Med School Discussion Forums are a Black Hole, Terror Level: Expert

Yesterday on the bus home from a wonderfully relaxing weekend at the beach I made the mistake of Googling “which year of medical school is the hardest” on my phone. About three minutes into reading a thread on the topic posted on a medical student forum my feelings had turned from restfulness to woe. I have a general rule about doing this (it’s to NOT) but I broke it and I regretted it immediately.

Although I only browsed through about fifteen messages written by students at various points of their medical education, most of them were very disheartening. According to what I read, every year of medical school (except maybe the second half of M4) is not only difficult but unbearable and that misery, depression, and maybe even a complete mental break should be expected.

So clearly at this point I am feeling pretty nervous and unsettled. But then I started thinking about the actual people I know who are currently in medical school. They are all hardworking, dedicated students, a few of which had to apply more than once to get in. None of them fit a “traditional” applicant profile 100% (going straight from college to med school with a perfect GPA and outstanding MCAT and a list of extracurricular activities 25 feet long) and I know it hasn’t been easy but everything I’ve heard from them has been the complete opposite of what I was reading on the internet.

Yes, they tell me it is hard, it is emotionally challenging and physically draining. But no, they never tell me they hate it or that it’s unmanageable. Instead they talk about how it’s worth it. They get the opportunity to learn amazing things everyday and they wouldn’t trade that for anything. I have an acquaintance who is an M4 at a school in Boston currently and I ran into him randomly a little while ago and we chatted about how his year was going. He told me quite frankly that rotations were rough- you work with difficult patients, don’t have a lot of time off for a social life and never get enough sleep but that he was learning so much and was loving it. It was so encouraging to hear. I see his status updates on Facebook all the time and for the most part, they’re always so upbeat they put a little sunshine into my day.

After I got home last night I was on the phone with a very close friend of mine who just finished his first year and has a similar attitude about school and he made me feel so much better after my foray into studentdoctor.net. He loves being in medical school all the time, even when it’s so difficult and stressful it’s hard to handle, and that gave me hope. Every conversation I have with him, even when he’s studying for an exam or waiting to get test grades back, he’s still so happy to be where he is. Obviously it’s not easy, telling anyone that would just be a lie, but he told me something really important that I think we all need to remember and that is: most of the opinion on the internet is from students who are unhappy or dissatisfied. You don’t usually hear from the ones who work hard and do well because they have nothing to complain about so it is essential to take what you hear with a grain of salt and not let it get you down. Because if you’re willing to work hard, if you’re in it for the right reasons, you will do well and that is all that matters.

As an aside I should mention that there is a higher prevalence of anxiety & depression among medical students (actually students in general) but that there are always resources to help cope and NO ONE should feel stigmatized or afraid to use them! We all need a hand (or a hug) sometimes :)

Volunteering at the NAPVI Family Conference

This weekend I volunteered at the NAPVI family conference for parents of visually impaired children that was organized by the Jewish Guild for the Blind and it was literally a life-changing experience to the point where this blog post will not do my feelings justice. I love caring for children and have been doing so since before I reached double digits but this was the first time I had ever worked one-on-one with kids who had visual impairments and/or developmental delays and it taught me so much more than I would have imagined.

I have always felt a little uncomfortable being with children who aren’t typical*, but only because I just didn’t know how to act. I think that’s fairly normal but it’s something that people struggle with because it makes them feel bad for some reason, like they are wrong for feeling out of their depth. I don’t think that’s fair. Instead, I think that we should all just acknowledge that sometimes it is disconcerting when you don’t know what to do and that’s why it’s important to get experience doing things that bring you out of your comfort zone so that you can learn how to behave in the kind of situations that you may have difficulty with, like guiding a blind child or playing with one who is in a wheelchair and has limited mobility. Because this is something I'm not great at, I am so glad that I was given the opportunity to work with some amazing educators and volunteers who helped me become comfortable taking care of children with a host of visual and developmental issues.

