What to do when you're really BEHIND at medical school

I feel behind. I am behind. I am overwhelmed. I am unable of forming sophisticated sentences.

I've just started brainstorming what to do in my situation and thought I'd share it in a post. I tried Googling what to do without success so maybe this will help some...



CJ's Damage Assessment and Strategy Tool for Medical Students that are Behind


1. Assess the damage

• take a long, hard look at yourself
• find an objective way to measure where you are and where you should be
• try to analyse why this happened. How can you prevent further damage?
• what is the gap? How long will it take to rememdy?

What I did: Used the MedBullet.com self-assessment exams to see how far behind I am and in which areas.

2. Forgive yourself so you can put the past behind you and move on

• whatever the cause of your situation, forgive yourself. In my situation, I spent too much time being a "mum" and not enough time being a "med student". I am not a bad person for doing this. It is ok. If you saw how cute my child is you'd understand. I made an error, likely becasue I want to be a good mum, and I have learned from it and am moving forward. This does not make me a bad person
• I also overestimated my knowledge and underestimated how much study I need to do. It happens. I have reassessed that my strategy is not working. I am making a new strategy
• accept this is life
• you are not a bad person
• you can still be a good doctor
• you are forgiven

Meditated. Had a wine. Doodled in my BuJo. Put the past behind me.

3. Create a new strategy

• be realsistic
• detail your strategy in as many steps as possible
• talk to others about their strategies and their advice (and take it with a grain of salt)
• what is your end-goal? Maybe its just to graduate, maybe it's to pass the AMC. Maybe you need a Leave of Absence.
• consider a tutor
• consider a new resource

Used the MedBullets study guide and tailoered it to my own schedule. Committed to reaing a chapter of Kumar's Clinical Medicine a night. Committed to watching a clinical YouTube video per day. Every day.

4. Prioritise strategy

• mistake are learning opportunities ONLY if you LEARN from them

Studying every day has become a non-negotiable now. 

Trial OSCE

I had a trial-OSCE a couple of weekends ago. Three students were taking their final OSCEs, and three students were having their trial run.

I hate to admit this but I did not prepare. I was in complete denial about what I was going in to. I figured it was a trial run so learning from mistakes is ok. I relied entirely on my paramedic background.

My paramedic background served me well. There were one station in particular where I felt uncomfortable (it involved a CT image), and one I completely lost the plot due to a reason I know but won't go into now. That particular mistake won't happen again. I think I might try and do a separate post about it.

So, anyway, it was actually good. I saw that I can so accomplish this with effort. There are things I need to do to get nowhere I want to be but it is very achievable. It was probably the best outcome I could have gotten from the experience.

I have being avoiding med school and pretending I'm not a med student since returning to work. I was so tired of the stress of it all, and with moving house and a new baby and returning to work, and no placements to go to, and with OUM pausing the clinical exams until the new year: I had little to motivate me to care to study in my free time. The little that I have.

Anyway, I'm trying to get back on the horse. At work I go the extra mile to learn about the cases we attend but not much else is happening. I hope to start some IM placements locally soon but I wonder how many timesI can harass my contact for a spot.

Fingers crossed for the new year.

Stress Management and clinical placement after-hours

Stress
In an almost ironic fashion when contrasted against my last post, this post is about Stress Management.

It turns out, from a DASS assessment, I have severe stress. Funny about that, because I don't feel stressed. Even though I have good reason to be stressed. I have been feeling irritable and frustrated. Mental health can be funny like that and irritability can be a symptom of chronic depression and/or anxiety.

Exercising regularly has some good evidence for its effects on stress. This morning I began my now daily goal of 20-30 minutes of exercise each morning. This sounds like a massive commitment to me, but I think I just needed a really good reason to prioritise my fitness. One of the problems is obviously I'm quite time-poor, but the other one is that I actually feel really good. I don't feel unfit or unwell or any need to do exercise (other than stress management).

Clinical placement after-hours
I am currently at the hospital after-hours (after 5pm) doing my clinical placement in paediatrics. Tonight, we have no patients admitted to the ward, There are 4 in special care nursery, all doing fine. The ED has my number, and so does the Paeds Reg. So, I'm up on the ward just getting some study in. I'm behind. As usual.

I have one topic a day to cover during my rotations (5 a week). So, for example, tonight I'm covering asthma which has a 30 minute lecture to watch, and the entire chapter of childhood asthma in Nelsons Textbook of Paediatrics, which is pretty substantial. That on top of your day on the ward, and, oh yeh, that little thing called "a life" outside of medicine.

