Prelude to "The Mind of an Examining Med Student - The Sequel"

Above: A Dominican kid climbing in the Salybia territory.
You'll find me climbing trees after my exam. Keep your eye out.

I never thought that I'd write again before my exam, but...
I'm in need of a break.

Here's why.

I think that another med student on a forum put studying for the big exam well... It's like running a marathon. Practice. Practice. Practice. So, out there, several studying-aid companies offer practice exams that are only 4 hours long, and there's exams that are also more like the real thing, about 8 hours long.

Well ... I took the 8 hour practice exam today.

As I took my exam in a deep corner of the library, stuck in a cubicle to separate myself from the rest of the world... I tried to simulate what the big day in a couple days would be like. Let me tell you, that the exam threw my mind left and right. At a point, I had no idea how I was doing. As much as every question is "mutually exclusive" from another in terms of content, I felt my confidence wane left and right, as one question that I was unsure about, totally made me doubt myself on a question I would typically be sure about.

And then... after all that, my reward: a number. My brain felt fried, cooked, well-done, over-easy, scrambled, and dipped in Tabasco all at once, but it did feel good to be done.

I think that's exactly the way that my exam will go on Tuesday (other than the number actually coming six weeks later). But... there's 5 days left to study, and here's the dash to the finish to making my score the best it possibly can.

It's game time.

Almost There.

Above: A Dominican Rainbow... so much better than reading pages of text. Spring 2008.

I'M STILL ALIVE...
I THINK?

The days are flying by, sometimes to the point where I the only thing reminding me of the date is the monday $1 special at the Caribou Coffee(s) I hit up. I moved my test date back to the 28th, but seeing how my progress is coming along (if there is one), I'm glad I did. However, as tempted as I am to keep pushing it back, I have to remember... I can't keep the test waiting forever. So... 28th, Regis, is my final answer.

It's me, my "bible," and a laptop, against the NBME in just a few days.

I'm still blogging, and I'll get y'all updated on what its been like these last couple of weeks (trust me, my nomadic travels of studying have taken me to some interesting experiences). This was just to let y'all know I'm still kicking. So thanks for keeping up with reading, for your support, and... stay tuned. We're almost there.

For now, its back to the books.

Two IMGers, Two Different Perspectives

Above: A view of the valleys of Dominica from Horseback Ridge.

12:45 PM. My typical lunch rush. I'm usually the type of person who schedules his lunch to avoid the lunch rush that occurs (I always thought it was a stereotype to head out for lunch at 1:00 instead of everybody else who leaves about 12:00 from their offices). However, I started my blog entry in the wrong place (I just ate Taco Bell, so it must be the food that's giving me coma)....

12:00 PM. Everyone else's lunch rush. I'm dashing between my First Aid Book and my USMLE QBank, trying to make connections for my upcoming exam (which by the way has been set on the 24th of this month, so wish me luck!). With my table of four at the library, I was taking up a lot of space on it, and this man comes in, trying to find a table. The man seemed to be about middle-aged and from the middle east. He pulls out the chair, and with simple enough body language (I had my headphones on, listening to Ramsey Lewis), I nodded to give permission to take a seat. As soon as he smiled back, I couldn't help but noticing a USMLE First Aid for Step 2 CS in his hands.

Okay, now its 12:45 PM. I see the man look like he was about to head home: he was putting together the gradually widening mess of papers that grew around his First Aid book, and I broke the ice...

Hey, are you starting studying for Step 2?, I asked him.

He nodded back to me, and also let me know he couldn't help but notice the Step 1 book in my hands, saying Step 1, I pass. Step 2, I think is hinderance for International Medical Graduate. He told me the whole story of his pathway with the ECFMG, as a foreign medical graduate, and how he now has to take the Step 2 again. I then told him that I also was part of the ECFMG as a medical student, and pointed right to the cover of my book: USMLE Step 1, it says in giant white sans serif font.

(Let's back up a step. As a Ross Medical Student, I'm a part of the ECFMG (spelled out, the Educational Commission for Foreign Medical Graduates). This is the sponsoring organization of Foreign Medical Graduates, such as myself from the Caribbean, but also from other countries, such as the middle east, where this gentleman was from.)