What I never realized is how fulfilling it would be. I met so many awesome little kids over the one and half days I volunteered at the conference and was really touched by some of them. One of the little boys in particular I decided I wanted to steal away because he was just so adorable. A was three and had retinoschisis (loss of vision due to abnormal retinal behavior) but was otherwise typical. He couldn’t see very well but that didn’t stop him from running around like a little puppy in his tiny sneakers (which he WOULD NOT take off, even for yoga time). I got to talk with his parents later and they were both such sweet people, I was amazed at their positive attitude. It was hard to think that this giggling little boy with his dimples and thick glasses will most likely end up completely blind. It really drove home the point that this is why we do research. Not to publish papers or to get our names out there, we do it so that one day little boys like A can grow up to have all the experiences a sighted kid gets to have. There was also M, a toddler who couldn’t see but ran around giving everyone hugs, S who may have been autistic in addition to low vision and who just wanted to cuddle, and C, a beautiful little girl who couldn’t walk or talk but loved looking at bright colors.

I was able to work one-on-one with several children with different issues and it was such an education. I learned how to be a sighted guide, how to appropriately help a child so you aren't doing everything for them (so they learn to be more self-reliant), and different ways to interact with children who are extremely unresponsive. I also learned that many children with visual impairments have a host of other problems as well, which I had never realized before. I think what struck me the most though was how sweet they all were. I was amazed at the ready smiles on their faces and loved the willingness with which they would seek you out for a hug or hold your hand. By the end of the first day I wanted to adopt half of them. 

The highlight was definitely dinner Saturday night which brought together the organizers of the event, parents, and all the kids in one big space. They started playing music at one point and, after one brave boy stepped out onto the dance floor to show off his moves everybody rushed to join. Parents danced with their children who danced with their friends and everybody looked unbelievably happy. There were little ones running around underfoot and children happily dancing along in their wheelchairs. It was a beautiful thing to see and definitely brought tears to my eyes. My heart went out to them all, especially the parents who work with their kids all the time to help them to attain a better quality of life. I only got to play with them for a day and a half and while I loved the experience, it was definitely a challenge and I can’t imagine how hard it must be for the parents. I ended the weekend completely exhausted, bodily and mentally, but so happy that I had gotten to experience the wonderful support there is for families who struggle to be advocates for their children every day.

***Update: There are pictures up on the Jewish Guild Facebook page! You can take a look at them here and while you're at it you can 'like' the page to get updates on other conferences and programs that help the visually impaired.

*this is the term that is generally used to describe a child who is at the appropriate stage of development for his/her age and does not have any motor or sensory disabilities.

We're Having a Heat Wave!

Although this is not really related to any of the usual topics I thought it was important to post a snapshot of what I'm going to be experiencing for the rest of my week...

Craziness!

I am definitely not complaining because I am a summer baby and I love the sunshine but this hot weather can also be dangerous so if you live in an area that is experiencing high temperatures then be sure to check out the Red Cross Heat Wave Safety Checklist for important information on how to stay safe during a heat wave. This is a great resource that includes instructions on how to prepare, suggested activities to avoid and symptoms of heat-related emergencies to watch out for.

Social Media & Medicine

Sometimes I’m not sure how I feel about the prevalence of technology in our daily life. There is definitely a line to be crossed when it comes to being on your phone constantly versus interacting personally with someone. I don’t think anyone enjoys taking the time to hang out with a friend only to have them sit there and play a game on their phone or text or check Facebook constantly.

On the other hand though, I do think that the widespread use of social media can be a really positive thing, depending on the circumstances. Social media allows us to get close to people we wouldn’t normally be able to. While for many of us that means following celebrities like Kim Kardashian and Amanda Bynes on Twitter so we can get the latest updates on their ridiculous antics, we also have the opportunity to use sites like Twitter, Facebook and Tumblr as a way to get connected to medical schools, cutting edge science news and application resources.

+AMCAS has a very well managed Twitter account and you can expect a timely response to any question you ask them regarding applications. They also tweet helpful advice and information on transmission deadlines which I find useful. The +The New York Times Health Twitter is another of my favorites because I love the articles they post and the AAMC recently started a creative Tumblr resource that highlights new medical research. You can also join special Google+ groups related to specific fields of medicine and connect with others who share your interests.

