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This is my first week (out of a possible 8+) back at the books getting ready for Step 2.

I honestly don’t know how much material I’m going to efficiently get through while running around at the hospital all week, but a girl’s gotta try. Maybe I’ll find time to post my schedule on the weekend.

In the meantime, gotta keep that rod and reel in the water if I want to catch anything.

Here we are! It’s a mere 7 months since I took Step 1 and I’m already getting ready for the next Step.

Applying for this exam would be half the hassle of Step 1 if I hadn’t gone and done a silly thing like get married and change my name. So, yah. I have to submit a Form 186 all over again and wait for MUA and ECFMG to verify it so that I can pick my test date and start studying. Because, you know, you can’t start studying without an actual test date.

Most students take Step 1 sometime after Basic Sciences and before Clincial Rotations. The timing to keep in mind for Step 2 is not the date you take the exam but ensuring you have your most excellent passing grade back before applying through ERAS for the match.

You know, The Match.

I’ll include another post on Match stuff later, but suffice it to say for now, it is important enough to deserve capital letters. I have heard varying reports about how long it takes to have your grades reported and available from Step 2, but it is generally accepted that you should have them both complete by June or July. If you don’t feel like you need Step 2 scores to boost your ERAS Match application, then there isn’t any rush to take the exam and you technically have until December or January to complete the exam before rank order lists are submitted.

Rank order lists? Okay, I’m using terminology from The Match again. Will save that for later.

Foreign and international medical graduates are encouraged to have their Step 2 scores available to increase their chances of getting an interview (and thus, residency position) for The Match. As such, I’m hoping to take Step 2 sometime in May.

Lastly, there are 2 parts to Step 2.

Clinical Knowledge (CK) is an all-day exam similar to Step 1. Except it’s an hour longer and is focused on the clinical application of all that Basic Science stuff you’ve forgotten in the last year. Fun! From this exam, you get a 2- and 3-digit score similar to the format used in Step 1.

Clinical Skills (CS) is a hands-on practical exam with people pretending to be patients. You will be expected to do a focused history and physical and write a patient note. All while proving you are a caring human being and can converse easily in English. From this exam, you get a pass/fail score.

Right now, my plan is to study during March and April and be ready to rock the exam in May. I’ll keep you posted on the exam date(s) so you can get those fingers crossed at the right time(s).

previous rotations: Obstetrics & Gynecology, Family Medicine

I was going to wait and write my impressions of my third clinical rotation until after I got my evaluation from the attending. But he is taking his time and I hear he’s (still. again.) browsing this site during the big group 10am meetings.

Embarrassing, yes. But not as bad as if I was actually in the meeting. Hi, everyone! I miss you all!

daily schedule:
7am – meet with fellow students (3 or 4) and interns (3 or 4) to go over patient list (anywhere from 12 to 18).
730am to 10am – pre-round on your patients and write SOAP notes.
10am – meet with the attending, case manager, social worker and entire Silver Team (yes, there is a Bronze and a Gold team).
1130am – start attending rounds in the ICU.
12 or 1230pm – break for lunch.
1 or 130pm – meet back again and finish work rounds.
4 or 5pm – go home.

actual daily schedule:
Pretty close to above, except a few of us students usually added 30 minutes into the pre-round time for breakfast. There were also days where we were done by 2 and others that stretched to 6pm.

what to wear:
As we are encouraged to observe or participate in any procedures being done to or on our patients, wearing scrubs is totally appropriate. But if you like to dress in a similar manner to your attending, then you’ll want to wear dress slacks and a button-down long-sleeved shirt. If it’s cold, toss on a nifty sweater or vest. And don’t forget your white coat and name badge.

what’s in my pockets:
- stethoscope
- small notebook with a list of patients, labs & data
- pen
- phone with Epocrates Drug Reference
- Maxwell’s Reference
- Cecil got bonus points for having q-tips and a tongue depressor on hand one day
- Washington Manual of Medical Therapeutics (okay that wasn’t really in my pocket, but I often carried it around)

patient notes you will be asked to write:
This is your most classic example of a blank-page SOAP (subjective, objective, assessment, plan) note. Our attending didn’t seem to care if the lab values came at the beginning of end of the O and the A/P is mostly a work-in-progress during third year.

