Exploring the US

The other day, my wife and I were driving to a residency interview in Ohio. It was a  hour drive from Baltimore and between listening to Econ Talks and the White Coat, Black Art episodes, it was obvious my wife was getting a bit bored.

At one point, she broke out her pen and paper and said excitedly, "Let's list all the cities we've stayed at least one night in!"

"Like, ever?" I asked.

"No, since we started clerkships."

That was mid-September 2011. And so we did the list. Between all of the cities we've done rotations in, traveling from one rotation to another, exploring and going to interviews, we came up with 25 US cities. To save both you and I the tedium of listing them, I'll include only those in which I've done rotations.

Chicago - Jackson Park Hospital - Family med, OB/GYN, Radiology

Baltimore - Harbor Hospital - Internal Medicine, IM Sub-I, Cardiology, Orthopedic surgery, Infectious disease.

Hollywood, FL - Regional Memorial Hospital - Surgery.

Catonsville, MD - Spring Grove - Psychiatry

Brooklyn - Interfaith Hospital - Pediatrics

I think it's great that these years of professional development hasn't been all work and no fun. I've had the opportunity to explore the US and since Saba has been kind enough to keep my wife, also a Saba student, and I together throughout all of this, that warm feeling of home is always just an arm's-reach away.

How to Choose Electives

Year 4, Semester 10, Block 3.

I'm currently in Baltimore, doing fourth year electives. I did internal medicine at Harbor Hospital here and had a great experience so I thought doing electives here would be a good idea, even if it comes with a price tag of $900/month on top of our tuition. So far I've had a sub-internship in internal medicine, cardiology and orthopedic surgery. Next is infectious diseases for 4 weeks before heading out to New Brunswick to finish up my last 6 weeks of med school.

I've been asked if it matters for residency what electives you choose. I'm not sure. It's never come up in interviews, if that's a measure. I believe having Canadian electives in the field you are interested in is important for getting back to Canada, if that's your thing. Other than that, there's a balance between being proficient enough in your field so you feel comfortable once you start residency vs being a well rounded applicant. My philosophy and my gut tell me that being well-rounded is more important. 3-4 years of a residency is long enough to get good at it. Now is the time to explore, I think...

Saba is good about "strongly suggesting" we do a surgical sub-specialty and enforcing this rule if your combined USMLE Step scores are below 440. They also suggest doing a sub-internship in IM or another field if you can find it. I think this forces students into uncomfortable roles. The role of the sub-I is the closest to being an actual resident. I know I was despairing having to do it, but it turned out to be really enjoyable... I do love being in the hospital, though.

I just finished up orthopedic surgery. I wouldn't have signed up for it unless I had a choice, but with my scheduling and my want to settle in one place (Baltimore) for a few months, it was the thing to do. Turns out, not only was it an enjoyable experience but it was highly relevant to my future practice in family medicine. With the 3 and a half clinic days a week, I saw my share of arthritic patients, mostly osteoarthritis in the knee or hip, some rheumatoid, some ACL or meniscus tears, dislocations, and post-op patients. I'm now an expert on reading arthritic radiographs. I can inject a knee confidently. I know how to manage the arthritic patient conservatively and, importantly, when to pursue surgery. I just learned the importance of this last point when, last week, listening to an episode of "White Coat, Black Art" (a Canadian medical radio show) they stated that the majority (something like 80%!) of knee and hip replacements are unnecessary. Wow.

I guess my point is that once you have a field in mind, it's possible to manipulate the elective into a relevant learning opportunity.  I could have spent more time in the OR and rounding on in house post-op patients if that was my thing. I chose an outpatient cardiology elective instead of inpatient. You know, that sort of thing.

Small Island

Two weeks ago I was in one of the grocery stores half-looking for tahini to make humus. I was only half-looking because I figured the chances of me finding any were as great as me making dean's list this semester (eek). Anyway, at the counter I asked the guy if by any chance he had any. He said he didn't but some should be coming in next week. I had heard this line before about other products and this time I really thought it was a ploy to get people like me to come back to his store.

Over the next few weeks I had been in and no tahini was in sight. I wasn't surprised until yesterday, when I was standing in line and the same guy looks up at me and says, "Did you see your tahini?" ... I was like, "What? Really?!" I thought he was bluffing, but nope! He even brought me to the aisle - and there it was.

I scoot from one side of the Island to the other in 15 minutes. And that's going 40kms/hr maximum. When a seemingly lost tourist is about, everyone knows they're a tourist. Everyone knows everyone else. At least by face. Some people don't like this, but I take comfort in it. I grew up in a big family, in a big house with lots of visitors - relatives and family friends - living with us for extended periods of time. This Island is an extension of that feeling. Houses are unlocked and people are kind to each other. It's clean. It feels like home.

Post-crastination

It's 10pm, Sunday and I have three exams tomorrow! Am I procrastinating or what?! I haven't written in a while, but have meant too.