I really wish I had decided to have a life before I decided to get this far into medicine.

Dichotomy of knowledge

I've been using USMLEWorld QBank as an additional resource to help me prepare for my weekly quizzes, and I found http://usmle-score-correlation.blogspot.com.au website to see what my QBank score would mean on the USMLEs.

It goes like this: The stuff I'm good at, from being a paramedic, ie cardiovascular/respiratory anatomy/physiology/pathology etc, I do really well in. Enough to get into what I want to get into. The stuff I don't have a background in, ie renal, isn't even good enough to pass. I haven't dared looked at my biochem scores for a long while.

Right now, what I'm not good in is outweighing what I am - too much.

I have a lot of work to do.

I'm gonna go read the renal sections of some of the books I have on my shelf now I've completed the allocated readings. It's a Sunday afternoon and I haven't left the house for days. I take no more than an hour off a day plus meal breaks.

Oh, and PS: my academic advisor doesn't count doing the readings as "study". Apparently I'm to read 100-200 pages per week, do all the lectures and meetings, and THEN do 40 hours of extra study on top. This could be where I've been going wrong. I've been doing 40 hours total, you know, a mere 7 hours, 6 days per week.

Under pressure

Wow - what a weekend. Been at the BFs again. Got spoiled by him a lot. We also picked up a baby miniature donkey to foster for a while on his farm. So cute.

I'm back on the 12wbt bandwagon. I'm glad to say that missing last week didn't have any majorly negative effects.

This week - I'm at work all week until Sunday night. I will be: working out in the back room, cooking up a storm, studying for next weeks exams, and preparing my house after work for my parents who are coming to stay next week.

Today, I made a nice berry smoothie for myself and my housemate for breaky and a nice Thai pumpkin soup for myself and my workmate for lunch.

Oooh - exciting news. My blood pressure is down to 115 (systolic) now! Yay! Hibiscus tea must be working. I had a massive weekend (alcohol+++) and am feeling under pressure with these exams and my parents coming to stay, and I was nervous to have my BP read again, and I haven't been taking the three cups of hibiscus tea per day like they did in the study, but still I'm so glad to be "normal" again.

Ego talking

The sky looks wonderful this afternoon as the sun sets.


I spent the first 13.5 hours of today in bed. I was catching up from the last week of working call and studying etc.


Yesterday I bought Deepak Chopra's Wii game called Leela. It's meditation and mindfulness through play, or something like that. I really like it. It's about the seven chakras and I can't wait to make it up to the throat chakra level lol I think this game would be better for XBox Kinect so you can use your whole body instead of just the Wii controller, but nonetheless I'm still enjoying it. There's a play section and a still section where you meditate - guided meditation or silent meditation. It's awesome. You even get to create your own mandala as your avatar.

So after spending too much time in bed this morning I woke up with the most massive ego. I had a friend who swore if you lay in bed awake your ego gets too much of a chance to take hold. And so it was. I felt I needed the rest but whoa! After about 2 hours out of bed it finally subsided. I tried simply observing and trying to find the root cause of the disharmony. It was perhaps a simple case of stress i.e. a feeling of not enough resources to meet the demands which came from me feeling like I didn't get enough rest this weekend because the BF was over and I was working on-call etc.

I did some vacuuming and vented to the BF a little - blamed him of course. Pointed out it was his fault and also the injustices of our relationship i.e. he should come to mine more than I go to his because I work more hours than he does. Luckily he had no idea what I was on about and knew just to give me a minute or two to calm down. About 3 or 4 strangely auto-corrected vent-text messages later, I felt completely fine. Weird. Vacuuming helped a lot too, but I was still feeling off and guilty for having a rubbish breakfast.

Then I played Leela and I feel wonderful and inspired. I even feel motivated to have a good dinner.

I asked my very wise friend who is currently living in an ashram what was going on and she said what I feel is true - my ego is at the surface now because it's under threat. I'm not feeding it as much as I used to (well, I don;t think so) so it's beginning to stalk and circle like a wolf. I know what it's doing and it's no longer in control.

Of course, I've had my eye on my ego for about 7 years now, but it's still had almost complete control of the reins during this time.

Nasty work

It's my last 2 hours at work for the week, it's 30oC, and I cannot wait to get home and get the barbie fired up (and the sav blanc opened).

I'm feeling good about this week and the study I've done at work. We weren't very busy this week so it made it a little easier. I also managed to catch up with some friends from uni (paramedic degree) and it's always great to do so.