The great thing about being able to follow med schools in particular on social media is that you get a unique look at how they work. From the pictures and stories they post and links that they tweet, you can get a glimpse into their on-campus dynamic and the kinds of activities they support. Some schools will tweet about breakthroughs in research or innovative medical technology, others take a different approach and post about events put on by the school or their participation in the community (RushMed recently tweeted pictures of students at Pride2014!).

As a journalist, it’s really fun to see social media being used for this kind of purpose. I especially like that I can follow all the schools I’ve applied to on Twitter. They’re getting the word out about cool science-y things and using the internet as a platform to show what they value as a school and I get to be a part of that. I like that I can interact with them and have gotten positive responses from several schools on a few things I’ve posted. It helps to show that these schools are accessible and they want to open up a dialogue instead of being aloof and uninvolved. I'm excited that more and more schools are realizing that social media is a great way to connect with people in their neighborhood, future students, and the greater scientific community. It's an effective way to use the internet as a wonderful tool to do great things. 

The Cost of Applying to Medical $chool

(See what I did with the title there? Haha)

Everything seems to be getting more expensive these days and applying to medical school is no different. For the primary AMCAS application this year the processing fee is $160 (which covers one medical school designation) with an extra $35 charge for every additional school you designate. This might not seem like much until you consider that in the 2011 AMCAS application cycle students applied to an average of 15 schools.

Secondary application fees typically run from $25 to $100, so roughly $60 per school and then there are incidental expenses that you might not even realize exist. These include small fees for transcripts or letters of recommendation transmission and the cost of taking the MCAT ($270) and any associated exam costs (like MCAT prep books or a course, which end up being several hundred to thousands of dollars).

Total fees for the MCAT, AMCAS and secondary apps together can range well into the thousands and that’s not even taking into consideration the costs associated with interviews such as flights, hotel, etc.

Luckily, there is help. The AAMC fee assistance program (FAP) is “available to individuals with financial need” and helps applicants by reducing various fees and offering complimentary resources such as free online MCAT assessments. If you received fee assistance benefits from the AAMC, most schools will also waive the fee for your secondary application. Eligibility is determined by poverty level guidelines; if your total family income is less than or equal to 300% of the U.S. Department of Health and Human Services determined poverty level for your family size then you can receive assistance.

I think it’s really important to highlight these kinds of programs because there are many economically disadvantaged students that have the intelligence, drive and passion for medicine that would not be able to apply to medical school without help. I hope that in the future, this kind of assistance can be extended to help defray the costs of attending medical school as well, so that one day students can graduate without being hundreds of thousands of dollars in debt (gasp!). I know, it sounds totally crazy, but how amazing would that be?

You can find more information about the financial cost of applying to medical school here and if you know of any additional resources that help with application fees, please let me know!

Happy Independence Day!!

I hope you all have a wonderful 4th of July filled with food, laughter & fireworks!

Holistic Review, An Exciting Trend in Medical School Admissions

Over the past few months I've come to realize that there are quite a number of schools that employ holistic review as a part of their admissions process. While this is a huge step in the right direction (in my opinion!) the problem is that it's difficult to find a lot of information on exactly which schools participate. To remedy this, I did some research on my own and came up with a pretty impressive list.

First though, a bit about what holistic review is. This NEJM article which I posted previously states that the process "emphasizes attributes, including learning ability, that are associated with excellence in physicians. Applicants are evaluated according to criteria that are institution-specific, mission-driven, broad-based, and applied consistently across the entire applicant pool at a given school." That's kind of a mouthful!

Basically, holistic review considers the achievements of each applicant in context of their life experiences. It's a way of looking at an applicant as an individual and giving equal consideration to the many qualities that may contribute to their success in the medical field rather than just their MCAT scores and GPA. In particular, "adversities overcome, challenges faced, advantages and opportunities encountered, and the applicant's demonstrated resilience in the face of difficult circumstances" are all considered impactful and are assessed in this comprehensive approach.