Life on the Island has definitely taken a few turns for the better. I'm out of Mathew's dorm, which is HUGE. I mean, I liked being in the dorm for the social aspects of it. I became good friends with people there, people who I wouldn't have had a chance to get to know. And I think since we were all going through it together it helped make the place feel like home.

But, am I glad to get out of there! I mean, only having a microwave to cook with and sharing a room with another person was trying. Luckily my roommate was really cool, but there were a few matchups in the dorm that didn't go over too well. So now I live in a house in an area on the other side of the Island called Hell's Gate. I don't know why they call it that - such a harsh name for a scenic spot. It's dead quiet and being here finally feels like actually being in the Caribbean. The view out my kitchen window is completely of ocean, horizon and the odd Island in between. It's beautiful. And there's a persistent cool breeze going through the house that I don't notice in The Bottom, where the school is. There are AC units in each room but the breeze makes it so using them would just waste electricity.

Having a kitchen too is so nice. I really missed cooking.

The second semester classrooms are way nicer too, in a building with aesthetically pleasing washrooms. You know, the ones you just wanna hang out in... Just kidding.

The second biggest improvement in my opinion are the classes (Biochem, Physio, Epidemiology, Genetics), which are much more engaging. The material is a lot less bulky and more about understanding concepts than memorizing Latin-derived ligaments. Lab exams were all about being able to conjure those few specific words in less than a minute and I've always had a rough time with that. So, thank goodness for no more labs! My lack of stress (apparent in the timing of this post) could also be due to the fact that of the few science courses I've taken in undergrad, Biochem was one of them. Of course, my learning curve is a lot steeper than my traditional Saba classmate who majored in biochem or genetics or biotech. Also epidemiology is a first cousin to health economics which I mastered in... The other day we were learning about standard deviations! Oh my...

But the BIGGEST improvement from last semester, BY FAR, has got to be Neuter. Neuter gets me from A to B in style, SCOOTER STYLE. I bought Neuter the Scooter off a 5th semester and I haven't stopped smiling since. This Island was made with scooting in mind - the windy roads, picturesque scenery, fresh tropical air. Living anywhere outside of the Bottom pretty much requires a vehicle, unless relying on the unreliable bus system is your thing. I mean, lots of people take the bus, but why THE HECK would you when you could instead travel by scooter. Independence, Freedom, Adventure. If I could find a license plate wide enough, that's what it would say.

Ok, back to studying. Pictures to follow.

New Block Resolutions

When I first came to Saba, one thing that became immediately clear was how helpful the upper semesters were at giving advice on how they studied, from what materials, how much time they devoted to each class, etc. This advice is really variable. I remember on Day 1 someone telling me to follow the same study methods that worked during undergrad. A few minutes later, a different student was telling me not to rely on my previous methods because these courses were more intense. I heard over and over again "Don't worry, but hit the ground running and don't stop until you're back in Canada in December." Needless to say, I was thoroughly freaked out early on, which definitely lit a fire under my ass for first block.

Coming from a non-science background and an undergrad that ended more than 4 years ago, I was sincerely anxious about my ability to actually pull this off. Everyone hears the stats - 25% of the class leaves in the first semester, a number of people fail or drop, etc. I think it's important not to listen to these statistics. For example, already 30% of my class has left. But the vast majority of these people left because they genuinely didn't like it here or they had problems back home.

The relief I felt after passing block 1 exams was great. But I knew I could do better so i set out to revise my strategies. I thought I'd share them.

Block 1: I didn't have much of an idea in this block. I studied mostly in my room and I spent most of my time pouring over lecture slides and converting them into cue cards in question and answer form. This was very time consuming and I ran out of cue cards in the first two weeks. Even with all of these hand-made cards, I still felt like I was losing a lot of information and that I was missing details because of how tedious it was. What was worse, so much of my time went to cue card making that I had very little time to review them. Some of them I still haven't taken a second look at.

Block 2: My new block resolutions were to exclusively study in the library, to sit nearer to the front of the class. By the end of this block, I was making very few cue cards, knowing that it really wasn't that efficient. I would read the lecture slides, then refer to Dr. Rao's notes to summarize what I had been studying. Dr. Rao is a past anatomy professor whose notes are still circulating among students years later. I did even worse in this block and I felt it was because I wasn't being active enough in my studying. I would read but it wouldn't stick.

Block 3: Early on in this block, I came across the blocking method and it changed my life. Really. The idea is simple - using the power point slides, block out the important words or diagram labels or whatever you would normally highlight in a textbook. The key to doing this is blocking in a way so that once you come across the slide again in the future, you have an idea of what's behind it. So blocking an entire sentence or slide doesn't make much sense. I think this works well for me for a number of reasons:
- Blocking requires active reading because you don't want to block irrelevant shit. So the first time you go over it, you're actually studying.
- It can be started in class. Although I like listening to the prof during class, a few blocks can be made here and there without missing out on the lecture.
- It's fast. I can get through an entire lecture and maybe even review it before the night is done.
- I'm not losing any information this way, like I was with cue cards. Each diagram is in perfect form (not hand-drawn). Because the slides are developed from a number of sources, there's little reason for me to consult another source, unless I'm not understanding something.