I'm feeling a little sooky this afternoon as I overheard a nasty job unfold down at the beach. These types of things always make me want to go home and hug my loved ones and not let go. Life is so precious. My other superficial worries don't seem as bad this afternoon as they did this morning.

FA Organ Systems Review

I got my First Aid for the Basic Sciences General Principles two weeks ago, and my FA for the Basic Sciences Organs Systems arrived two days ago. I didn't get these two books intially because of the bad reviews on Amazon, but I have to say - I'm loving them!

I'm sure the second editions, when they hurry up and release them, will address the issues and I wish they would release an errata like they do for FA for the USMLE Step 1, but I can cope with them how they are.

For me, the visual lay-out is important. It needs to flow and be organised like the way I like my mind to be organised. I have spoken about the importance of gestalting before.

Anyway, I love them. I used FA Step 1 all the time. I almost never use the Kaplan versions "MedEssentials" due to the clunky lay-out.

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I've done a little more work on the research project this morning at work, so I'm happy with how that is travelling - nice and stress-free. I wonder if I can make it into the professional magazine we have called "Response" by Paramedics Australasia and whether that would be good enough as a "published" article for my residency applications as a start. For my Masters I will have to do something bigger and better but this will be an excellent learning opportunity and at the very least it will help me next year when I get to that stage.

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Pretty much loving life right now. This helped me put things in perspective this morning:

Enjoy....

Survival stroke

Survival stroke was a swimming style we got taught in school as kids - ie how to not drown.  That is what I feel like I'm doing this week in med school.

We were busy at work, and because I feel like I totally stuffed up last week and I have a few extra pressures coming up this week, I sit down, look at what I have to do, have a mini-meltdown, and the completely freeze-up.....

Ah, that reminds me of a story.....

I have been mentally collecting stories of the best (ie worst) excuses for calling an ambulance and getting despatched to.  Out in my rural area, these types of incidents are few and far between.  The best one I have personally got despatched to was a cut finger while cooking.  A few nights ago I topped my previous personal best of "hungry" and "scared of thunder" when I heard a city crew got despatched to a "brain freeze" - yep, the kind you get after drinking a slurpee too quickly.  Seriously.  How does that even make its way past the call-taker to the despatcher.  I'd love to know what the paramedics had to say to the caller.

But I digress....

I'm in brain-freeze myself, but the other kind.  The kind that makes you go completely mentally blank.  If I was trying to write a novel it might be called writers block perhaps?  Or is it pure procrastination?  Overwhelment (yet again)?

I'm in damage control. Again.

In good news, my fitness regime has been going surprisingly well!  I hope I can keep it up.  I've decided to workout every day on my days off, and to not worry on my days I'm working.  That's still 7 days a fortnight which is pretty good and includes cardio and muscle workouts - TAM of course.  I caught a quick glimpse of some surprising muscle definition this morning and I am again a converted follower of Ms Anderson.

My diet has been going well.  My sugar cravings have diminished quite a lot which is good.  My brain is getting used to functioning on slow-release carbs and fruit instead of lollies and Coke.  This has to be a good thing.  I'm still into my tofu and veges.  I craved a cheeseburger last night, got one, ate about two bites and  seriously couldn't stomach it.  My dog was happy about that.  I'm not sure what has happened to me - this doesn't usually happen.  I can still usually have my cheat food day, but this week I struggled to eat a Cheery Ripe.  I had to eat half, take a break, and eat the other half later on.  Well, I think I know what's happened - I started drinking this meal replacement called Rapid Loss.  I got sucked into the infomercials and I'm kind of glad I did.  It's working well for me.

So this morning I had a meeting online with my academic advisor and we started going through molecular biology and the basics of pathology, you know, just to add more study on top of my endocrine case studies, the intergrated learning series, etc.  Ugh.  So I looked at the MIT free online courses (Open Courseware) and I've ordered the molecular biol text to do their course.  WTF?  When will  Ido this?  Ugh. 

Overwhelment.

Damage control.

Survival stroke.

No time

I think it's fair to say if you're working full-time and studying med, you have no free time.

I got called out for work until 3am this morning.  I got up early at 11am to do a bit of urgent house work (dishes) before returning to work at 1pm.  After an hour for shift change-over, lunch, doing some work-related admin, management dropping in etc I got so little actual study I'm starting to feel stressed. In 4 hours I read four pages from my textbook.  Where on Earth did the time go?

It's now Friday night. I just got home from work and I've done the rest of my urgent house work which included vacuuming.  I'm on-call again tonight so who knows what the night will bring.

