Scholarship Opportunity for Third Year Medical Students Interested in Primary Care

I just learned about this scholarship opportunity. $10,000 goes a long way to reducing debt! Check out the details below:

One Medical Group is a primary care practice designed around the fundamentals of quality medicine: listening, evidence, collaboration, trusted relationships – and more time with patients.

In their efforts to invest in the future of primary care, they are excited to announce the One Medical Group Scholarship Program. The scholarship is open to to any third-year medical students who have an interest in pursuing primary care. The scholarship winner will receive $10,000 which will go towards funding their last year of medical school.

The application will be open on January 10, 2014 and they’ll be accepting applications until March 14, 2014. You can find more details about the scholarship and apply here.

One Medical Group Scholarship Program

Award amount: $10,000 (non-renewable)

Eligibility: 3rd year medical student enrolled at a U.S. medical school with an interest in primary care.


Open date: Jan 10, 2014 

Deadline: Mar 14, 2014

Results Announced: May 9, 2014

Contact: (Subject Line: One Medical) or toll free 855-670-ISTS (4787)

Final Exam: Book Discussion

What follows is an essay I wrote about Final Exam: A Surgeon’s Reflections on Mortality. 

“I had never expected to deal with the dying so intimately or to face mortality so directly.” Pauline Chen’s words reflect what I think many in the medical profession feel. She notes earlier in the book that she went to medical school to save people, not care for the dying. I think the potential for cure draws many to medicine. Whether directly or indirectly, we have felt the pain and dismay of disease and medicine offers a way to treat or even prevent that suffering. But the limitations of medicine become clear very quickly. We cannot treat or prevent all suffering, and even if we could we cannot prevent death. Death is something that each physician must face. As a transplant surgeon Dr. Chen is keenly aware of this fact. Her book takes us on her journey learning how to better respond to death and fill a huge void in her education.

I cannot remember a lecture on death in medical school. I know we talked about palliative care and hospice but I can think of little mention of what the death process looks like or how to care for someone who is dying. Dr. Chen had a similar experience. She notes the various ways she was exposed to death throughout her training, first with a cadaver in medical school, then as a part of her first code and then the first patient to die under her care. But the training in how to respond to death was part of the “hidden curriculum” of medical education, it was something she picked up from those around her.

Some examples made her uncomfortable like the resident who showed her how to declare someone dead, claiming “See how easy it is?” Other examples were more positive, like the attending physician who stayed with a family as their father was dying and explained what was happening. This changed how she interacted with dying patient’s families. “I stopped slipping away from my dying ICU patients and their families. Instead with my hand in my pocket, I would usher the families into the ICU. I would bring them to their loved one’s bedside and close curtains around not them but us. I would point to the irregularities on the monitor and describe the characteristic last breaths of the dying. I would touch family members, embrace those who looked particularly lost, and tell them of the final comfort of their presence.”

This passage resonated with me. I know if I were in that situation I would make any excuse to not be around a family during that time. I would justify it in my head, and tell myself I would be intruding in their moment. But this passage challenges me to face my own discomfort. In the midst of such sadness and confusion, I imagine it would be a great comfort to have someone explain what was happening when a loved one was dying. If I chose to miss that opportunity because of my own fear I would be performing a disservice to a family.

One of Dr. Chen’s more disturbing stories was about an infant. The boy named Max was born with a severe defect and required multiple surgeries to correct it. These surgeries led to complications which led to more surgeries. One of the complications was the need for a liver transplant. Dr. Chen’s team took Max to the OR on twelve separate occasions. He died as a result of a fungal infection. Dr. Chen was talking about the case with a nurse who remarked, “Maybe it was a good thing, huh? I mean, how much can you do to a person?”

There does seem to be a point in medicine where the treatment can become worse than the disease. This is hard to think about, especially with children. Stopping treatment may be viewed as giving up. With an infant there can be no comfort in saying, “Well he lived a good, full life.” But as I read the story about Max, I wondered how I would feel if he were my child. If I truly wanted the best for him would I continue to put him through multiple surgeries for a slim chance of a normal life? I truly do not know the answer. But it helps me to try and put myself in a parent’s shoes. I can use that to try and guide conversations about the care I will provide.

As a pediatrician I may not deal with death as much as other specialties. However I still need the tools and experience to guide parents and children through such an ordeal. Final Exam helped me realize some of the gaps in education I have in regards to issues surrounding death and gave me some ideas to think about how to address those gaps. While I still fear being around death (especially with children) I think I will approach the issue with more self-awareness. This will allow me to recognize my fears and subsequently better serve my patients and their families.