He then replied... I notice you speak good English. I smiled a little and then said, I was born here. After sharing a few more bits about myself, I learned the man was about to take his important exam for his career at about the same time that I was about to take the most important exam of my life. I then wished him good luck and told him I will see you in the library quite frequently. After he nodded with a smile, I packed up my stuff and I was off to lunch.

Apparently he wasn't off to lunch: he was about to duke it out with his books for a few more hours...

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As simple of a conversation that was, it made me take a look again at where exactly I fit in the whole realm of medical students for the United States. We've got the U.S. Medical Graduates, and then the International Medical graduates (IMGs... like the middle-eastern gentlemen). As an IMG in the Caribbean, I forget that there's IMGs from other countries trying to find their medical niche in the states, but combatting battles such as language barriers and medical technique differences. These are differences that the Carribbean schools have worked hard to minimize, something I am grateful for.

However, although we have differences as a very diverse group of Truly foreign IMGs and Natural US Citizen IMGs, I believe we're all in this together, all finding our way to work for improving healthcare and for a decent living in the United States. And that realization on this July 4 weekend has brought a smile to my face.

Humble Beginnings

Above: A doctor making a quiet appearance in Robert McCall's mural Reaching for the Stars, 1982.

"EGO IS THE BIGGEST
ENEMY OF HUMANS."
-- The Rig Veda, a collection of over 1,000 hymns, which contain the mythology of the Hindu gods.

I don't know if it was truly planned this way, but I think that Ross gave me a neccesary humbling view of the medical profession...

A few weeks ago... During COMP studying, I was sitting in my typical spot at one of the public libraries. While working on questions, I look up and there was one of the people I went to high school with (keep in mind, long story, but high school wasn't exactly a Cinderella story for me). When I looked up she was about to head in another direction when our eyes linked, and the first thing that came out of my mouth was, "Hey!" She walks over and says "I see you're studying for the Step too." I knew that she went to a U.S. Medical School, so I told her about how Ross gives us the COMP, how I'm away from Dominica now, and the nine-yards about coming from a Caribbean Medical School. The whole time I could tell she had one of those smiles that kinda was put there for kicks. When I finished, all she could say was "Good luck." I wished her the same, and she walked away.

I turned around back to my computer screen, thinking, "Wow, she seemed really snotty."

For those of you unfamiliar with the medical school stories, in short there's definitely discrimination of us Caribbean students pitted against the traditional US student. Our programs are virtually the same in many manners, from organization, to class structure, to topics taught. There's not enough space to fit all of us future doctors in the states, so Caribbean schools were opened, one of the first for this purpose was Ross University in 1978. Although there are many similarities, that "I'm better than you" sentiment has been felt and seen with many of my friends interacting with US Medical Students at residencies and rotations. However, the feedback has been good for us Ross students, with many of our rotation sites saying that our performance has been equivalent or better than U.S. students.

So there :P. But I'm not here to get egotistical about our performance, for a reason.

Going to Ross has made me think retrospectively: had I gone to a med school in the states would I be acting the same way to someone who hasn't made it into med school? Would I be acting the same to my friends who went to a Caribbean med school? I'll be honest, I don't know. But what I can say is that being in this position has really taught me that, no matter who you are, Caribbean or US Medical Student, we're all in the same boat right now: about to take one of the most important exams of our lives, the Step.

Yes, going to a US Medical School is quite an accomplishment, as getting in over thousands of students is no easy job, but in truth, wearing that ego may do more damage to the profession than one may think. We're all going to become doctors, we all have the goal to help the health of the human race. Who cares what school one went to: a respectful sharing of knowledge, fighting for the patient, and effective teamwork is what us doctors need to do to carry medicine forward. When working separately, and not sharing knowledge appropriately, who knows if our decisions are the best ones made or if we overlooked a detail or two? How about encouraging other doctors to perform their best, even if it may seem bettering others than ourselves? Our pride as doctors should, in the end, benefit our patients not our ego.

To me, an ego can only stand in the way of taking care of our focus: patients. An ego won't get any of us closer to our goals as doctors, will it?

What's Next?

Above: A Med Student's Bible, First Aid (2006, 7, 8, or 9). I have the odd -numbered years in that aforementioned set :P.

"IF WE CAN DREAM IT
WE CAN DO IT."

