram: @MDPhDToBe

I was elected to the ACP Council of Student Members (CSM) this year, so I just was in Philadelphia for a CSM meeting. As the Vice President for APSA this year, I spent a weekend in Atlanta this summer for our annual leadership retreat. I also visited my college roommate in Montana over spring break. I’m ready to take a break from flying. 😫 However, I am so thankful for these opportunities to travel the country, connect with others, share my research, and help organizations more effectively help other trainees and patients!

 

I earned a teaching certificate

My graduate department requires that all PhD students teach. I’ve gone beyond the teaching requirements to teach 4 semesters. Since i had spent that much time in the classroom, I thought I might as well attend a few more workshops and reflect on my teaching skills so that I could earn a certificate. I’m a little biased, but I really do believe taking this extra time to focus on my didactic skills has made me a much better teacher.

I have been a teaching assistant for an anatomy & physiology lab for 3 years. The fall semester, which I teach, covers histology, bones, muscles, and the nervous system. The first time I taught this class, I was overwhelmed with how much there was to know! Shout out to all of my students who have worked their butts off to take on this class while carrying a heavy undergraduate workload. The second time, I was taking my medical school anatomy class at the same time and was starting to pick up on a lot more things and was a much better teacher. The third time, having completed M1 anatomy and in the process of my teaching certificate, was even better. This was a particularly fun semester to teach because my classroom had the same cadaver that I had dissected the previous year!

Cadaver.png

Between having a much more in depth understanding of anatomy and attending teaching workshops, I feel that I have really grown as a teacher. As a result, I was given an excellent teaching rating by my students for the first time for this class (I also earned one when TAing a microbiology lab). Teaching does take quite a bit of time away from my research, so I’m done for it for now.

 

I’ve missed out on a lot

I think it’s important to point out that while I have been able to do a lot of great things that I am incredibly excited about, I have also missed out on a lot. For example, I’ve only made it back home to see family a few times in the past year. My niece was born in July 2016 and I’ve seen her at 2 weeks, 6 months, and 11 months. I’ve been able to facetime a few times, but it’s just not the same.

Family Dinner.png

Screen Shot 2017-08-12 at 7.44.49 PM.png

I’ve missed weddings. And birthdays. And home Gopher football games (an important part of my undergrad).  So I’d like to thank all of my family and friends for dealing with me and being ever so patient with me when you don’t hear from me for extended periods. I’ve had to let a lot of friendships fade out over the past few years, but I promise you all still mean so much to me! I’d especially like to thank my partner for dealing with my craziness and considering working together at a coffee shop a “date.”

Now that I’ve covered quite a bit, I’m going to get back to everything else. I have a paper to write, events to plan, websites to design, policies proposals to draft, personal statements to write, experiments to plan, and so much more! As always, feel free to contact me, I’ll try to respond as soon as I can. But no guarantees when that’ll be… Here goes year 5!!!

Tips for Mastering Anatomy

Human gross anatomy is one of the first major rites of passage that medical students undergo on the way to becoming physicians. I won’t talk much about the emotional experience of it here, but let me just say that it is life changing and a true honor to experience. As you go through it, though, it can be easy to become desensitized to the emotion that is elicited by dissecting a human body, especially when there’s hundreds of structures to identify and ingrain in your memory. It is this sheer volume of information to learn that makes anatomy one of the hardest classes in the first year of medical school.

But I didn’t think it was that bad.

I did, however, have one advantage over many of my classmates – I had actually taught anatomy to undergrads (as a teaching assistant) and was currently teaching the class again as I went through my M1 anatomy course. I had learned alongside my undergraduate students as they studied the bones and their markings, muscles (their origins, insertions, actions, and innervations), and nerves – I had not taken anatomy before teaching it! While my knowledge of anatomy was not that great even after teaching (and was limited to those three systems), I did come away with a better understanding of how to effectively study for anatomy, and that made all the difference. Because of that, I would like to share some of my tips – both for medical students and my undergraduates – to help you all master anatomy!