I pose this question to my readers: How will you deal with death as a physician?

AAP Conference and Step 2 CS

I’ve had a busy week. Last weekend I went to the American Academy of Pediatrics National Conference in Orlando (thank you AAP for the generous scholarship!) and yesterday I got back from Step 2 CS in Chicago.

The conference was a great experience, I met some awesome people and gained a better appreciation for what exactly the AAP does. I came away very impressed. The AAP does some great work overseas (see the Helping Babies Breathe project) as well as lobbying for children’s health in the United States.

Have I mentioned that I love Pediatrics? One day I’ll write about what led me to choose it as a specialty.

I also heard Atul Gawande speak! He’s a cool dude. He talked about how complex medicine is becoming and how we need better tools to handle this complexity (he advocates for the use of checklists). Good stuff.

Step 2 CS on the other hand was not so much fun. For those who don’t know, Step 2 CS is the “practical” Step exam. You see twelve fake patients and write notes on each of them. It also costs $1200.

I’m not a fan of this test for a few reasons. Check out this article which states:

“Of 17,852 examinees taking the exam in a given year, we predict that only 32 per year would not pass the exam on a repeat attempt. Even if no examinee had to use a loan to pay for the exam, the cost of identifying a single “double failure” would be $635,977; using the adjusted expenditure figure of $36.2 million, we calculate the cost as $1.1 million.”

Basically it’s an incredibly expensive test that serves little purpose.

Here is my question: why can’t we trust medical schools to administer this test? Get the AAMC to require a similar exam that meets certain standards in order to be an accredited as a medical school. Creighton already does this in order to prepare us for Step 2 CS and I have a feeling many other schools do as well.

Cut out the huge fees, cut out the inconvenient travel that interferes with our actual education (CS is only administered in five cities across the US) and cut out another source of anxiety for medical students. I see no downside to this.

Medical school sometimes seems like a series of hoops to jump through. While many are necessary, Step 2 CS seems especially arbitrary.

Anyway, sorry about the rant. Thanks for reading- stay tuned to the blog the next couple weeks. I am going to start giving away books that I no longer need and want to see others use! For free! It will be awesome.

The Best MCAT Prep Courses and Books

What is the best way to study for the MCAT? Between live and online courses, books and audio prep the choices can feel overwhelming. While I used a combination of Examkracker’s books and practice questions there are many other ways to successfully study for the MCAT. I decided to do a little digging to find out which courses and books are used most by students who aced the MCAT.

Student Doctor Net (SDN) has a forum thread that has been going on since 2007 titled “30+ MCAT Study Habits- The CBT Version”. While you could spend hours reading through each student’s strategy, I decided to condense things down.

On each page I did a word search for the popular ways to study for the MCAT including Kaplan, The Princeton Review, Examkrackers and The Berkley Review. My thought is that word mentions would roughly correlate with the popularity of each method.


The MCAT prep course most often discussed by students who had scored a 30 or higher on the MCAT was Kaplan with 2621 hits.

The second most popular course was The Princeton Review with 1649 hits.

Analyzing data for the most popular books was difficult for several reasons. The term “EK” is used to refer to Examkracker’s, however in the word search any word with the letters EK will be picked up. Therefore the 3715 hits for “EK” is not an accurate number. It was clear just by browsing the thread however that the Examkracker’s books were a popular choice.

It is worth noting that the most popular Examkracker’s books are six years old and there are very few reviews for the latest edition. Another popular Examkracker’s item is their MCAT Audio Osmosis CDs.

Speaking of data, the Kaplan MCAT Review Complete 5-Book Subject Review has a great 4.5 star rating on Amazon and could be another helpful choice for self-study.

The other books that started gaining popularity over recent years are The Berkeley Review. They were mentioned 318 times in the last year. The books are hard to get a hold of on Amazon but you can also find them on their website. They also seem to have prep courses in California.

Prep Course Options

If you decide a full prep course is for you both Kaplan and the Princeton Review have several options. These are expensive but for some people are the right choice.

Through Kaplan you can do:

Through the Princeton Review you can do:

I hope this post has been helpful. The MCAT can be daunting and some help preparing can go a long way. If you decide to self-study don’t forget to make a study schedule and use practice exams. Good luck in your journey to medical school!

Affiliate links are present in this post.

