Let's Talk Medicine: Reflecting on My First Year of Medical School

With my summer coming to an end in less than a month, I've been doing a lot of thinking about school - what I learned, what I want to improve on, and how I want to approach my second year of school.

When I started this blog, one of my main reasons for doing so was to document my journey through medical school (maybe even residency some day). I didn't do a very good job of that! On one hand, there really isn't anything too exciting about lectures, study groups, and pouring over notes. On the other, plenty of other cool things happened like standardized patient encounters (pretend to be a doctor), Simulation labs, practical exams, and all my activities outside the classroom that I wish I would've talked about more!

Usually when people ask how school is/was going, my response is pretty simple, "I survived," - and I mean that in every sense of the word. I survived the rigor and the new "balance" in my life. I made it through and I'm so proud of that - it was a tough year but a very fulfilling time as well!

To sum everything up nicely, here are my thoughts on my first year! {Here's my post on my first semester}

Classes
We're considered to be an "OMS-I" or Osteopathic Medical Student year 1 (MD counterparts are MS1s). If you're scratching your head asking "What is Osteopathic medicine," click HERE. We receive the same training as MDs with some additional training in manual manipulative techniques to diagnosis and treat patients - basically another tool in our toolbox. Beyond the technique, osteopathic medicine professes a unique philosophy that is easily summed up by the four tenets:

1. The body is a unit and the person is a unit of mind, body, and spirit.
2. The body is capable of self-regulation, self-healing, and health maintenance
3. Structure and function are reciprocally interrelated.
4. Rational treatment is based upon an understanding of the basic principles of body unity, self-regulation, and the interrelationship of structure and function.

In summary, osteopathic physicians seek to "find health" and support the body's ability to regulate and heal itself. We believe in evaluating and treating our patients holistically - everything from considering their socioeconomic status to their personal attitudes about health and more. Think about it - how helpful is it for me to prescribe a treatment plan for a patient that they are unwilling to follow - maybe they have personal objections to it or maybe they can't afford it. As physicians we need to be in tune with these considerations and get creative! 
I think you will find that allopathic (MD) physicians have been embracing these principles for many years now as well!

For the first two years of school, we spend most of our time learning in a classroom - lectures, small group sessions, anatomy lab, OMM lab, etc.

My school operates on an integrated systems-based curriculum which means the traditional subjects - histology, physiology, pharmacology, biochemistry - are all taught at the same time for a given body system such as Cardiology or Neurology. In addition to our system courses, we always have Introduction to Clinical Medicine and Osteopathic Principles & Practice running.

Traditionally the first year of medical school is spent learning how the body should function normally with the second year devoted to dysfunction and disease. I feel like most programs these days, regardless if they are systems, discipline, or another configuration tend to integrate the information taught in order to make it easier to put it all together in time for boards and clinical rotations. 

                                       

First Semester:

• Anatomy & Embryology
• The bread and butter of medical school and our first class ever! Hours spent in the cadaver lab dissecting and then many more hours trying to memorize everything we learned in lab and lecture. That class and I got off to a rough start in the beginning but I worked my butt off to finish strong in the end. 
• Scientific Foundations of Medicine 
• Four years worth of basic science (lots of biochem, genetics, micro, etc.) smushed down into about three months. Our first lecture: Water. How appropriate as med school is often described as "trying to drink from a firehose," or "eating a whole elephant." As the name suggests, we covered all the basic science we would need in order to understand our systems courses. Many students major in non-science fields of study so they want to ensure we are all on the same page!
• Hematology
• Anything and everything related to blood (except cancer - that's all in another block). I found this course to be really enjoyable and interesting.
• Skeletal Muscle 
• This was a short course that was packed into the last two weeks of our fall semester - kind of a catch all to set us up for our Neuro block. We included some musculoskeletal injuries and basic muscular disorders. 
• Osteopathic Principles & Practice 
• "Learning to be an osteopathic physician class" - we learn ALL about the musculoskeletal system and how that interacts with all the other body systems -- i.e. a problem you are having with your gut may manifest as referred pain, tenderness, or restriction elsewhere. I actually find OPP to be challenging at times -- learning to use your hands and your eyes to assist your diagnosis and treatment is a lot harder than you might think!
• Intro. to Clinical Medicine
• Our "learning to be a doctor class" - taking a history, doing a comprehensive physical, writing SOAP notes, telling patients good/bad news, motivational interviewing, nutrition, reading EKGs, spirometry, case studies, group work, etc. Everything we're learning in our systems course is nicely paired with ICM so we are fortifying our knowledge. The most exciting part of ICM is our standardized patient encounters: a patient/actor plays out a scenario and we perform a history/physical, discuss our findings, and develop a plan. Then we write up our SOAP note - including our orders and plan for the patient. This is probably my favorite class - I enjoy getting to practice my new skills & learning how to put what we've learning into clinical situations.

