Med School Done Right
By Luke Murray
It was Friday afternoon and the morning lectures had just finished. I surveyed the challenge ahead of me: 20 lectures that I had only been through once, another 6 that I haven’t been through at all, and the test was Monday morning…
Time to do the obvious: panic.
In the words of every 13-year-old that’s ever sent a text message: “JK…kinda.”
While I did not physiologically manifest a full blown panic attack, the ‘plans’ I put together were almost totally void of the two things that would make them useful: (more…)
By Luke Murray
As I wrote about in my earlier posts, ‘The Avoidable Cycle of Self-Doubt’ and ‘Give Your Presentation Backwards’, I used to be confused about what I ‘should’ be doing on wards… presentation-wise. Most of the time, I tried to do what I thought they wanted or leaned towards what the textbook said to do, or I hedged my bets by giving more information instead of less, because I was concerned I’d leave something out. I used to read every lab value and every section of the H&P out loud because…that’s what it says in Bates.
The problem was: my presentations were painfully boring because 90+% of what I was saying didn’t matter. And I was spending so much effort and brainpower collecting and reporting every last bit of information that I didn’t have the time (and my team didn’t have the patience to help me) intelligently organize and share the most important part of the H&P – the Assessment and Plan.
None of the residents presented in the classic med student way. They just talked about their patient in a generally organized way. That’s it.
Now in my second year of residency, I’m doing the same. And it’s making me a better doctor.
For example, I had a patient come into the ED last night, he was tachypnic, had increased work of breathing, and I was working him up appropriately but starting to feel in over my head and stuck in a few places, so I called my attending.
This was my ‘presentation’: (more…)
Love your First Aid book, but wish it was easier to use? We asked one of our blog authors, Luke Murray, to do a quick run-through of how to modify your First Aid book by unbinding, then rebinding, his own copy.
By Luke Murray
I have lots of different regrets about my time in medical school. I should have tried more things professionally, personally, and socially. I can’t tell you how many nights I sat in my room thinking I would go out that night or call someone up to hang out but thought, “I need to get to bed in a hour so I don’t really have time…” So instead of actually spending time with someone for an hour, I’d watch YouTube videos for the next two hours. In hindsight, I should have made this mistake once or twice, wised up, and then spent that time with friends or even strangers – anything really. But I didn’t, and the naturally isolating experience of medical school remained so for much of my time there. I left a lot of memories and potential friendships on the table during those years.
Another regret has to do with the way I studied. Like my social decisions, I should have known and admitted something was wrong much sooner than I did. I didn’t do well on my first quiz in anatomy just a few weeks into medical school (I failed it, actually). At that time, my strategy was to be as thorough as possible with each pass through the material, to just make sure my eyes saw as large of a percentage of the content as there was for them to see. As an obvious consequence, I only got through the material a couple times (if I was lucky) before a test. I did poorly, again, and then vow that I would study even harder, be even more thorough, next time around. No paradigm-altering changes, just doubling down on an obviously losing strategy, thinking that ‘time spent’ was the only variable that needed tweaking. I continued to stay in the bottom of my class, until my second time through my second year. (more…)
By Luke Murray
In my last few posts I’ve argued that all you have to do to be a “good” third year medical student is be “engaged.” In order to make this insight more actionable, I described the biggest source of disengagement for me (not accepting my circumstances and calibrating my expectations) and what I wish I had done about it. In the third article, I talked about distractions as a source of disengagement, and what I did to minimize my own. In this final post, I’ll talk about the last category of reasons for which I found myself mentally unplugged during rounds: physical discomfort.
There’s no denying that being “engaged” is mentally and physically taxing. And the more physical discomforts you have to ignore in order to keep your head in the game, the more exhausting it is – and the less likely you’ll be able to keep it up. This experience is called ego depletion, which is “the concept that self-control or willpower draw upon a limited pool of mental resources that can be used up. When the energy for mental activity is low, self-control is typically impaired, which would be considered a state of ego depletion.” The following were my biggest “ego depleters” and what I did (or should have done) about them. (more…)
By Luke Murray
In my last couple of posts, I’ve argued that all you have to do to be a “good” third year medical student is be “engaged.” In order to make this insight more actionable, I described the biggest source of disengagement for me (not accepting my circumstances and calibrating my expectations) and what I wish I would have done about it.
In this post, I’ll cover the second category of reasons I would often “check out” while on the wards and how I was able to fix it:
Even if you’ve accepted the fact that you’re going to be ignored by the team for 97% of the day, you will be tempted to do something besides be bored. Perhaps it’s texting your friends, or browsing your favorite website, or playing CandyCrush on your iPad. You know you’re not supposed to be doing these things, but when you’re dying of thirst, it may be too difficult to expect yourself to ignore the wellspring of distraction vibrating in your pocket. (more…)
By Luke Murray
In my last post, I talked about what defined a good third-year medical student. In a word, they are: “engaged.”
If you’re “engaged” as a third year student, you’re constantly improving and your attitude is appropriate, which are pretty much all that matters (that you can control) when it’s time for those that are grading you to do their evaluations.
But engagement is a nebulous concept. And even if we did successfully define it, turning this definition into action items that are clear and universally applicable would be tough.
However, posing the same goal in the negative, “how to avoid being disengaged,” does seem to lend itself to a more actionable approach.
For example, part of being engaged is paying attention. But saying, “pay attention” isn’t really useful. Identifying why you aren’t paying attention and coming up with a strategy to avoid it would be useful.
So, as I’ve thought about my third year of medical school and all the reasons I would end up unplugging from the experience, three categories began to emerge. I’ll talk about the first (and most important) one below along with the strategies I used (or wish I’d used) to avoid them. (more…)