Tips for the Third Year of Medical School

Forget what you know about 4927466850_53ce280aa5medical school, the third year is a completely different animal. On top of being able to absorb a large amount of information, third year will test your ability to adapt to new environments, communicate effectively and work well with others. What follows is a list of tips I think will help you thrive during the third year.

1. Be Flexible

It’s number one because it is probably the most important. You will likely be changing clinical sites every 2-4 weeks. This means learning a new system, interacting with new people and having different expectations. This is probably the most difficult part of third year. You begin to become comfortable and then you are shipped off to a new place. Roll with it, get used to introducing yourself to new people and smile.

2. Practice Empathy – For Everyone

I see empathy as putting yourself in someone else’s shoes. Obviously this is useful when interacting with patients, but have you thought about being empathetic towards your residents, your attending, the nurses or your fellow students? For each of these people I asked myself, how can I make things a little easier for them? I found trying to think about things from my resident’s perspective allowed me to be a more helpful and involved medical student.

3. Put Away the Smartphone

I know there are incredibly helpful resources available online and through smartphone apps. But in general I think it is better to keep the smartphone in your pocket. You may think you are being discreet but people can tell when you are looking at it and even if you are looking up something relevant it still looks bad. More importantly it is a temptation that allows us to be easily disengaged from what is going on around us.

4. Read about your Patients and their Diagnoses

Everyone will say this because it is true- it’s the best way to learn. Things stick better when you can attach them to a real person. Countless questions I have answered on exams thinking back to clinical experiences I had with patients. It also allows you to ask relevant questions to your attendings and residents. You can say something like “I was reading about this, can you clarify something for me?”

5. Expand your Reading Beyond UptoDate

UptoDate is a useful and simple to use resource. If you want to go a little deeper, nothing beats finding relevant journal articles. I have found very helpful articles by searching Pubmed and specifying “Review” under article types on the left side.

6. Emulate the Best

You will have the privilege of working with and observing many physicians during your third year. Carefully observe the attendings and residents you respect the most and incorporate what they do into your own practice. What phrases do they use when they talk with patients? How do they talk with each other? What physical exam tricks do they use?

7. Adopt a “Craftsman” Approach

I highly recommend Cal Newport’s book So Good They Can’t Ignore You. In it he advocates for a craftsman’s approach to all kinds of work. Essentially that means identifying skills and then constantly practicing and improving those skills. This can easily translate to medicine. Taking a history is a skill. Physical exam. Suturing. Communication with others. All these are skills that can be practiced and improved upon. Find areas you know you need improvement on and actively seek out opportunities to practice.

8. Relax

I hope I haven’t seemed too intense with these tips. Being perfect all the time is impossible. You have the freedom to make mistakes. Ultimately, if you show up and are eager to learn and participate third year will go great for you.

That’s all I’ve got for now, I hope these are helpful. What tips have you found to be useful during the clinical years?

Photo Credit

Recognizing Suffering

I recently read this article by Eric Cassell for a course in medical school. What follows are some reflections on the article (here is another link if the other doesn’t work).

Cassell’s essay on suffering broadened my thoughts on what constitutes suffering. Previously I had thought of suffering in a very visceral sense, mostly related to pain. I did consider emotional pain as well as physical pain to be suffering. This would include grief, the pain of an injury or illness or the loss of a relationship. Cassell’s simple definition of suffering made me realize how limited my view was. He states, “I believe suffering to be the distress brought about by the actual or perceived impending threat to the integrity or continued existence of the whole person.” While this definition is brief, a thorough examination leaves a lot of unpacking to do. And while it includes my previous thoughts on suffering it clearly involves much more.

The key phrase for me in the definition is “whole person.” The idea of the self as more than a physical body allows for suffering to be perceived in a variety of ways. Cassell’s expansion on self-identity clarifies this idea further. He talks about the idea of a person’s past, present and future identity. When I think of someone with a disabling injury, while thinking of their suffering I may have only considered their pain and perhaps the limitation on their activities. With Cassell’s framework I can expand this to understand that this person may be suffering from their loss of identity. The things they were able to do in the past, they may no longer be able to do in the present or the future. Beyond the day to day limitations on daily activity it could also present as a serious threat to a person’s sense of self. An elderly person who gardens for example, may have to accept that due to new limitations they can no longer identify themselves as a gardener. If they are able to find a restricted way to garden they at least have to modify what kind of gardener they understand themselves to be.

