“Professionalism” was a word I had only heard a time or two before beginning medical school. Thank God I don’t have to hear it anymore, but not before I got sick and tired.

An anonymous reader of MSH tipped me off to this whole “professionalism” thing being taken to a whole new level (thanks, you know who you are). I won’t get into any infringing details, but let’s just say that big brother is watching you when you’re not at school.

In short, there have been some incidences of student activity on web sites (such as blogs as well as social networks) being monitored by school administration.

Students at some schools are now being punished for voicing their opinions. This is not OK in my opinion. Some schools are even going so far as to include statements about “inappropriate activity” in their professionalism code of conduct. Such “inappropriate activity” can potentially include cynical commentary on social networking sites or personal blogs.

How far is too far? Will the administration start banning together with bar and nightclub owners to spy on student activity away from class? Will your alcohol consumption begin being monitored? How about sexual activity or sexual orientation?

A student’s time away from class is their personal time. As long as they aren’t breaking any laws, it’s an infringement of basic human rights to punish a student for something he or she said on a personal blog.

I’m a huge fan of free speech, and I’ll say whatever the hell I feel like saying. I know some medical school administrators read this blog, and the ones that enforce such inane policies can all kiss my ass.

Always remember that MedSchool Hell is waiting with open arms to accept student’s cynical, politically incorrect, or otherwise anti-medical school commentary. Students of every medical school across the country and abroad may contribute anything they wish and not ever worry about their dictator-like administration catching them. Everyone is anonymous here.

I have to wonder if blogs such as this one are the root cause for such new policies going into affect at medical schools. Are you afraid to visit MSH from one of your school’s computers? If so, you need to take a step back and fight for your freedom of information.

This is all completely rumor at this point, but I have decent information that Step 2 CS is going to be retired beginning next year or the year after. Since I’ve been out of the medical school game for awhile now, this is something that you guys may be hearing around your schools as well.

The rumor is that US medical graduates will no longer be required to take the exam, but FMGs will still have some version of it. It’s basically a reversion back to the old days pre-CS for American graduates.

Let us know if you’re hearing the same things around your school.

The damn monkey is off my back. I f’ing passed.

Step 2 CS, for those of you who don’t know, is a newly instituted (2004) part of Step 2, the second of three Step exams one must pass in order to become licensed to practice medicine. Personally, I think the damn thing should be its own Step. Have four Step exams to prove how insane the licensing process is, instead of pretending it’s part of Step 2. Before long, the geniuses at the NBME will split off the communications portion of CS and have a “Step 2: Empathy & Social Work” exam.

What does the test entail? It’s a $1000, daylong exam, which is structured as follows: 12 patient encounters, each 15 minutes each. During each encounter, you are supposed to do a history & physical, and after each encounter you get 10 minutes to write out your findings, workup, and diagnosis on a patient note. Ten encounters are graded, and two encounters are non-graded test encounters. (One-sixth of the exam, therefore, is horseshit to begin with.) The grading is pass or fail, and more on that in a bit. There are only five testing sites around the nation: Atlanta, Chicago, Houston, LA, and Philly. The test is insanely hard to schedule unless you do it many months in advance.

It actually took me two tries in order to do it. Yes, I failed the first time I took Step 2 CS. Because of that, some of you might think I’m kind of an idiot. Here’s what I have to say to you:

1. You’re correct: I’m kind of an idiot.
2. Clinical medicine blows and I don’t really care about patients*, and especially not H&Ps and patient notes.
3. I’m going into Path: I’m not gonna be an intern next year or a clinician when I graduate residency, so I don’t give a shit about all this.
4. Actually, forget all that. Blow me, just like Step 2 CS can do.

In all seriousness, this test is crap. I hope that someone sues the NBME over it and wins. Other than it being completely unnecessary, because medical school and residency prepare you to be a practicing clinician, there’s no way to know WHY you passed or (more importantly) WHY you failed. If you pass, which is about 80-90% of US students, all they do is put “pass” on your score report. If you fail, they give little bars in each of the three areas that really give you no good information. The three areas:

A. English Proficiency
B. Communication: You probably can fail because you don’t drape people properly, which obviously reflects your lack of proficiency in medicine. This section is graded by the standardized patient.
C. Data Gathering: A reasonably fair area to test, consisting of the patient encounter and the patient note. The patient encounter is graded by the standardized patient, who ostensibly has no knowledge of disease pathology or presentation (and any sort of degree?) other than the script and checklist he/she is given. The patient note is graded by clinicians.

Supposedly there is a percentage of medical students who are not competent enough to be clinicians, and this test allegedly weeds them out. I’m not a great clinician, I never have been, and I never really aspire to be. But I passed. So the test is about knowing how to pass the test. In fact, someone on the internet somewhere mentioned that someone without ANY medical training could grab First Aid for Step 2 CS, study for a month, and go pass the exam. I agree with that statement.

For those of you that have the exam coming up, do a few things: learn Step 2 CS for First Aid backwards and forwards. Use USMLE World or the Kaplan book as well. Most importantly, practice with a partner or spouse! Have an algorithm for taking a history and physical and do it every time. Know the steps you have to do (state your name, drape, etc.) and the questions you need to ask for each symptomatology complex outlined in First Aid. That is, chest pain = location, quality, intensity, time course, diaphoresis, position, medicines tried, dyspnea, palpitations, etc. That makes it SO much easier to rattle off questions instead of trying to remember exactly what you need to ask. Use First Aid or Kaplan’s mnemonic for history taking. Create lots of mnemonics.