I think the fact that this trend is gaining momentum is fantastic for several reasons. One is that we belong to an incredibly diverse society. America is a "melting pot," to borrow from popular vernacular, and our society consists of people from countless walks of life. Our physician population needs to reflect this diversity in order to deliver a higher standard of patient care. I feel particularly strongly about this as the daughter of an immigrant parent from Portugal who has only ever met one Portuguese, female doctor in her entire life.

Secondly, holistic review allows for greater consideration of nontraditional applicants. A student involved with exciting and challenging work or research but with minimal clinical experience may have cultivated vital qualities that will make them an amazing doctor. When you take the time to evaluate this student on the basis of all his experiences, you may see something in him that you might not see in a student who has a lot of volunteer experience but has never had to handle the responsibilities of being in the workforce.

Finally, there seems to be a dearth of physicians nowadays practicing medicine who are not very good doctors. I mean that in the sense that they can't connect, they aren't warm or caring, and they're ultimately unable to deliver proper care to their patients. I can think of over a dozen times I've talked with family members or friends who had a horrible experience at a hospital or with their primary care physician because their doctor simply didn't listen, didn't want to help or was just plain rude. I think that when looking for someone who will make a good future doctor, attributes like their ability to interact with their peers, cultivation of leadership skills, and demonstrated care for others are just as important as a good academic record.

Boston University, mentioned in the NEJM article as a pioneer school to transition from a more traditional admissions model to a holistic approach, is just one of the many schools I found that either explicitly state or otherwise imply that they are utilizing holistic review. In 2010 the AAMC launched a project on "Integrating Holistic Review Practices into Medical School Admission Processes." I came across this report that they published as a result and was impressed by the amount of information and the schools that participated. I won't go into the details because I think it's an important read but I will say that it's refreshing to see the amount of work that's being put into changing the way medical school admissions work (for the better!).

To make my list, I included all of the schools that were a part of the AAMC advisory committee and working group as well as all the schools that I've come across on my own that mention they employ holistic review. While it is by no means complete (I didn't look at every single school in the US), it is fairly large and I hope will be helpful. If you know of any others, please feel free to comment and I will add them! I update this list every application cycle so feedback is greatly appreciated.

Non-official list of medical schools using holistic review (31 total):

AAMC Advisory Committee on Holistic Review (12 schools)

1. University of Washington School of Medicine

2. Rush University Medical Center 

3. Pennsylvania State University College of Medicine

4. University of Arizona College of Medicine

5. University of Miami

6. Duke University School of Medicine

7. Oregon Health & Science University

8. George Washington University School 

of Medicine & Health Sciences

9. Johns Hopkins University

10. Boston University School of Medicine (three cheers for my alma mater!) 

11. Medical College of Georgia

12. University of Colorado at Denver and 

Health Sciences Center

AAMC Medical School Admissions Workshop Working Group (9 schools not on above list)

1. University of Texas Medical School

2. Tulane University School of Medicine

3. Creighton University School of 

Medicine

4. Mayo Medical School

5. Weill Medical College of Cornell University

6. Wayne State University School of Medicine

7. Geisel School of Medicine at Dartmouth 

8. University of Wisconsin Medical School

9. University of Iowa Carver College of Medicine

Additional Schools (10 schools)

1. New York Medical College

2. Oakland University William Beaumont School of Medicine

3. UC Davis School of Medicine

4. Drexel University College of Medicine

5. Florida Atlantic University Charles E. Schmidt College of Medicine
6. Rosalind Franklin University of Medicine & Science
7. Stony Brook University Medical School
8. University of Vermont College of Medicine
9. East Tennessee State University Quillen College of Medicine
10. Temple University

Ascovime USA - Part Deux

Hey everyone, I know this is sort of a repeat post but Mike (who is in charge of all the Ascovime USA efforts and who I've been working with to get the word out about the organization) wrote up a lovely piece about his volunteer experience in Africa and Dr. Bwelle's mobile clinic and I wanted to share! Check it out here.