How to pass Sem 8 and 9

Now, as the time for the internship exam creeps closer, students of the art search frantically for the legendary 'Flying Colors' that will aid in passing their exams. A few words of wisdom has been imparted to this insignificant one, who decided in view of her failing memory, to write below:

From Doctors

The Dean: Just know Kumar and Clark backward, forward and upside down and you'll be alright. (yes, all 1446 pages)

The Orthopaedic Surgeon: Don't worry, The Dean will make sure all of you know how to pass. Now, let's talk about something more practical, like how to describe a fracture on X-ray...

From the Registrars

Gen Surg: Just read Talley O'Connor 4 times. That's what I did. Didn't read anything else.

From the Interns

Intern: Didn't study anything, didn't do anything. I was quite happy when I got 67%. (please don't try this at home, kids.)

From the Seniors

Girl: Just relax. It's not that hard to pass!

Boy: What exam?

And so you have it. Words of wisdom from those who know best.



Excuse me while I scream into the pillow.

How Can I Handle the Pressure of Medical Training?

Question
I feel like my residents and attendings always expect more of me, which causes considerable stress. What can I do to reduce this constant feeling of pressure?

Response from Geoffrey Talmon, MD
Surgical Pathology Fellow, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota

As a third-year medical student, I was assigned to an obstetrics rotation off campus with a group of private physicians. They were notorious for pushing their medical students hard, and consequently I was dreading those 6 weeks. During the first half of the rotation, we were absolutely swamped. Every delivery room was always filled, and we always seemed to have a very long inpatient census to round on each morning. Added to this, it seemed as though I did nothing right. My attending would tear my notes to shreds as he critiqued them, I never seemed to answer any question correctly, and in surgery I was apparently incapable of holding a retractor. This was a level of pressure that I had never experienced before. I certainly did not talk about it; weren't medical students supposed to be able to deal with all of this with a smile on their face?

One night, I was in the doctor's lounge while on call, and my attending asked me how I was doing. I must have been really tired because I actually told him about all of my anxiety. He smiled and admitted that he tended to ride medical students hard, but he said that his expectations were simple: See your patients in the morning and write a note, participate in rounds, and show that you were reading about your patients. All of the other criticisms were in an attempt to make me improve and be more efficient. He said that I was at least meeting if not exceeding all of his expectations. After hearing this, the pressure that I felt while on service was reduced incredibly, and I actually enjoyed the rotation.

Handling pressure from superiors is a constant in life. From school to business to sports, it is something that everyone must find a way to deal with in order to succeed. It is one of the skills that employers often use to determine who is promoted and who cannot handle their current position. As such, a number of books, presentations, and symposia have been developed to provide advice on handling pressure.

Medicine is no exception. On top of the stress that comes with making decisions that affect patients' lives, perceived demands from residents and attendings create more anxiety. The hierarchy of academic medicine makes coping with these stressors even more complex. Attending physicians' diverse backgrounds engender numerous styles of teaching and interaction with subordinates, as well as differing levels of patience with student doctors. As a result, determining what is wanted of a trainee can seem like aiming at a moving target.

On top of all this, medical students often have high self-expectations and a desire to please. This can make handling pressure even more difficult. When I discussed high-pressure rotations with my friends during medical school, many of them would say things such as, "Well, at least it only lasts for a month." This thought offered little solace as I was often very concerned with my evaluation or the potential for a letter of recommendation. For those like me, how does one deal with pressure from more senior physicians?

To start, it is important to recognize that "pressure" does not equal abuse. The days are over when medical students had to put up with verbal abuse from supervising physicians. Even if an attending is glaringly upset with your performance, there is no excuse for name-calling, swearing, or insults. In such instances, nearly every medical school has mechanisms for reporting unacceptable behavior, often starting with the rotation director.

It is also important to determine the source of your pressure; is it coming from your superiors or from inside yourself? Almost all medical students are driven to overachieve, so we often set unrealistic standards. We feel that we need to answer every question correctly, present every patient perfectly, write the best clinic notes, etc. Whenever we fail at one of these self-imposed goals, we experience internal anxiety. Then, the more that is asked of us, the more pressure we feel. In hindsight, I realize that most of the time when I felt "under pressure" while on service, it was of my own making. Two nonthreatening ways to determine the source of your pressure is to ask other students who were on the rotation before you what the attending expected of them, or talk to your residents about your performance.

Similarly, you may be able to reduce the pressure from senior doctors if you know precisely what they want from you. Thinking back, some of the best attendings and experiences I had on service came when I was told at the very beginning of my rotation what my responsibilities were. I did not have to "guess" what I was supposed to be doing, which often removed a large amount of stress from my day-to-day activities. It is almost never incorrect to ask your supervisors this question, although it is advisable to have such discussions in private and at a less hectic time than during the middle of rounds or a surgery.

So, what should you do when there is true pressure from your supervisors to perform, either due to the volume of work or high expectations? Unfortunately, these situations are occasionally unavoidable, and they often occur as a student gains more responsibility (eg, a new fourth-year medical student or a new first-year resident). In most cases, the goal is to make you more efficient -- shorter notes, more focused histories and physical exams, and so on. Again, the key to handling these situations is talking with your senior physicians. Ask them for their assessment of your performance and for hints and/or advice on how to improve.

The overriding theme in all of these tactics is communication. When you, as the student doctor, feel that the weight of demands placed upon you by senior physicians is causing excessive anxiety, talk to them about it. Ask them what is expected of you, whether you are meeting those expectations, and what you could do to improve. Because the goal of academic medicine is to turn you into a better physician, such questions are not inappropriate, and they can help reduce the amount of stress and pressure that you are feeling.

Taken from here

Medical Clerking

Dedicated to all medical students, future med students and doctors young at heart - you'll probably be the only ones with a big smile after watching.

With all I am

I just found out that Youtube is the best place to find songs. Slow, aren't I?

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