Second Semester:

• Neuroscience
• By far the most challenging course for me, thus far! Neuro doesn't come to me very easily to me (which makes OPP fun too since they rely very heavily on each other).  It was packed into 6 weeks (really 5 after all the snow days). Definitely have to spend extra time with this information for board prep.
• Cardiology
• On the flip side - I LOVE LOVE LOVE cardio. I think the heart is the coolest thing ever (and I have a special love in my heart from interpreting EKGs - I love puzzles!). If for some reason I change my mind on specialties, I could totally see myself specializing in a cardio field. Our course director is incredible - I will post his website when I create my Resources blog post. 
• Pulmonary
• Lungs. Lots of physics involved, or at least it seemed that way. Blood gases, spirometry, etc. Meh.

• Renal 
• A lot can go wrong with those cute little guys. I think it's easy to gloss over the kidneys but they really do a lot more than just make pee :) 

• Osteopathic Principles & Practice
• Same as last semester with more emphasis on honing our technique and individualizing our approach to treatment. As our course director says, "there are many ways to skin a cat." As long as we are treating in a safe, effective manner we have a pretty free license to treat according to our strengths (there are a variety of techniques and ways to ennact change.)
• Intro. to Clinical Medicine
• As with first semester, we had standardized patient encounters (Objective Standardized Clinical Examination - OSCE) - one for Neuro and one for Cardio/Pulm. We also had an integrated OSCE for OPP. In addition to OSCEs, we started utilizing the SIM lab - we were presented with a clinical scenario while working in teams using real patients or SIM man. Following the encounter, we were given feedback by a faculty clinician. These were usually lower stakes and meant to be a learning opportunity (still received a grade though...).
• Most weeks we had a lecture related to the systems course material and then a small group discussion of case studies.

Overall, I'm enjoying the systems courses. Our faculty does a fantastic job of integrating all that we've learning in the course AND previous courses so that we a forced to recall old material. Everything in medicine and in the body is interrelated -- I'm hoping this approach will make board studying just a TINY bit easier!

My Two Cents
My tips for your first year of medical school (or really any higher education pursuit) are pretty basic. 

• First of all, be prepared to make sacrifices. While college may have seemed stressful, nothing will every compare to the daily stress of graduate school. Your free time will vanish and your priorities will shift. You will cherish moments with your family and friends more but you will miss out on things you wouldn't have missed before. 

• That being said, it is VERY important to create balance in your life. Too many people burn themselves out -- several of my classmates seemed completely miserable throughout the year because they never gave themselves time to relax and breathe. IMHO, school is always a top priority but what good am I to anyone if I'm not taking care of my basic needs? Physical activity, healthy eating, time with loved ones, hobbies, etc. -- it is all still doable! 

• Take care of yourself. This goes along with balance but safe guard your health. Make time for physical activity - it will relieve stress and could be a social opportunity. Make time to eat healthy - it's easy to grab-n-go and eat lots of junk when you're studying all night but I promise, with a little prep it can be done! 
• Get enough sleep! Aim for 7 hours a night - in my opinion, if you are studying actively and working diligently there should be no reason to skimp on sleep. That said, I've pulled some pretty late nights leading up to exams - mostly because I felt unprepared. Do it if you must but don't make it a habit. There will be plenty of time in residency to be sleep deprived!
• Monitor your mental health. 20-30% of medical students suffer from depression. That is a staggering amount - I don't know the specifics of that statistic (at any one time or collectively through the first two years). The point is, depression and other mental health issues are a VERY real thing. If you start to struggle, seek help from professionals and lean on your support network.