 

Use the right resources

Your professor will likely assign a textbook for the class. We had Grey’s Anatomy for Students, which was helpful because it had an overview section in the beginning of each chapter that was a good place to start (and usually all that I read if I read the book at all). The book also has highlighted clinical correlations that were particularly good review for the written exam. It was also suggested (but not recommended) that we purchase an atlas, which I didn’t do until after the first semester (Netter’s Atlas of Human Anatomy is the shit). We had them available in lab, but it was incredibly helpful to have at home as well. While nothing can replace studying on actual cadavers (or models if your class also uses those), looking at images can be a good place to start/a good reference for clarification while/after looking at bodies/models/a good last minute review before the exam.

Another resource that is helpful is actually Wikipedia. While teachers 99.9% of the time tell you to never use Wikipedia (the information is unreliable, etc.), anatomy is the 0.1% of the time when it is an acceptable resource. My professor told us that anatomists have done a good job at maintaining the accuracy of these pages (though it is always important to cross check the information with your textbook/lecture notes, especially if your grading is strict like in the class I TA). Therefore, I mostly used Wikipedia for my information. I liked it because I could find out everything I needed (and then some) about a structure easily – I tend to learn things best by learning too much/putting it in greater context.

Make Connections

Nothing in the body exists in isolation. The most important part of anatomy is not just being able to identify individual structures but being able to understand their relations to each other. Learn to see how things are connected, whether through a direct interaction (this nerve innervates this muscle and thus runs along it) or indirect (this muscle lies next to this other muscle, and they are both innervated by the same nerve). By making these connections, you can reduce the number of pieces of information that you need to learn.

Spend time in lab wisely

The most important part of this first is that you NEED TO SPEND TIME IN LAB. I simply cannot emphasize that enough. I could definitely see a difference in scores between those students who came in extra times to lab to learn the material and those who did not. Anatomy is a highly visual and tactile subject. You need to see the muscles/arteries/nerves/etc. and understand where they are in relation to other structures. While Netter’s and other anatomy text books have pretty looking pictures, they cannot do the real human body justice. You need to look at both your body as well as other bodies in the lab since you’re likely going to be tested on all of them (see point #3 in my Almost Doc’s article 5 Precise Techniques to Become to Most Effective Learner Ever). No two bodies look exactly alike, and it is important to truly appreciate that.

You also need to spend your time in lab WISELY. My undergrad students are required to be in lab for 1.5 hours each class, most of that time being free time for them to learn from models/cadavers/etc. as they see best. But many of them would spend that time talking to friends (not about anatomy), working on things for other classes, sleeping, texting/facebooking/online shopping, or doing something else totally unrelated to class. Others would spend time superficially going through the bigger (and easier) items to learn, usually while looking up information online/in the text book. Very few would be actually using the models that they would be tested on (though they did spend a decent amount of time with the cadavers). Yet before every exam someone would ask for more time in lab to study. Had they come to lab with a plan and used their time to study things that they couldn’t study at home (such as looking at the models and cadavers that they would be tested on), they wouldn’t feel that they need any extra time.

The same idea of wisely using your time applies to M1 anatomy. Come to lab during the extra hours with an idea of what you want to study. My recommendation – start with the things you know the least. Everyone wants a confidence booster by going through the things they know the best, but that is low hanging fruit. To make the biggest leap in your understanding, you need to focus on increasing knowledge in areas that you understand the least (see the personalize section in my blog post Study Tips for the MCAT (More on How I Prepared in a Month)). For me this was usually arteries and nerves – they can be hard to differentiate, there’s lots of branching – so I would try to start with these areas that I knew the least and try to go through the whole structure list for those areas before moving on to topics that I was more comfortable with.

 

Have a study buddy

One of the best things that I did was study with other people. I was fortunate to be placed with a great dissection group of super intelligent human beings who were both fun and hard working – the perfect study buddies. We were thorough during our scheduled dissection times (usually using the whole time if not going longer) and often some of us would meet up at other times to go over our dissections. I’m not one to study with other people, but in anatomy this was essential.

Screen Shot 2016-08-11 at 11.07.24 AM.png
The best anatomy group ever.

The benefits of studying with others are many. First of all, they can help you flip a body if need be (something I tried to avoid at all costs). Second, they probably know things that you don’t know and vice versa. We would usually go through our structure list and take turns teaching each other/quizzing each other. By reading a term, saying it out loud, identifying it on a body, and having confirmation from another person, you are giving yourself more opportunities to have that information ingrained in your memory. Also, not knowing a term, being quizzed on it, and having someone explain it helps you learn from being wrong/not knowing. Of course, working together to figure out something neither of you know is also quite helpful (make sure to have text books/atlases available to reference while in lab).

