Sexism in Clerkship

I’m going to point out that frequently during your clerkship, you will experience sexism. Sometimes these moments will be not too bad, a patient thinking you’re a nurse (are you kidding? I wish I knew that much in clerkship!)

Most times, it will be subtle. It will be everyone ignoring the suggestions made by the female clerk. It will be judging her outfit or flirting with anyone. It will be interrupting her, presenting her ideas as their own. It happens. It becomes common. Everyone will act like this is just how it is. Your job, male or female, is to make sure this is no longer common. Your job is to make sure that clerk feels supported. This is your team, you all need to be strong.

Here’s how to do it without waving a flag and making everyone on the team afraid of you.

When she is interrupted or ignored, wait until the interrupter is finished speaking, then say “I think that Meredith was making a good point, did everyone get to hear it?” When derogatory comments are made, ignore them and change the topic to whichever patient was being discussed prior to the comment. If someone is presenting Meredith’s ideas as their own, be subtle, this one is tricky. Something along the lines of “It’s a great idea, I thought as much when Meredith said it this morning at rounds. Maybe you two should work on it together!”

Everyone on your clerkship team deserves to feel supported. Everyone deserves to be able to show what they know and learn. When your colleagues thrive they bring you with them.

Be the colleague you want to have.

Not even the end of second year

And already my colleagues from medical school who have chosen other specialties are dissing family medicine docs.

We are not just a dumbed down version of your specialty, or even all the specialties.

We are a specialty of our own. We deserve your respect. I guarantee, no matter what you think, you could NOT do my job for a day. I couldn't do yours. And that's ok. It's why we chose different specialties to match to.

I know we need to be cocky to do our jobs well, but it should never, ever, be at the expense of another specialty.


- Posted using BlogPress from my iPad

Residency Blues

Starting around 4-6 months into residency, almost universally, residents everywhere get hit with the blues. It is soul sucking and demoralizing to work every day, for what feels like millions of hours, at something that you are never really that good at.

We rotate through different specialities and disciplines every few weeks to every month or two. Our advisers change daily or weekly. Just when we think we're starting to get the hang of how this guy likes to see his notes written, or how she will think about making orders, we're thrown into a brand new situation.

Actual mastery of any domain is difficult to achieve because Family Medicine residents are meant to be exposed to as much as is possible so we get little time to hone our skills before moving on.

I'm in a community based program. This means that I'm in a small hospital which is great for being the only resident on and getting more chance for exposure to cases as they come through the door. It also means I'm the only resident who understands what I'm going through. Even though there are technically 4 of us in the hospital right now, we never see each other because we are never on service together. When we do see each other in the halls there is a flood of conversation, sympathetic smiles, and general advice from our experiences with the rotation before we need to move on.

I came from a large, very close class in med school. I miss them like crazy. We would frequently run into each other in the halls of the hospital while on clinical rotation and give each other pep talks before running on. We had small groups where we could all commiserate and hug and eat chocolate. We didn't feel alone. I knew that more than 140 other med students had my back, and they knew I had theirs.

I feel alone now.

Residency can be very isolating. I love my partner dearly, but he has no idea. He has always been my cheerleader and believes that I'm a rock star no matter how badly I mess up. Other residents get that we do make mistakes and they're horrible and say things like, "Well, you still have a good outcome...", or "No no no. THIS is a terrible mistake." We work through what went wrong and try to learn from it. Residents know how the teams in hospitals work and the questions to ask such as "wasn't there a note in the chart about the patient being diabetic?" This can really help to put things in perspective.

While I love that my partner thinks that no one is smarter than me and that everything will be perfect, it's difficult to believe after being raked over the coals by a preceptor for not knowing the full differential of rash in a 2 year old. It's not that I'm not willing to explain all the ins and outs of the interactions I have at work, but most days when I need to blow up, I just don't have the energy.

The problem with residents though is that they never really have time to chat. It takes forever to set up a good time for us to actually spend time together.

I'm looking for a good solution.

Ceremony

Graduation day itself was a whirlwind of activity and emotion. I've always been a crier - especially when a large group of people is doing something together (dancing, singing, chanting, swaying). When we sang the national anthem as a class, I cried and couldn't sing because I kept thinking, this is the last time we're going to sing together. As a class, we are incredibly talented and always put on a great show at our annual variety show. Singing with the class has just been part of school.

We were accepted by the vice - chancellor to be graduates from the class of medicine (phew) officially making us all MDs. That was a bit freaky and still makes me nauseous when I consider what that really means.

The ceremony itself was lovely and suited our class perfectly. There were irreverent moments and times of great solemnity. It was exactly what I had hoped for.