I tried to make sure that I went through each lecture 3 times before writing the exams. I'd finish each lecture by night time, review all the lectures of the week on the weekend and again before the exam. By the third time, I usually had a great idea of what was going on.

Anyway, I felt I had a lot more time with this method, I knew the material way better and I kicked ass at the exams. Of course this won't work for everyone but I suggest you give it a try.

I supplemented this method with doing all the BRS and Michigan questions the weekend before the exams.

Block 4: This block I want to doodle and write out lists, etc. Not anything fancy to study from, but just to make the process even more active.

Oh I should also say what I love about this method is that there's a defined amount of work to do thus I know exactly how much I'm behind at any give time, or when I'm done the lecture that evening, I don't have to feel bad for taking the rest of the night off. This is important for sanity purposes.

Anyway, hope this helps.

Paradise

Block 3, Semester 1, Year 1

I sat down tonight for supper on the balcony of my residence with the sun setting and the view of two rocky hills divided by the ocean, and I couldn't help feeling how privileged I am to be here. I had to laugh and think, This is ridiculous. Not only am I pursuing my dream, but I’m doing it in paradise. There’s no crime here and the streets are clean. The only thing in the air is clouds and rain and birds I’ve never seen before. Yeah, sometimes the power goes out, but the running water doesn’t give you amebic dysentery. The mosquitoes don’t give you malaria. I come from a country that will gladly foot my tuition costs until I’m finished residency. I’m healthy, I eat well and I exercise. And I’ve intimately experienced enough places and people not only to recognize these qualities as indulgences in my life, but to be able to appreciate them as such. I don’t imagine that I’m any more or less privileged that anyone else on this Island; hopefully my peers are sharing my sense of appreciation tonight as the purple sky gives rise to the sounds of crickets.

Island Woes

So every couple of weeks we have an in-class quiz. If you get 100% on it, you get an extra 5% attached to your block exam mark, which is a pretty sweet deal. They also give incentive for the students to keep up with the material which I think is a great idea. The day before the last quiz I worked my ass off in the library - put in a solid 7 hours. I didn't do so hot on the quiz due to a few really stupid mistakes, but more importantly, I felt caught up with the material. All of these facts that were tumbling around loose in my brain had solidified into something more complete. Even better, that feeling of despair melted away.

Today, I thought I'd hit the library and catch up, maybe read ahead. But that my-ass-is-on-fire just wasn't there because I knew that the next quiz isn't until Friday. I ended up reading over the same slide for 2 hours before I called a spade and spade and went home.

Then I realised it - this place is really very boring. I had no idea! I've been too busy worrying about how I'd break it to my parents when I flunked out. Or too busy calculating if retirement was a viable option to notice this before. Without school filling my every waking moment with anxiety and deadlines, this place is severely limited. My classmates are figuring this out too.

I was going to lay low tonight but a cute girl asked me to go to a party - how could I say no? There, I got to talking to my drunk peers and quite a few of them were having a difficult time with the Island life. Until this afternoon, I really couldn't relate. I'm not saying that I'm having a difficult time living here - On the contrary, often times when I look at the hills surrounding campus, or I walk at night under a bright star-lit sky, I smile knowing what a lucky life I've lived and have been living. I could have certainly done worse, and God knows I've lived with less. To say that I'm comfortable here is an understatement.

With that said, I realize that this place isn't for everyone. I'm coming to understand that people have different levels of what they consider basic necessity... This necessity has probably derived from a number of things like how they've lived their lives before coming to this Island, and their expectations of what going to med school Should Be Like. Socially, this place is more like high school. The same people who were out last night were the same people that were out tonight. And Monday morning, in class, these people will be there again. A few of the guys I was speaking with were talking about wanting to get laid. It's understandable, but basically the gender ratio isn't in these guys' favour and, I could be wrong but it seems as if everyone is too busy and anxious to put out. Heck, I know I am. Well... I could spare a few minutes. But I'm not most people. Most people need to be woo-ed and there's no time for that here - being brought out to dinner, complimented in a variety of ways, you know the deal.

I digress. The moral of my story this evening is that if you're thinking about coming to Saba, there's a great chance this Island isn't for you. But, if your lucky, the class material will intrigue and captivate you in such a way that you won't notice. And in your goal-oriented, time-managed life, you might even take comfort in knowing that there is very little here to distract you. That the Island itself is just as helpful as the profs, peers and upper semesters at seeing that you reach your goal.