Perhaps one of my favorite benefits of studying with others is learning how they remembered a structure. We all hear different mnemonics that can help us learn. Sometimes it’s not a mnemonic but rather an interesting connection/observation that stands out to remember a term. One of my favorite examples of this is the transverse cervical artery that runs vertically just deep to the trapezius muscle. When the trapezius muscle is dissected, it can be flipped to the side to see underlying structures, including the artery. Thus the artery, which goes with the muscle, appears to be running in the transverse plane of the body. One of my lab mates excitedly pointed this out, and even though the artery doesn’t run in the transverse plane when placed in anatomical position, I always remembered the name of the artery that lies under the trapezius because of this discussion.

 

Make your own study guides

I’m a big fan of making my own study guides. I do this not only for anatomy but many of my other classes as well. Everyone learns information a little differently and by making your own study guide, you can display this information in the way that makes the best sense for you to remember it. Also, simply the act of writing things down is helpful for memorization (which is why I HIGHLY RECOMMEND doing this especially for learning the CORRECT SPELLING of these terms, which is often a component of your grade). For anatomy, I would go through my whole structure list and make study guides based on the topic for all of the structures. By doing so, I learned a couple of very useful techniques to make the most effective study guides that I describe below.

Use tables

I never appreciated tables until I took anatomy. As an example of how I used tables, see the image below:

Screen Shot 2016-08-10 at 12.20.38 PM

This is the table I used to learn the muscles in the anterior compartment of the forearm (a connection between these 8 muscles). For most of my muscle tables, I only included the origin, insertion, action/function, blood supply, and innervation. However, I also included level (superficial vs. deep) to understand the relative location of these muscles since there are so many in this compartment (and I listed them superficial to deep). Having all of this information in a table is helpful to see the connections between structures. For example, you can see that the three muscles listed as being “deep” are also supplied by the anterior interosseous artery while those being “superficial” are supplied by the ulnar artery. This also hints at the location of these arteries. You can also see that the three superficial wrist flexors all have their origin at the medial epicondyle of the humerus.

Screen Shot 2016-08-10 at 12.27.14 PM.png

I also made tables for other topics such as nerves that I didn’t necessarily need to have multiple columns like for muscles. However, I made the table as a replacement for writing out notecards (since writing that much would take forever and would destroy my hand). Though writing  by hand has been shown to be better than typing for retention, I tried to do things like emphasizing parts my writing (see the bolded words to emphasize a connection to another term, other times I used all capital letters, italics, or underlines to emphasize different things). By having changes in formatting, I was able to have important parts of what I wrote come across easier.

Make a list

One of the biggest revelations I made when making study guides was how to learn the branching pattern of nerves and arteries. Initially, I would make a table for these (like I did for muscles) that included source and branches. But then I figured out to make things like this:

Screen Shot 2016-08-10 at 12.33.23 PM.png

This may just look like a list to you, but it is actually a very well thought out list that gives away much more than just the structure names. The terms are listed in order of how they are found – proximal to distal. Each indentation indicates that the artery is a branch of the artery above it. For example, if you wanted to know how the common interosseous artery in the forearm arose, you would be able to see that it is a branch of the ulnar artery, which is a branch of the brachial artery, which is a branch (well actually a continuation) of the axillary artery. You can also see that the common interosseous artery comes off of the ulnar artery after the posterior ulnar recurrent artery and before the anterior interosseous artery. I would bring these lists in lab to go through as I tried to identify all of these terms on the body. A major benefit is that it is concise (and usually fits on a single page) but provides a lot of information!

 

And that’s all of the advice I can think of at the moment! I will update with more advice as I think of it/questions arise. Otherwise, I just want to say that I hope you all enjoy anatomy as much as I do! Best of luck!

A useful resource for M3/M4!

Ever get frustrated with poor teachers? Dustyn Williams did during his time in medical school, so he combined his frustration with his passion for teaching to make a resource to help students survive the clinical years. I had the opportunity to talk with Dustyn about his website, onlinemeded.org, a little while ago and wanted to share this great resource with all of my readers!