Considering suffering that is the result of their own actions may reveal why shame and guilt are such powerful emotions. Perhaps someone has made decisions that threaten their existence or sense of self. Not only are they mourning the suffering caused but they are also mourning the fact that they brought the suffering on themselves.

What I appreciate about this more inclusive definition of suffering is how it helps me be more compassionate. I could see myself brushing off certain things someone may tell me as not that big of a deal, but considered in the “whole person” concept of suffering it becomes a big deal and reveals perhaps why this person thinks it is important to talk to me about it. The idea of a “perceived” threat to self helps us to be more compassionate for psychiatric patients whose threat is not reality. Or for parents with a sick child who jump to the worst conclusions possible. Their perception of the threat to their child may not be reality for a pediatrician, but it is a possible reality in their minds. This allows us to not only be understanding but the take the next step and educate in a compassionate way that acknowledges and addresses their fears.

At times in my clinical experience I have been nervous or shy around someone who was clearly suffering. Thinking about all the different types of suffering allows us to be more creative in alleviating suffering. Instead of being frustrated by not being able to completely relieve pain, we can make effort to alleviate other forms of suffering the pain is causing such as loss of function or stress on relationships. When approaching a patient I think I can ask myself a few simple questions. How is this patient suffering? Is there any possible perceived or actual threat to this person’s self-identity? If I am unable to relieve one kind of suffering, am I able to relieve a less obvious form of suffering in this person? I think addressing these questions in all my patients will make me a more complete and compassionate healer.

Developing Your Peripheral Brain

This is a guest post from David who writes an excellent blog called The Physicians Library. Thank you David!

“What did you use on the floors?” This is a common question I have been getting recently from the recent third year medical students. Third year is a great time to begin building your “peripheral brain” – the pocket references and device apps you use to quickly look things up on the floors. Of course, your own personal preferences will depend on things like specialty interest, how much you want to spend, what do you have available, etc. If you want to use technology some things may be device dependent but in general there is a lot of overlap between Apple and Android apps available. I also used to have a Blackberry Torch and had some apps on there so perhaps there is good news for any holdouts out there. Here’s what I ended up using this year:

Pocket Books

Maxwell Quick Medical Referenceclip_image001

At my school, the fourth-year class usually presents this as a gift to the new third-year students and I have some other schools doing this as well. Don’t worry if you can’t get this for free – it is dirt cheap. Really, there is no reason not to have this book. It’s a lifesaver for everything a student or resident needs to do from writing orders to the mini-mental status exam.

Pocket Medicine

clip_image002This may be more relevant for those interested in internal medicine but there are also similar books for other specialties. I also used the Pocket Pediatrics book. I liked these books because of the charts and algorithms presented. References for primary literature are also provided which can be useful if your attending asks you to look up the article for that particular recommendation. Another nice feature is that these books are in binders which you can open up and add your own pages. A common alternative I have seen others use is the Washington Manual of Medical Therapeutics.

Device Apps


clip_image006This is a free app and all you need is a Medscape username and password. Although not quite as good as Up-to-Date it is fairly complete and well-organized. For most diseases it will have labeled sections on diagnosis, work-up, and treatment or management. It also includes its own drug monograph database and a host of calculator tools such as Ranson criteria or Centor. The one drawback is that it is not as searchable as I would like. For example, you cannot search for the aforementioned criteria as Ranson or Centor. You have to look for “pancreatitis prognosis” or “strep throat evaluation”. However, usually the search pulls a list as you are typing so you will likely find what you are looking for before you even completely type in a word.

AHRQ ePSSclip_image004

This stands for Agency on Healthcare Research and Quality Electronic Preventative Services Selector. This app is essential for a rotation with a primary care component (e.g. outpatient medicine, family medicine). You type in the patient demographic data including gender, age, smoking status, and sexual activity and it pulls the current USPSTF recommendations for preventative services that patient should or should not be receiving.


This was my preferred drug monograph database during third year. It has a nice interaction checker, calculators, reference tables, and more. There are others like Micromedex and the one on Medscape. Whatever you do, have one and understand how it works.

Rotation Specific Tools

Surgical Recall

I actually am ambivalent on this book. For future surgeons, it may be more appropriate. I found it useful to a point but it had only decent yield for “pimping” and was not quite appropriate for the NBME shelf exam.

Quick Reference to the Diagnostic Criteria from DSM-IV-TR

I am not sure if all medical students will still be working with DSM-IV but either have a pocket reference (check if your school provides one) or download an app. Learning the specific criteria is particularly high yield for a psychiatry rotation and standardized tests.