-- From EPCOT Center's Horizons (1982-1999)

I really enjoyed that I took some time off for R&R after the COMP. Spending some time at Epcot to refresh myself on the promises of the future, and now on the shores of Daytona Beach to relax, I'm back to get into the grind of studying (I miss my coffeehouses).

I talked a few entries ago about where I want to go as a doctor. Well, it's time to take that issue head on. For every medical student, the boards (a more lax term for the three "steps" of the United States Medical Licensing Exams - USMLE) are fate-determining for medical students. Many studies show that the First Board Exam will almost absolutely determine what type of doctor I'll become. So, I'm about to head onto the fog once again, and its time to start thinking who, or what I want to go with medicine. And, here's three prospects...

1. Pediatrics. I have always loved kids... they're the hope of the future. Hence, I've always dreamed of working in a pediatric hospital, treating some of the worse of diseases. Sometimes it may seem that diseases are simply spontaneous, but for many kids they're born with them. Chromosomal abnormalities, physical deformations, immune system and even tumors present at birth plague these kids. And for some odd reason that pulls me that some of the pride of the future is affected from the beginning.

On my flight to take the COMP, I had an opportunity to meet a Canadian resident currently doing pediatrics. She caught me carrying two of my step books with me. However, as we were talking about our medical experiences, she mentioned one thing that stoked me... pediatrics encompassess a lot of embryology. I see embryology as one of the most intriguing parts of medicine, and it focuses a lot on the origins of the different parts of the body from the start of the merging of a male sperm and female egg cell. I'll be honest, that with the complexity of the way cells develop in a baby during pregnancy, I feel that embryology albeit interesting, is neglected in today's medical education: I felt it was something we had to simply memorize instead of understand.

2. Pathologist and potentially as an educator. I bet you're thinking: You're crazy... from kids to dead people. I'm not. Pathology was one of my favorite subjects in medical school. Opening up bodies, with the pursuit of mystery and problem solving, in addition to mastering the visual art to realize minute differences in the appearance of pathologic organs, makes pathology a quite interesting field (if you don't believe me, watch Dr. G: Medical Examiner on Discovery Health). Yes, interacting with people isn't involved, but I figured I would make that up if I would become a medical educator. With inspiration from my favorite(and in my opinion best) professor, Dr. C, back in dominica, along with my aspirations to teach others, this has appeared as a great option. Because pathology is a subject in medical school, my clinical and educational aspirations have found a great partnership.

3. Anthropologic medicine. I have always been interested in behaviors and culture. And we know that both of these options affect the ways that people treat themselves. Looking at the Wikipedia entry on Medical Anthropology:

In general, we may consider the following five basic fields:

• the development of systems of medical knowledge and medical care
• the doctor and patient relationship
• the integration of alternative medical systems in culturally diverse environments
• the interaction of social, environmental and biological factors which influence health and illness both in the individual and the community as a whole
• the impact of biomedicine and biomedical technologies in non-Western settings

I honestly believe that understanding patient behaviors and the rationale behind them can improve healthcare. And, with my likening for research, I can see how this might be a field for me in the future. Along with the pathology field, I can see how this may get me re-involved with becoming an educator (via academia), along with participating as a clinician. The disadvantage is that this may involve additional education: a PhD may be in the works here, perhaps in Anthropology or Psychology, but those are definitely other interests down my alley.

A recent AMSA The New Physician article is what started me on this idea. These people do cool things, see great places, and get to interact with people the average clinician won't see on a daily basis. A little adventure to make things exciting, right?

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SO...With these options: Perhaps there'll be a research component? Like I said, I love the clinician aspect, but i always wanted to do more with the job. Perhaps I'll need extra education? I love academia, so I wouldn't mind. Perhaps I need to do more research on my future? Yes. Perhaps I need to have a back-up plan in case things don't work out? Obviously. Perhaps I'll change my mind? Who knows.

My options are open... the higher my score on the boards, the more options I can keep. Well, all of us med students value options... Therefore, we value this exam. Along with my friends who have/will take(n) this exam too, this is a time we all need to put our best foot forward. Good words from the king, Elvis, put our situation well: It's now or never.

However, I prefer to look at the situation using the words that started this entry... :D