First of all, what exactly is Online Med Ed? It started as Dustyn began making videos during M4 and residency. The website officially launched in 2014 and provides these videos for FREE. Yes, FREE. These videos don’t tell you everything about each topic, but they tell you what you need to know about a topic. As Dustyn said, he wants a student to make the right choice in the clinic to save lives. The material he provides on this website is designed to help you do that.

How is this different from medical school teaching? For example, say you were on your OB/GYN rotation and wanted to know more about contraceptives. The medical school may bring in an expert who gives a 2 hour lecture on different contraceptives and their mechanisms of action. On the other hand, Online Med Ed has a 15 minute video that is a general overview of contraceptives that focuses on what you will most commonly need to know in the clinic. Basically, it is a lot more efficient. Obviously it does not cover the material as thoroughly, but is a good starting point for learning the material.

These free videos are just the start of what is offered by Online Med Ed. They know that not everyone learns the same way, so they have expanded to providing other tools such as notes, downloadable audio, study questions, clinical cases, and flashcards (available with a premium subscription). They’re also using technology to help you use these tools most effectively. This includes a schedulizer to help plan your studying throughout your clinical rotation and reminders through the application to promote forced repetition for longer retention.

Check this out in your clinical years of med school!

Curious why my cat, Smeagol, is the featured image for this post? Check out onlinemeded.org and you’ll understand. 🙂

Fitting in a week in DC

[Insert usual “sorry I haven’t written in a while” statement here. #mdphdproblems]

As a MD/PhD student, I consider myself a master at fitting as many things into my schedule as possible. This week is no different. It is the final week of exams for the M1 class, and since I am an eternal M1 while completing my PhD, it is also exam week for me. Luckily, one of the M1 classes I opted to take this year ended in March and the other class I took this semester is anatomy, which had its final written and practical exams earlier today. I left Illinois soon after my practical exam and am now writing this in Washington, DC!

Why Washington, DC? I’m here to attend the American College of Physicians’ Leadership Day and Internal Medicine Meeting. The American College of Physicians (ACP) is the largest medical specialty group in the United States with 137,000+ members. As an aspiring oncologist (we’ll see if this changes once I reach my clinical years), I must first specialize in internal medicine, which is essentially medicine focused on adults. I have also been involved in my school’s internal medicine interest group since starting my MD/PhD program and know that it is the specialty that interests me the most. So naturally, if I had the opportunity to attend an ACP event, I would take it.

The Leadership Day is actually a two-day event, which focuses on educating attendees on policy changes that would benefit the practice of internal medicine (and most importantly patients!) and then giving representatives from each state the opportunity to meet with congressional staff to discuss these proposed policies. This is not my first Leadership Day. I attended two years ago (see my blog post). As I read over the material provided by ACP to prepare for this event, I was stricken by the difference in focus from two years ago. To illustrate these changes, here are the key policies from 2014 and 2016:

2014

  • Eliminating the SGR (sustainable growth rate), a formula for physician payment
  • Extending Medicaid payment policy for primary care services
  • Medical liability “safe harbor” legislation and pilot health courts
  • Graduate Medical Education (GME) financing
  • Sufficient funding for federal health care workforce programs

2016

  • Improving care of patients with chronic disease
  • Improving health information technology
  • Improving telemedicine
  • Integrating behavioral health into primary care
  • Stemming the increase in opioid abuse
  • Addressing the rising cost of prescription drugs
  • GME financing

One of the biggest differences I noticed right away is that the focus in 2014 was much more on paying for medical services – mainly via repealing SGR and extending Medicaid payment policy – while 2016 is much more focused on promoting certain areas of improvement – such as chronic disease, behavioral health, opioid abuse and prescription drugs, and medical technology. Of course some things stay the same, mainly the need to increase the number of physicians going through GME.

One reason for this change is that the SGR was finally repealed in 2015! The SGR was enacted by the Balanced Budget Act of 1997 (which also limited the amount of GME spots funded by the government) and has been a problem for quite a while. Basically, it was like a rollover system like some cell phone plans – don’t use all of your minutes in the month? They’ll carry on to the next month – except for it was for how physicians get paid by Medicare. The problem is the converse, however, such that if the expense one year was too high, the payment to physicians was proportionally decreased the following year, which likely made some physicians not want to care for Medicare patients.