If a new patient is admitted to your team, you may also be asked to conduct an H&P. Work on a kickass history and physical. And be able to present it in a logical and coherent fashion, including pertinent positives and negatives. Leave the non-pertinent stuff out.

what to study:
Study your patients. Know their diseases inside and out. If your rotation is anything like mine, you will see the same things over and over (diabetes, pancreatitis, stroke, etc). Diagnosis, assessment and treatment will all sink in a little more each time you see the same thing.

After a few weeks, you’ll look back and take for granted everything you know now and didn’t know before. Most of the time during this rotation I felt like a complete idiot. And yet, this was my favourite rotation so far.

a few unforgettable things learned along the way:
- I can calculate TPN (total parental nutrition) in my sleep! Word!

curious things other students do:
- wear shirts that show cleavage
- include observations in their SOAP note that they didn’t actually observe
- spend a lot of time on their phone

My friend Kev sent me a present in the mail in February 2007, shortly after I found out I was accepted to MUA. Pauline Chen wrote about her experiences as a liver transplant surgeon and hooked me as a reader for life.

As such, I’m immensely thankful when readers (thanks, Jay!) forward me articles by her in the NY Times.

How Mindfulness Can Make for Better Doctors

Looking Beyond MCATs to Pick Future Doctors

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*note: This photo is from February 2007 and boy, do I ever miss my red chair. Oh, and I agree with the way the NY Times pluralizes MCATs!

A 10-year old could learn how to read EKG’s from Dubin.

That’s how I know this book is good.

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sidenote: I’ve never liked using “apostrophe-s” to pluralize acronyms. I realize EKGs looks funny, but EKG’s looks possessive and doesn’t make sense to me.

These days are KO-KO: keep on keepin’ on. Today’s photo is from a couple of days after our big blizzard, when there were still cars randomly abandoned as if the apocalypse had hit. I’m staying on track.

Time is flying and life is great. I don’t want a thing to change.

So, I got an email the other week from a publisher wondering if I’d like a review copy of Atul Gawande’s new book, “The Checklist Manifesto.”

I responded, “Heck yes”. I LOVE LISTS.

I am a big fan of Gawande’s other two titles, “Better” and “Complications” and was considering investing in his next book. Once it came out on something cheaper than hardcover, of course.

And then it showed up on my doorstep. Hardcover and all. I’ve burned through the chapters in a couple of days, but can tell I will go back and re-read most of it. It’s a simple but inspiring solution to succeeding at highly complex and unpredictable jobs: make a checklist so you don’t miss anything.

“We have accumulated stupendous know how. We have put it in the hands of some of the most highly trained, highly skilled, and hardworking people in our society. And, with it, they have indeed accomplished extraordinary things. Nonetheless, that know-how is often unmanageable. Avoidable failures are common and persistent, not to mentioned demoralizing and frustrating, across many fields — from medicine to finance, business to government.

… the volume and complexity of what we know has exceeded our individual ability to deliver its benefits correctly, safely, or reliably.”

Gawande is a surgeon. And nowhere is this more true than in medicine. In med school we joke that it’s like trying to take a sip of water from a firehose. There is just so much information to memorize. As physicians, you may not need to know tiny details of the glucose degredation enzyme pathway on a daily basis, but there are still a ton of details to manage with an emergency case of DKA in a patient.

Right now, as a student, I’m practicing an established set of checklists that were created by people who studied medicine before me: labs, reviews of systems, medications, allergies, etc. I ask a predetermined set of questions in a history & physical to make sure I don’t miss anything. I check the same CBC and BMP values every morning. Pre-rounds have a different set of questions for a patient with pancreatitis than frostbite. The checklists evolve according to each situation, but I still feel certain things falling through the cracks with my lack of knowledge and experience.

