The learning that takes place during medical school is often described as “trying to drink from a fire hose.” As a former firefighter/paramedic who was affiliated with two departments over the course of seven years, I have found it an apt expression. The deluge of information that comprises the preclinical scientific months is enough to keep you rustling through books, scrolling through thousands of PowerPoint slides, poring over study guides, and yes, turning to Google and YouTube to understand complex concepts of anatomy, pathophysiology and pharmacokinetics.
At first, entering a new patient’s room to take a history and conduct a physical exam can feel as daunting as this image conveys
Firefighting has simplistically been summarized as “putting the wet stuff on the red stuff” and the grind through medical school employs another water-based saying: “Just keep swimming.” There are formulas to learn and memorize in both fields and ultimately, the stakes are high. Failure to master pump operations means that an inadequate water volume per unit time is delivered to the fire, which can result in a failed effort or even put the people inside the structure at risk. Forgetting to calculate an anion gap when assessing a patient’s laboratory results may cause you to overlook underlying physiological responses.
Thirteen years ago, my training included the complexities of a fire engine pump panel
Of course, there are other parallels between my time on a fire department and medical education. Now that we are on our clinical rotations, my M2 classmates are also fellow comrades in a larger system entrenched in its own traditions. It’s the kind of teamwork that comes with having shared familiarity of a process – even though you’re assessed singularly for your contribution. All the while, our inexperience makes us the “rookie” on the team.
Rounding at the hospital with a team means discerning when to lead versus when to follow (photos courtesy of Ohio Fire Academy Class 0022-2005-003)
Finally, it seems there’s another silly tradition that has carried through for me: At some fire departments, it’s customary for someone to have to buy ice cream for the station when they experience a “first” (first time intubating a patient, first time using the defibrillator, first time they set up the helicopter landing area, etc.). I didn’t make the connection initially, but in retrospect I definitely swung by the hospital cafeteria for a cup of soft serve after a long day in the operating room during my obstetrics/gynecology rotation!
The word “scientist” often evokes thoughts of lab coats, mice, and untamed hairdos. Although there is some truth to those images, they don’t tell the entire story. For people who don’t interact with researchers daily, it feels a bit mysterious. But we all reap the benefits: from safety improvements in vehicle design, to medicines that treat or manage conditions, to knowledge gained about biological and environmental processes. This truth is why proposed budgetary cuts to the NIH (National Institutes of Health) were swiftly rejected this fall with bipartisan support.
One of dozens of informed consent documents I’ve accumulated as a research participant
I’ve experienced the process of clinical research from both sides – researcher and participant. As a research assistant, my duties have included subject identification and enrollment, detail-oriented data collection/entry/management, performing chart review of medical records, background and literature reviews. Going through the informed consent process with patients and their families was a means of protecting their rights and aiding in their decision making.
As I start on my clinical rotations, I’m even more appreciative of the power of research. What we learned in the classroom setting is based on a foundation of scientific inquiry. It is staggering when I consider the gravity of the thousands of work hours it takes to determine treatments, therapeutics, and alter protocols. Medicine is dynamic, and questioning the What and the Why are crucial to advancing health care. Many of the interventions that we learned are more nuanced in reality; these lessons come from more up-to-date evaluations comparing approaches.
A big thank you if you’ve ever volunteered for research; it has meant so much for medical progress and the advancement of safety measures. For those of you who are interested in taking part at the University of Michigan, this site (https://umhealthresearch.org/), can help you get started exploring studies you might be eligible for – whether as someone affected by a certain condition or as a healthy control. In the past few years, I’ve given samples of blood and saliva, received an fMRI, answered questions about my health behaviors, and completed a dexamethasone suppression test to assess cortisol levels. Being a part of research from the perspective of a participant has opened my eyes and allowed me to experience firsthand some modalities, procedures and medications that I may soon be recommending to patients as a physician-in-training. It has given me even greater empathy and understanding for some of their fears, concerns and questions. (Plus, the occasional compensation is a nice perk…to think, my spit is worth $20!)
Of course, the scientific method can be implemented in each of our daily lives to solve practical problems — ask questions, collect evidence, implement new strategies, and continually refine. This may take the form of finding the optimal time to commute to work to minimize traffic, thinking of better ways to organize the kitchen cupboards, or indulging in allowing yourself to take a deeper dive and search for answers when random thoughts pop into your head. (Highlights from my Google search history include “What does a pansystolic murmur sound like?”)
Using patient-centered decision-making, I’ve witnessed physicians demystify the jargon of scientific literature, explaining risks and benefits of options, while also clarifying potential/anticipated side effects or other outcomes to help come to a mutual agreement moving forward. No matter what specialty I end up choosing, I hope I have the opportunity to similarly engage with my patients to convey evidence-based recommendations.
Congratulations to the newly white-coated M1s and welcome to the Michigan Medicine family! As you’re settling into your favorite seat (whether located in a lecture hall, computer lab, or on your couch) commencing the marathon that is this year, let me offer a few pieces of advice:
I tried nearly every study technique at some point last year: going to class/streaming, note-taking with a stylus/typing, entering comments directly into PowerPoints/using an online note-taking platform, following study guides, making flashcards, drawing on white boards, studying alone/with a friend, etc. You’ve probably gotten this far by identifying what worked for each subject and establishing a set routine, so it can be a bit unnerving to find that you must constantly change up your style. Be patient as you learn what works best for you.
The general state of my living room. Not pictured: coffee mug.
This will always be a work in progress for me; however, I consciously attempted to maintain a balanced life last year. Ironically, once I got involved with activities and made my relationships a priority, I became more attuned to productive task management. With that said, I bit off more than I could chew. There will be many organizations you’ll want to get involved with, but be wary of charging in at every opportunity as it will be harder to scale back later.
The mindful practice of “self-kindness”
I am intensely critical of myself and if you are similar, you’ll need to get in the habit of reminding yourself that you deserve to be here on this journey. You’ll be terrible at some things and stellar at others. Be gracious about the arenas where you’re a rock-star to the same degree that you punish yourself for the areas you fall short. Of course, be prepared to be humbled. Your classmates will be compelling and you’ll learn immensely from them. Try not to make comparisons too often though; sometimes you have to “stay in your own lane.”
Try to see the big picture
If you proudly identify as a lifelong learner, you might have a penchant for going off on tangents of an interesting topic mentioned in passing. Unfortunately, because of the volume of information and time constraints, in-depth curiosity must often suffer. I know, I know…not delving deeper seems wrong, but getting bogged down in the minutiae will only leave you more confused and frustrated. This is more than just about the grade aspect: distinguishing high yield versus low yield concepts is a necessary skill in medicine (just like the ability of doctors to discern “sick” from “not sick”). Lest you be too discouraged, remind yourself that there will be time to come back to those interesting facets. Jot down notes of things you want to mull over and allow yourself to do that later – as research or just for fun. It’s all about timing.
Cultivate a life outside of the med school bubble
Whether pursuing interests/hobbies, or intentionally seeking out relationships with non-students, it will be a necessity. What was meant to be a quick hiking break this year turned into eight hours of daytime studying lost, but it was what my spirit needed.
Personal flexibility is also crucial
Know what is non-negotiable, but also be willing to allow yourself to experience new things. Allow the narrative you have already written for yourself to be edited – from the field of medicine you’re considering pursuing to the type of life you think you’ll have while doing it.
Finally, don’t hesitate to reach out to those who have gone before you if you have questions along the way. As a Cameroonian phrase goes, nous sommes ensemble (we are together).
Best wishes and Go Blue!