I still have a lot to learn about healthcare policies, but I am so glad to have the opportunity as a medical student to get a taste of advocacy. No matter your skill as a doctor, systemic hurdles may still make it difficult for you to offer help to the patients who need it the most. That’s why I think it is so important to make our voices heard in the realm of policy and why I’m attending this Leadership Day.

In addition to the Leadership Day, I am also attending the Internal Medicine Meeting, ACP’s national meeting, where I am presenting a poster on one of my projects looking at how the scaffolding protein I study protects the liver against damage. Just from carrying my poster through the airport it has given me the opportunity to tell non-scientists about the importance of the liver and health in general. Looking forward to the week!

#AcademicsWithCats

If you follow me on instagram and/or twitter, you may know that just over a month ago, I adopted a sweet little 1 year old cat from the Humane Society. Since then, I’ve been 1) too busy playing with her and 2) too busy preparing for my qualifying exam (mostly #2, but I wish it were more #1) to post about her. Now that my qual is done, I’d like to finally introduce you all to my precious girl, Smeagol!

I know the name probably reminds you of this little fellow from LOTR:

Source: Dugbee | Flickr
Source: Dugbee | Flickr

But no worries, she is nowhere as creepy as Gollum (and luckily not possessed by a magic ring). But she is gray/brown, which fits with the name, and I’ve always wanted to name my pets after characters from middle earth.

2015-03-26 17.51.25

So why am I posting about my cat on a blog about med school and grad school? Well, a little while ago there was a hashtag going around twitter, #academicswithcats. Now that I’m one of them, I wanted to share some of my pictures of how this little cat has changed the way I work.

Working on the computer is a lot harder.

2015-03-08 11.00.49

I can’t edit my writing.

(That’s my qualifying paper).

2015-03-15 13.20.28

I can’t access the papers I’d like to read.

2015-03-23 11.41.01

But it’s totally worth it!

2015-03-30 09.25.59

If you’re looking to get a pet, please consider adoption!

Why Medicine?

Q (from ask.fm): Why do you want to become a doctor? Did you ever consider any other profession?

For a time in my life (primarily during the med school application and interview process) I HATED this question simply because I was asked it oh so often. But really I LOVE this question. I love it because it makes me sit back and think about why I’m doing what I’m doing.

I’ve seen the quote “Medicine is for those who couldn’t imagine doing anything else.” by Luanda Grazette spread throughout twitter and time again by premeds and med students alike, and I simply do not agree. At least with respect to my own situation.

Since I have begun seriously considering my future (which started in late elementary school since I have always been nearly too obsessed with planning out my future), my career goals have consisted primarily of medicine, pharmacy, and research though at a younger age interior design and architecture were also top candidates. During this time, politics and business leadership also drew my attention briefly because I felt I could make a difference in those positions.

Making a difference. That’s the source of all of these career goals (minus architecture and interior design… I just wanted to make pretty houses). In medicine and pharmacy, I could make a difference in individuals’ lives through improving their health. In research, I could potentially discover something that would make a difference in our fundamental knowledge that could be applied to making a difference in many lives. In politics, I could make a difference by instituting policies that had a larger benefit for the nation with special interest in healthcare policy. And in business leadership, I could help bring a company success and target the goals of the increased revenue to giving back to others with particular interest in nonprofit charitable organizations.

As I explored these career options, my interests became more refined but I took something from each one. My interest in pharmacy holds true as I hope to have my research relate to the development of therapies. My interest in politics holds true as I am still particularly interested in healthcare policy and hope to be able to use my position as a doctor to educate others and make a difference in the way our healthcare system is set up. My interest in leadership holds true as I take the leadership skills for business and apply them to some day running my own lab. In fact, it is pursuing these other interests that I believe will make me a stronger doctor.

So why medicine specifically? First of all, the human body is beautifully complex and it is an amazing challenge to understand and seek to control its processes and especially its pathology. It is a challenge that I find absolutely invigorating and I believe it will keep me enthused about my work until the day I die. Second, it connects me to others and gives purpose to my work. It allows me to help others achieve their most basic need – good health.

I can imagine myself doing many things, but I have CHOSEN medicine because it is simply the best choice for me.