• Study SMART. I think the biggest difference between college and med school (for me) is that you need to be more efficient with your time (I struggle with this). In college I was involved in several activities, had a job, and was a science/pre-med major - reflecting back, I had SO MUCH FREE TIME. When you study, you should be active and focused. That means set a timer and ditch Facebook, TV, cell phones, etc. If you study well with a group, make sure you pick people with similar learning styles that are also focused. Find out how you study and run with it. Just make the most of your time so you CAN have that life balance! 

• Remember why you are there. When you sit in a classroom all day, it's very easy to forget that one day you will have the honor of caring for people in their most vulnerable moments. You are studying all of this because you want to be the best physician possible for your patients (not to be number one in the class or get the most scholarships - though I'm sure that helps!). Keep YOUR reasons for pursuing medicine at the forefront of your mind for those times you want to give up, quit, leave, or pursue a new life as an AP Biology teacher named Chastin Carmichael living in Georgia with your 4 beautiful children and successful husband....that's definitely NOT my backup plan ;) *side eye*

• It gets better. Or worse. It's up to you. Depending on who you talk to, you will either hear positive or negative things about your chosen profession and the future of medicine. I think it's easy to focus on the negative things you hear - even when I was shadowing as a pre-med, doctors would advise me to NOT go into medicine or NOT go into their chosen speciality. Same with medical school. I've heard 2nd year is the worst. 2nd year is the best. 3rd year is the worst. 4th year is the best. And on and on and on...I tend to think it is up to ME whether this all gets better or worse. My attitude will determine if I am miserable (I'm sure I will be at some point) or happy (I'm positive I will be, too). Attitude is everything because there are always 50 things going on that could potentially ruin your day...you choose whether they do.

• Be kind. Life is hard enough, just be a nice person. Whether you like it or not, medicine is a TEAM sport. Be nice to the nursing students/nurses. Be nice to your fellow classmates. Be nice to anyone you meet! Medicine is a small world and people will take notice of people who a difficult to work with. My classmates are AMAZING - they are dedicated, motivated, highly involved, and also super hilarious and fun! I feel sad for the minority of students who go all "gunner mode" and miss out on establishing lifelong friendships. 

Most of all, be kind to yourself. You might fail a test or a quiz (I did), even if you were the top of the class in college. That doesn't mean YOU are a failure or should move home to live with your momma. That means it's time to reevaluate your study habits, seek out assistance, and move on. Remember, you belong here! 

What's Next?
Second year is a very important time because immediately following the conclusion of our school year, we will take our first set of licensing boards before starting our clinical rotations. As a DO candidate, I have the option to take both the COMLEX (DO boards) & USMLE Step 1 (MD boards). These scores will be used to evaluate my residency applications so they are VERY important - often they are weighed significantly more than your basic science course grades.

In order to keep my options open, I will be taking BOTH sets of boards. I want to give myself every advantage during the Match process. Many DOs disagree with this strategy, saying that if a program values your education and your degree then they should accept your board scores. I'm not willing to risk it. I plan to take USMLE first and then do a week or two of OMM prep, then take COMLEX.

As far as a medical specialty, I'm leaning heavily towards Emergency Medicine or Pediatrics. Originally I was very interested in OB/Gyn but the unpredictable hours don't appeal to me as much -- I want to start a family some day soon! My ultimate goal at this point is the double board in EM/Peds so I can work in both Pediatric and Adult ERs, as well as work as a Pediatric Hospitalist if I choose to (EM is notorious for physician burn out). I'm about 90% sure I do NOT want to enter into private practice - I want to be a hospitalist of some sort. I'm anxious to see if my mind changes as time goes by. For now, I plan to keep a very open mind and just do my best to be a competitive applicant!

My next medical post will be a list of helpful resources for the first two years & finally a Q&A! 

Stay tuned!