Until the recessional tune was started by the string quartet.

My class has always gone berserk for Journey's Don't Stop Believing. It's a huge part of what I think it is to be a 2011. We all run for the dance floor and fist pump to the song whenever it's on in whichever bar we've taken over.

When the string quartet started playing Don't Stop Believing, I was treated to our class singing together again. I tried to sing along too, but frankly, that's incredibly hard to do when one is bawling at the same time. It was the most wonderful surprise I have ever experienced. I'm still a bit in shock that the perpetrators of the surprise were able to keep it from me - I thought I knew just about everything that was going on in this class. Nothing could have made me happier and sadder at the same time.

Graduation Day

In 2007 I recited the Hippocratic Oath with a huge group of strangers.

Today, I'll repeat the Oath, but this time I get to say it with the strongest, funnest and most amazing people I've ever had the opportunity to get to know.

This is a huge step for us that we get to take together again. It's heartbreaking though that every step after this will be taken separately.

My class has been my support and my burden. They've been my friends and my pains in the ass. There are members of the class I will sincerely not miss, but only a couple. Despite our best efforts, I'm sure that we will not be as close over the coming years as we wish we could be.

This is going to be a bittersweet day - celebrating our amazing accomplishments but also mourning our close friendships. There is something precious in the day to day interactions that I've had with my class over the years - getting to know everyone's quirks, their dreams, their food preferences and being able to smile and say hi to 144 people and having that reciprocated.

My partner keeps referring to my class and the medical profession in general as a cult. I get that. We use a "secret" language, we are bound to one another tightly through extraordinary circumstances. Mind altering substances (mostly tequila) are used liberally. We see each other and medicine in general as the most important things in our lives next to our families and own health. We follow the doctrine of evidence based medicine (state your source!). We were kept together in close proximity during our clerkship training, very much like the compounds used to prevent cult members from seeing anyone in the outside world.

But I digress.

Big day. Big big day.

One version of the Oath:

The practice of medicine is a privilege which carries important responsibilities. All doctors should observe the core values of the profession which centre on the duty to help sick people and to avoid harm. I promise that my medical knowledge will be used to benefit people's health. They are my first concern. I will listen to them and provide the best care I can. I will be honest, respectful and compassionate towards patients. In emergencies, I will do my best to help anyone in medical need.

I will make every effort to ensure that the rights of all patients are respected, including vulnerable groups who lack means of making their needs known, be it through immaturity, mental incapacity, imprisonment or detention or other circumstance.

My professional judgement will be exercised as independently as possible and not be influenced by political pressures nor by factors such as the social standing of the patient. I will not put personal profit or advancement above my duty to patients.

I recognise the special value of human life but I also know that the prolongation of human life is not the only aim of healthcare. Where abortion is permitted, I agree that it should take place only within an ethical and legal framework. I will not provide treatments which are pointless or harmful or which an informed and competent patient refuses.

I will ensure patients receive the information and support they want to make decisions about disease prevention and improvement of their health. I will answer as truthfully as I can and respect patients' decisions unless that puts others at risk of harm. If I cannot agree with their requests, I will explain why.

If my patients have limited mental awareness, I will still encourage them to participate in decisions as much as they feel able and willing to do so.

I will do my best to maintain confidentiality about all patients. If there are overriding reasons which prevent my keeping a patient's confidentiality I will explain them.

I will recognise the limits of my knowledge and seek advice from colleagues when necessary. I will acknowledge my mistakes. I will do my best to keep myself and colleagues informed of new developments and ensure that poor standards or bad practices are exposed to those who can improve them.

I will show respect for all those with whom I work and be ready to share my knowledge by teaching others what I know.

I will use my training and professional standing to improve the community in which I work. I will treat patients equitably and support a fair and humane distribution of health resources. I will try to influence positively authorities whose policies harm public health. I will oppose policies which breach internationally accepted standards of human rights. I will strive to change laws which are contrary to patients' interests or to my professional ethics.

Graduation Festivities

I'm going to skip over the MCCQE and what I've been up to since writing it, with a promise to come back to it later.

Tonight our convocation festivities start.

One of the guys in my class said that he thought his family was making a much bigger deal of this than he thought it was worth. He recognizes that getting to this point in our lives is huge, but from his perspective, just another step.

I definitely get that. I think that these celebrations are a way for us to share what we've been doing for the past 4 years with our family and friends.