Final Thoughts

Whatever you decide to use for your peripheral brain make sure you keep it tight to a select few resources and know how to find the information in each. It does you no good to be overloaded with tools and spending too much time figuring them out while you need information. Take some time on a weekend to really play with your tools and familiarize yourself with them.

Essential Books for the First Year of Medical School

What books do you really need for the first year of medical school?

This is not an easy question to answer. Everyone uses textbooks differently. I am not a huge fan of textbooks, at least not as the primary way to learn something. Medical school  textbooks are also notoriously expensive and I am always trying to find way to cut unnecessary spending. What follows is a brief list of books that I found most helpful (or wish I had used more) during my first year of medical school. I have divided the list into three categories:

1. Recommended

2. Mostly for Second Year, Useful for First Year

3. Optional


Netter Atlas of Human Anatomynetter

  • I cannot imagine making it through anatomy without Netter. The labeling can often be busy and overwhelming, but you come to appreciate the detail. Read my full review here.

The Human Brain in Photographs and Diagramshuman brain

  • Our school teaches Neuroscience during the first year, which may not be the case everywhere. Whenever you take Neuro, this book is extremely useful. It displays every useful pathway in an easy to understand way.

Mostly for Second Year, Useful for First Year

First Aid for the USMLE Step 1first aid 2013

  • One of my biggest regrets from the first two years is not getting a copy of First Aid earlier. It won’t make or break your first year, but getting familiar with the book will be helpful in the long run as you approach Step 1. Sections on biochemistry, genetics, and microbiology would be especially helpful to look over during first year courses.


  • If you’re starting med school soon, you’ll quickly learn about Robbins (everyone seems to forget about poor Cotran). Complaining about how big the book is is basically a rite of passage. If your school has access to an electronic copy, using that may be a better option than purchasing it.

Clinical Microbiology Made Ridiculously SimpleMicro

  • Most of this book will be used whenever you take Infectious Disease, but some schools have an Intro to Microbiology course in the first year. This book is fun and easy to read.


These books I may have used sparingly in my first year or know fellow students who found them helpful. Read a little about them and see if they might be for you.

Medical students, are there any other books that you found essential your first year of medical school?

On Third Year

Perhaps you’ve noticed a lack of posting on my part. Perhaps not. Either way I want to address why I haven’t been writing much recently.

It is not for lack of ideas of what to write about. In fact it may be the opposite: I feel paralyzed by how much I want to express. I have so many stories, observations and random thoughts about my third year of medical school that I’m not sure where to begin.

Let’s start with one general observation: the third year is a lot more fun than the previous two years of medical school. Knowledge actually comes easier as I apply what I am learning to actual patients. It is much easier to wake up in the morning knowing I will actually have meaningful experiences with patients and colleagues. Lectures are fewer and generally very practical.

But there are difficulties too. Just as you start to get a little comfortable , you are shipped off to a new location to start over again. Even within each rotation I’ve been at a different site each month. At my last rotation the staff was so used to new students each month one nurse just called me “student” the whole time even though I worked with her every day. She slipped up once though and actually said my name and the other staff joked about how that was a big deal. Ha.

I can’t help but look forward to a little more stability. Working with the same people, learning their names and understanding their expectations. Working in the same place and knowing simple things like where to find a bandage. Having a well defined role. Can I look forward to these things in residency? I guess we’ll see.

Dickies Scrub Pants Review

I was recently offered a pair of Dickies Scrub Pants in exchange for an honest review. How could I pass up free scrubs? I am no fashion blogger, but here is my best effort at a review.

Overall Impressions

I was sent a medium pair of men’s scrub bottoms which I have worn a couple times.

The scrubs are a huge upgrade over the basic scrubs at most hospitals. Lets talk about a few things I like about them:

  • Comfort. They fit really well and I can see myself using them as just an everyday pair of pants. The material is sturdy but not irritating.
  • Color. A solid navy blue that looks professional.
  • Utility. Lots of useful pockets and loops for hanging things.

Cons are minimal. The only thing I don’t really like is having both a drawstring as well as button and zipper on the front. Just the drawstring would be sufficient.

I’m not sure what else to say about them. If you’re willing to pay a little extra for some comfy, useful scrubs I’d say these are a great bet. Check them out over at Uniformed Scrubs. Use the code “15PBRM” for 15% off.