Don’t underestimate the test. Know that it is possible to fail, as I did to begin with, but you can also make a ton of mistakes (as I did the second time) and still pass. 80-90% of US students pass the first time. When I took the test the second time, I changed a few things: I knew the mnemonics better for each symptomatology complex, I did better physical exams, I typed my notes instead of writing them, and I did a better closure. Closure is important! Read First Aid for more about that stuff.

I pity those of you who have yet to pass this evil test. May God have mercy on your souls. As for Step 2 CS: suck it long, and suck it hard.

*I actually care about people, I just don’t like dealing with sick patients. Part of me blogging for Hoover’s badass blog is to help convince some of you NOT to go into medicine. Or, at least, let you know what to expect. That’s pretty damn humanistic!

Simple enough, here are 101 things you wish you knew before starting medical school.

1. If I had known what it was going to be like, I would never have done it.
2. You’ll study more than you ever have in your life.
3. Only half of your class will be in the top 50%. You have a 50% chance of being in the top half of your class. Get used to it now.
4. You don’t need to know anatomy before school starts. Or pathology. Or physiology.
5. Third year rotations will suck the life out you.
6. Several people from your class will have sex with each other. You might be one of the lucky participants.
7. You may discover early on that medicine isn’t for you.
8. You don’t have to be AOA or have impeccable board scores to match somewhere – only if you’re matching into radiology.
9. Your social life may suffer some.
10. Pelvic exams are teh suck.

    Continue reading →

I was miserable.

The blaring of the alarm clock radio startled me from my sleep. It’s 4:30 am already, and this is the 7th straight day in a row of waking up early to go into the hospital. It’s Sunday morning, and I don’t get a day off until this upcoming Saturday. Like a ritual with witchcraft and candles, I do my daily countdown until my next day off.

Usually we round a little bit later on the weekends, but today is special. We have a heavier patient load than usual. I don’t get to look forward to knocking off at noon, either. Today is our “long call” day, so I’ll be working until 7 pm. The dead of the morning is deafening. Through the silence my cat meows to let me know it’s inappropriate to be up at this hour. He knows more about this charade than he lets on.

I look over and my wife is fast asleep. If only I could continue to lie there with her. She looks so peaceful. I fight the temptation to lie back down and jump in the shower.

With fresh scrubs on, I walk out the door and to the car. Damn it, I forgot to warm the car up. It’s freezing outside, so I take out my drivers license and scrape the ice from the windshield. “What have I gotten myself into?” I think to myself.

“Ahh, fuck it.”

I see the Sunday newspapers lying in the driveways of the houses in my neighborhood. I know that in a few hours, most of my neighbors will be waking up. They’ll dash outside to retrieve the paper and then sit reading it while drinking coffee. Later on, they’ll spend some quality time with their significant other. Perhaps they’ll watch a movie together or go out for brunch. God, how I miss those days.

I won’t be doing any of those things, though. Fetching vitals, dealing with old people who just want to die, and the scent of hospital food is what my day has set out for me. Sundays make me want to puke. If only I could be a normal person again. I would do anything for that.

In a few hours my wife will also be waking up. One of two days of the week where we can spend significant time together, and I’m stuck at the hospital all day. I curse myself for ever going to medical school in the first place, and then I curse my wife for talking me out of quitting school. She doesn’t really know what it’s like. She thinks it’s just a regular job with long hours, but I know different.

On my drive to the hospital, I note that there’s no traffic out at this time of the morning. I know that this is going to be the highlight of my day. No people, only the stray white of headlights glaring in my sleep deprived eyes. It’s not human, and I am relieved. Humanism makes me sick, the way they force it on you. It’s always about the patient. What about us? Where do we come in? I spend my days feeling ill.

I arrive at the hospital. The walls are made up of little green tiles. It reminds me of the bathroom in my Grandma’s house. The fluorescent lights shining on the green tiles in contrast to the dark of the morning is depressing. They are extensions of these depressing halls. Little green extensions.

There is one other student on this rotation, and she’s already there as I arrive. She’s there every day before I am. Am I a slacker? Probably so. I wait until the last minute to come into this hell hole every day. She’s enthusiastic, and seems to love what this mess is all about. Just like every day, I take a minute to ponder why she loves this shit so much. I never ask. I guess I don’t really care that much. I take that minute to put off starting my pre-rounds.

I do my work and watch the clock at the same time. Nobody really talks to me much, outside of the normal medical babble. They know I hate this, they can see the depression in my face. I hate the very thing that they do to put food on the table. I think they resent me for that. I don’t care, though. At this time of the day I would rather not talk.

I laugh to myself as I think about what my Grandma will be having for lunch today. The whole family will be there just like every Sunday. As I check my pockets to make sure I have enough change for a pack of crackers and a Coke from the vending machine, I think about the green tiles in my Grandma’s bathroom.

I always hated Sundays the most.

Note: The following post was a recollection of the thoughts and feelings going through my mind as a junior medical student on my internal medicine rotation on one cold Sunday morning in January. I still remember them like it was yesterday. As you can probably tell, it was a rather dark time of my life. I no longer feel like this since I am thoroughly happy with the outcome of my decisions not to enter medicine. I never passed those feelings down to this blog while I was feeling them at the time.

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What I’m listening to: Jeckyll and Hyde: Freefall (Extended Mix)