From our perspective, not much changes from when we first got our white coat four years ago to when we get our parchment tomorrow. It's true we've grown and learned, but we have been doing this at incremental steps so that it doesn't seem like much has changed. It's true that there has been work, but there's been fun and we've been doing it as a class with whom we've become close. It's hard to think about our day to day work as difficult when you're doing it with friends. Plus, we still need to start our residency in July which means packing, moving and trying to not look like an idiot on our first day. Our focus is far ahead to what is yet to come.

Our families on the other hand, have been dreaming of this day for longer than we have, even if they don't want to admit it. They are so proud of what we have done, seen and learned. They recognize the changes in our personalities, appearance and confidence. They are excited to see the class again since not seeing us all together since year 1. There have been few opportunities for them to share our accomplishments with us. They are excited to take photos of the new doctor in the family, to shake our hands and give us hugs. And to brag to everyone who will stand still for more than a few seconds to hear that cousin impostor is graduating from med school on Friday.

Our family and friends are proud of us.

I can't blame them really. I couldn't be more proud of my class.

Post Match

This week has been incredibly emotional so far.

The day of the match included celebrations, crying, disappointment, drinking, dancing, hugging, crying and screaming.

Did I mention the crying?

It's hard when you are a type A personality who is used to having everything that you've worked for given to you to suddenly be given your second, third or 39th choice. Or even worse, to not get any of your choices.

Your world suddenly falls apart. Things you thought were true are no longer true. The beautiful bubble of perfection you have been living in pops and everything comes crashing down.

For some of us, the crash was largely in our heads. There was little really wrong with what we have matched to, it just wasn't our first choice.

For others, it meant taking a position provinces away from their partners or not matching at all.

It's been difficult for some members of the class who matched to their number one spot. They want to jump up and down and scream and laugh and be happy all the time. But they feel constrained by their love of our class and not wanting to hurt anyone who is less happy.

It seems unfair that their joy needs to be constrained.

The Interview Tour

The interviews account for a certain percentage of our overall score that the schools use to rank us. How much they make up depends on the program and usually we have no idea. Personally, I think voodoo is involved.

The goal of our interviews (and everything to this point actually) is for the schools to want to rank ME number one. ME ME ME ME. That makes it much more likely that I will get the program I rank number one. I’ll explain this in a post about ranking.

Prep for the interviews includes collating all our best stories from our clinical experiences. We want to make sure we have examples of good and bad team interactions, leadership, earth shattering awareness that THIS is the specialty for us, strengths, weaknesses, difficult ethical experiences, conflict with a “superior” and anything that shows that we’re not the babbling idiots we usually feel like we are. We practice answering questions but have to be careful not to practice too much because it tends to make it sound too rehearsed.

We buy a suit, or two, and worry about which shirt to put underneath.

Then the actual interviews begin. CaRMS interviews take place in the last week of January to February. In Canada, winter can be less than reliable. Students in my class have had their flights and trains cancelled. Roads have been slippery. I haven’t heard of any interviews that had to be cancelled for weather, just plenty of stress in getting in on time.

The kind of interview you get depends on what specialty you are applying to. Since I want family, my questions usually went something like this:
1. why family?
2. what skills do you bring to family medicine?
3. what challenges do you see family docs may have?
4. challenges the residents may have?
5. tell me about a good/bad team experience and what you learned from it
6. tell me about a particularly difficult clinical encounter and how you feel it has shaped the doctor you will be
7. why this program?
8. tell me about this thing you wrote down on your cv...
9. tell me about your strengths and weaknesses
10. tell me about yourself (very few actually asked this)

Family is a very chill interview - they try to make it more like a conversation so they can get to know us and figure out if we are the kind of person they can work with for the next few years. I was always interviewed by a doc and a resident in a clinical exam room, except one where I was in a board room of a hotel. The interviews lasted 10-30 minutes, with an average of 20.

Friends in other specialties had different kinds of questions though. My friend applying to gen surg was asked “if you were a salad, what kind would you be” - what?? Another in obs gyne was asked multiple ethics type questions and had MMIs rather than just hanging out with the one group. Safe to say that the type of interview you will get really depends on to what discipline you are applying.

With family and some of the other disciplines, there is a morning orientation when they go over the program in detail and why the residents *love* to be there. Family is split into programs on multiple sites so we always get several lecturers to talk to us about the different programs available through the school. This can take hours and is why family med orientations take so much longer than the other specialties. On the upside, we often get at least one meal out of the deal, usually two.

The orientation is followed by the actual interviews. Having such a long introduction to the day has the odd benefit of lulling us into a close to coma state so we are not as stressed about the interview itself. Or maybe it’s just me.

The interview tour has brought out the best and the worst in some people.

Some are acting like competitive children, ignoring conversations started by students from other schools. Others are actively trying to psych one another out. Still others are so insecure in their own worth, they are lashing out at those around them.