So I have to end this post cause I need to get a few more pages done now before watching some Kaplan videos tonight.

One of the worst things is, I've just realised the readings I was supposed to do last week, and the references I have been given for both weeks are for a different edition textbook, that I figured I'd better read the whole endocrine chapter of Robbins Pathologic Basic of Disease but I'm making the mistake of back-pedalling.    Feeling overwhelmed.  I've gone against my won rule.

And I so need to wash my hair tonight.

Relaxation and dealing with stress and anxiety

As if it wasn't obvious from the pattern of my recent posts, but I have been suffering from a fair bit of stress lately and that has started to creep over into the realm of anxiety.  I completely blame my job, and more specifically the on-call roster, and also myself for working too much.  I do enjoy the stress.  If I'm not pushing myself I feel bored.  I don't think you need to be a doctor to figure out this might not be entirely healthy.

I like to chill-out too, though.  Preferably on a beach with a cocktail that is served in a coconut with a straw and one of those little umbrellas.  I also like to sleep a lot.  And I love my bubble-baths and TV.  I've often considered putting a TV in my bathroom above the bath.

But my anxiety was starting to affect my composure and ability to study this week.  I was feeling too on-edge to absorb anything and I didn't even want to think about studying.  I had even gotten to that point where nothing seemed to be going right.  I even stubbed my toe and bumped my funny bone. 

It's kind of embarrassing to admit all this and as a med student I don't want anyone to think I can't hack it or I don't have what it takes.  But it would also be portraying a false image to pretend that med students and doctors are perfect, robot-like identities that don't succumb to human emotions.  I hate people who are fake.

Anyway, fortunately for me but not for them, I am not the only one I know going through this so I was put onto this great DVD by Glenn Harrold.



It is a relaxation DVD that uses hypnosis and I have to say it works a treat.  Actually, I went through all this before I went to Samoa last year, and then again when I came back from Samoa.  Before I went to Samoa I emailed the accommodation to make sure they had a DVD player as I got so dependant on this DVD.  I tried my friend's Valium once and it only made me have worse rebound symptoms.  Excercise is great too, and eating Low GI, but this DVD is like my Valium.  I probaby don't have to mention to avoid caffeine and alcohol.  I also read my Dalai Lama book (in the bath) and the first chapter is on stress and also helped.  I feel SOooooo much better today. 

The quiz last night - I did it, felt confident,..... then got 0%!  I nearly died (this was before I did my hypnosis).  I thought "No friggin way.  I know I got these right".  I then realised what might have happened - I had let the timer run out without pressing the "submit" button.  Seems so obvious now, but I was thinking that if I didn't press submit, and let my timer run out, then it would just accept my last answers (which is a MCQ bullet-point format).  I emailed the curriculum coordinator and he sorted it all out.  I got 100%!!!  I also then asked him to look at my 2nd quiz, and, sure enough, I was supposed to get 80%!!!  So for my quizzes so far I have go 95% correct.  One more to go... Hopefully it will end up being an easy 30 marks for the module.

Things are starting to turn around.

A day in the life of

I just got home from work.  I'm on-call tonight.  I stayed back about an hour and a half to do a handover as our branch manager is going off on leave and someone else is taking over.  She has just come back off leave so there was lots to go over before I went home, and I'm the Health and Safety Rep, so thereare a few things we have in the works atm.

We were busy again today.  Ever since we moved to this new despatching system our workload has increased by about 50%.  That's about 3-4 hours a day of downtime I've lost now.  We were out late again last night until 4am on a call-out.  My dog is about to disown me.

But that's ok, I don't mind working for my wage, it just calls for an adjustment in my schedule.  I'll probably do less overtime now on my days off so that's where I'll pick up the hours to study.  However, my roster is 5-on/5-off so one week I'll have heaps of time and the next week barely any.

Nevertheless, the show must go on.

I'm now about to login and attempt my terrifying weekly quiz.  I've just opened the books for a quick refresher as it is for the gout case I finished a week ago.  I have my pager and portable radio and luckily these quizzes only go for 5 minutes (timed) so if I get a call-out now I'll be ok to complete it.

My stress and anxiety was good all day until I remembered this quiz.  Now it has gone off the scales again.  As my adrenaline levels don't seem to go back to zero at all, it just takes one minor stressor and I'm off the charts.  It happens every time my pager beeps, or I think about the potential of getting a cardiac arrest as I haven't done one now for over a year (being in a rural area and on-call by the time we get to people they are usually past possible resuscitation).  Anyway, this anxiety thing happened at about this time last year and it finally went away.... when I went on leave.