I’m curious to see how the book ends. And I’ll be sure to share the checklist I come up with to help organize my daily 3rd year med student tasks.

Brandon proved today that he isn’t very good at relaxing. He had the entire day off for the first time in months and I was sadly disappointed to come home and find him starting his next MBA class instead of working on a good butt groove in the couch.

I, on the other hand, did a great job of enjoying some serious downtime in December. But now that the next step of my medical licensing exam is just around the corner, it’s time to get back to the books.

I have found that coming home to study in the evenings after 8 or 10 hours in the hospital is a lot different than 8 or 10 hours in a classroom. My brain is fried. I just want to veg and crochet and absorb everything that happened over the course of the day. I would rather shove toothpicks under my fingernails than roll through just 50 Q&As in a test question bank. Ugh.

So I have to switch it up. I’m going to try getting back to those 4am mornings I was so fond of on Nevis and punch out a couple of hours of studying before hitting the hospital.

I had considered cutting down on my morning caffeine in the new year, but I think that idea might have to wait until after I finish med school.

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*photo: old rendition of the hospital I work at found in a basement hallway of the Capitol Building.

Mom and Dad B flew home. Christmas decorations are coming down. 2010 is officially underway.

I wasn’t planning on doing one of those year-in-review reflection summary posts. But here it is.

2009
January – Brandon and I rang in the New Year in Saskatoon. It was blizzarding. His first visit to meet my family and experience Canadian winter.

February – Booked tickets for parents to come to Nevis.

March – MED 5 has a garage sale as we all prepare to leave the island.

April – Finish Basic Sciences. Say good-bye to Nevis. Initiated refund process with Travelocity. Whisked away on a surprise trip to Venice. Engaged!

May – Bought wedding dress at first stored I tried. Nightmare getting it fitted. Mornings at YMCA with mom. Days at Moose Jaw library with Step 1 material. Fought with Travelocity for refund.

June – Brandon surprises me by driving to Moose Jaw. More studying. Robin and Aruna visit the farm on their way to Ontario.

July – Finally receive refund from Travelocity. Step 1 is done! I passed!

August – Married! Rotations start in Oklahoma City. Deliver a couple of babies.

September – Husker season starts. Ob/Gyn is replaced by Family Medicine. Suh joins our little family.

October – Family Medicine (and H1N1 flu season) ends. Enjoy Internal Medicine.

November – Brandon cooks his first turkey for American Thanksgiving. The Roughriders make it to the Grey Cup.

December – Mom and Dad B come to visit! Brandon takes Step 1!

I can hardly predict how this year is going to top the awesomeness of last year… but here’s a sneak peek at what’s to come.

2010
January – Finish Internal Medicine rotation. Start Pediatrics. Apply for and arrange fall elective rotations.

February – Head to Vancouver for a few Olympic hockey games. Joyce takes Step 1!

March – Psychiatry rotation.

April – Take Step 2. Start 3-month Surgery rotation.

May – Maddy turns 7!

July – Roughriders are back in Mosaic Stadium.

August – 1st anniversary!

September – Husker season starts again!

December – Brandon finishes his MBA!

Today’s photo is of the Survivor Tree at the Oklahoma City Memorial for the Murrah Federal Building bombing. I absolutely adore this tree. I don’t know what it is. Maybe the old grainy black-and-white photos of it sitting in someone’s backyard decades ago. Or the way new growth sprouted the spring after the bombing when everyone needed to believe life would go on.

I am thankful we are more than just “surviving” this time in our life. We are soaring and celebrating. Life is awesome.

Just a little reminder that we love you forever, through thick and thin. Doing well or poorly or average on this exam doesn’t change a thing. Not even for a second.

We’re looking forward to relaxing with you during January while you take some much-deserved and highly-needed downtime. I know you’ll beat Lego Indiana Jones way before I do.

Now stop being so hard on yourself, relax, and go into that exam armed with the confidence that all these months of preparation have brought you. You know this stuff!