The majority are just trying to get through interviews in one piece.

The best though are sticking up for one another. Sharing hotel rooms when the weather is terrible and requires colleagues to stay in the city an extra day. They are meeting the people from other schools and getting to know them as well. Some even help up clumsy candidates when they fall all over the ground...no one I know I’m sure...

They are being the genuinely nice people they are. These are the classmates I am incredibly proud to know.

I was definitely not immune to the stress. The night before one of my interviews I had a dream that the school had decided to get rid of the usual Q&A and make it a spaghetti eating contest instead.

I decided it would be easier to not rank that school than deal with the insanity.

Back to Class

It's shocking to us how tiring it is to be back in classes for hours at a time. Some folks are here for 9 hours of class per day, no breaks. Gah.

After 2 hours, I fuzz out and have a difficult time concentrating on what is going on at the front of the class room. For example, right now I am in class. Half the class is reading the newspaper (on their laptops or paper versions), the rest are sometimes paying attention to the lecturer.

The OSCE last night went well enough. One of the downsides of being involved as heavily as I am in curriculum and the medical community, is that my examiners were all people I know from outside class. It's one thing to humiliate yourself in front of strangers, but another all together to do so in front of people you have been working with as a colleague for four years.

This morning I had my first residency interview. One of the out of province schools came to us to interview which is wonderful. I get to save money on a flight out there to apply, though, I have dumped all my out of province offers. Applying in the first place was terrifying and I was sure that I would be the person in the class who didn't get to match because I let the interviewing committee know that I'm just an impostor and don't really deserve to be here. Then I got interviews everywhere I applied. Not everyone did though so I realised that I really was a competitive candidate.

I've decided to save my money from the flights and go south on a cheap vacation while the rest of the class continues their interview tour around the country. This had the dangerous effect of making me feel *too* comfortable in my interview and talking quite loosely rather than following any sort of clear plan when answering questions. I hope I'll stay competitive anyway.

I feel a strong draw to the oceans of the Maritime provinces. There's something magical about practising medicine on the coast. The hospitals in the small communities are run by family doctors with other specialities acting as consultants only. This seems like real medicine to me. Dr. Quinn Medicine Woman real medicine. I would be able to learn an enormous amount of medicine in the short two year residency.

When the rank list is due, I'm going to have a very difficult time choosing how to rank my choices.

Random facts about The Impostor - Med School edition

1. I often bath rather than shower before an exam. This is so I can study in the tub.

2. Even though almost everyone in my class thinks I'm intelligent, I'm barely making it through my exams.

3. Anatomy lab makes me HUNGRY. Which really grosses me out.

4. I'm addicted to having textbooks but rarely use them (though the Case Files series may convert me).

5. When my class chatters while we should be listening to a lecture, I'm ashamed of them.

6. I have consistently done poorer than the class average on all my exams and assignments but one.

7. I crave the approval of those around me. I worry what will happy when I move into my own practice and need to encourage myself - this is when the impostor part of me takes over.

8. I'm terrible at completing projects - I can have several going at once and never truly finish one of them.

9. Even though I know my school has a pass/fail system and that my potential residency programs won't see those marks, I worry that they will somehow find out that my marks aren't brilliant.

10. Drinking herbal tea with fun sounding names makes it easier to study for exams.

11. I watch TV while I'm studying. That likely explains my poor marks.

12. Every now and then I get these moments when I realise that I'm going to be a doctor - soonish. At first I go into this sense of awe and happiness, that is later replaced by abject terror. While I feel I can talk the talk, I'm not sure I'll be able to walk the walk. Maybe dermatology is the thing for me? I like raspberries in my water.

13. I want to specialize in everything.

14. Our class is incredibly charitable. We spend a great deal of time raising money for people overseas, kids who are chronically ill and friends who are fighting great battles. It makes me very proud of them.

15. My favourite block so far has been MSK. I like diseases and body systems that I can see.

16. I was drinking 8 cups of coffee a day. I'm down to 2 now because the hypertension and tachycardia caught up with me.

All talk no action?

One of the first 'touchy feely' things we talked about in med school was how to doctor the doctor. That is, how to treat a colleague in need of medical attention.

I've been thinking a bit about that discussion and how applicable it really could be.

There's something terribly abstract about a lot of the discussions we have in our weekly groups. We talk big, things we would do in certain situations, but will we actually act this way?

I spent a large part of the last three weeks in the hospital with my parent who was having heart surgery. This was unexpected and very scary. My family was kept in the dark quite often about what was going on. Doctors would talk to the stoned patient who would then pass on incredibly strange interpretations of what was going to happen next/what had already happened. At one point, the staff had Dad wrapped up and ready to ship to another hospital while my mother and I were worried in the waiting room, oblivious to why the procedure had taken so long and wondering if anyone was going to come and talk to us. Apparently, they weren't.

Patient centred my large white bum.

Losing control of something as simple as how information is passed on to us was incredibly upsetting, especially for me. I had no idea I was such a control freak, but apparently no one else was surprised.

My father is now home and doing well and doesn't remember much of his hospital stay. All the more reason that his medical decisions and information should have been considered with a family member present. I'm glad he's doing well, but confused about how others dealt with the situation.

Apparently my entire family but one is afraid of hospitals and illness. They choose to ignore it and hope for the best. The one exception is overseas - I can't imagine how stressful that can be.

What bothers me about everyone being afraid of hospitals is the assumption that I will just take care of everything. I get that I'm in med school and can handle a bunch more and understand what's going on. I worry that when my parents are old and in need of help that I will be expected to be the one to take care of them. That worries me. A lot.

I was also thrown by classmates' reaction to me while this was going on. I am currently the epitome of depression. It's from being emotionally and physically exhausted and just so far behind in everything that I need to do. I know it will go away, but I really need support now while I deal with it.

One classmate who I consider a friend but wouldn't think of asking for help emailed me her notes to keep me in the loop on days I missed. I was surprised and very very happy that she cared that much and recognized that I needed a hand. A few others in the class have been very supportive. Ones I would and would not have expected. They noticed I was missing and wanted to know if I needed help. So fantastic.

Others that I consider to be friends are completely ignoring me. I guess they're waiting for the non-depressed me to show her face before trying to engage in conversation again.

This makes me worry about 'the person in our class who will develop mental illness during our 4 years here'. Apparently there's one in every class. I hope the person who notices the out of character behaviour is able to help and can act in the idealized way we discuss in our groups.

What Med School is Like

It seems like whenever I get overwhelmed with what is happening at school, someone asks me how school is going. They mean well. I love that they care, I really do, but I have no way of explaining how I'm feeling without sounding like I'm whining.

The blogger "The Rumours were True" compared med school to eating 5 pancakes every day. He has something there, and it's definitely worth a read.

The idea was made into a short film.

Why do we put ourselves through it?

Dr. Unnecessarily Angry Surgeon comes to in to teach at least once a month

I've been able to get to know the entire class. Really. I know everyone's name and at least 2 bits of interesting information about them. Even the ones who never come to class.


OK, too many videos on one page, I'll start actually writing now.

I love school, it's a great experience. What gets to be stressful though is how absolutely impossible it is to do everything I want to. My undergrad style of note keeping went out the window within a few weeks of starting class - there just isn't time and it just keeps coming. There are "interest group" lectures about absolutely everything. It's a great way to learn what I want to do when I'm done school and I want to hit every one, again, can't.

There are a million committees and community interaction groups, councils and academic events that I want to take part in but again, just no time.

Not to mention the weekly (at least) party.

I'm constantly feeling guilty that I'm not getting to everything and doing as much as I possibly can. It's a bizarre thing. I'm getting used to the fact that I can't do everything but I don't like it. You know I'm pouting.

Talk about surreal

I think I've made it pretty clear that one of my biggest concerns about coming to med school was getting along with my classmates. I was treated like an alien by most of the people in my program during my undergrad. I thought this time would be different.

I spent quite a bit of time last summer researching cultural norms of the average 23 year old, hoping to acquire a language that we could all speak. Imagine my surprise when "Don't Stop Believing" by Journey became our class anthem. It comes up every time we go out as a class and everyone who is out has their rock finger in the air pointing and singing at the top of their voice. We're insane. A woman in the class who doesn't go out to many events came out to a recent one and witnessed the insanity that is our class. We act like fools and really get into whatever it is we're currently doing, singing, dancing, stripping... and none of us judge each other while we're at it. She said "I know completely understand something I previously didn't know existed. When are we going out again?"

Other classes think we're mental/immature but we're having a lot of fun and frankly don't care.

Guitar Hero had a huge impact on the music my classmates listen to since it's how they spend so much free time. It's amusing to me since I remember when most of those songs came out on video and they just think of them as something that happened way back in the eighties.

Our last day of school is in 38 days (YIKES!!) and we're planning a trip away to someone's farm to camp out. The weekend will be named after an eighties band that I was fond of during high school. This is what I bring to the class, an ability to pull from my huge repertoire of eighties trivia to make the year more colourful. And I don't need to do anymore homework to fill this role!