"Of course you can ask me that, you are my almost doctor person!"

I just finished my third week on outpatient medicine in Seattle. It has been so much fun, but I have been really busy (that is why I haven't posted as much recently). For outpatient medicine I am with a really nice girl named Ana that I actually know fairly well from my anatomy group. She is very smart and organized and is also very helpful and kind to every one around her - in short, a perfect person to have a rotation with. Our first day of the rotation was spent trying to get an ID badge - would you believe it took us 6 hours? I was joking that the id badges are so precious and take so long to get that if you got mugged on the way home from clinic you would probably say, "Take whatever you want, just PLEASE let me keep my hospital ID badge!" Maybe a little bit of an exaggeration, but not by much. :)

As far as what we do in the hospital on our outpatient rotation, we go from seeing patients in the primary care clinic to seeing patients in the ER (the medical side, not the surgery side), to observing physicians in the hematology/oncology clinic, to seeing patients in the renal clinic, etc. Some of the other really helpful clinics we observe/see patients in are the endocrine clinic, the movement disorder clinic (aka neurology), and the musculoskeletal rehab clinic. When we see our patients the sequence sort-of goes like this: We quickly review the chart and or the complaint that the patient is coming into address. Then our attending physician/teaching fellow introduces us to the patient and says, "Christine is a third year medical student and she is going to take a history on you and do a physical exam. Then she will present your case to me and we will come up with plan together." So you chat with the patient and collect the history of why they came into the hospital. Then you perform a focused physical exam - as pertains to the thing(s) the patient is complaining about. Then you take a few moments to collect your thoughts and present in about 3-5 minutes what the patient just spent a considerable amount of time collecting from the patient. At the end you tell your preceptor what you think the differential diagnosis is and what you plan for management is (this is the part that I am by far the weakest on right now). Then your preceptor/attending physician tells you all the things you missed or should have thought about and tells you the parts of your plan that are good or need improvement/more thought. You go back in with your attending physician and he/she checks some of your physical exam findings and asks a few questions and lets you present the plan to the patient. Then you or the attending put orders (such as tests, labs, etc) or consults into the computer which have to be signed by your attending doctor. Then you write up a "note" about the encounter including the history you took, the physical exam findings, and your assessment and plan. This may take 20minutes - a couple hours depending on how complicated things are and how clear your thought process is. Then the note goes to your attending physician who has to read it and sign it (and/or make corrections) before the note is finally part of the patient's file. Then sometimes you get to call the patient later on with the results of lab tests, etc. All-in-all, it is really interesting and a lot of fun. I learn so much everyday!!!

This last week I had patients that I got to see twice (so some continuity) it was nice to see how things were going with the medications that my preceptor and I suggested. It is also nice to get a taste of what it would be like if you were seeing the same patients over and over again if you were a real doctor. Last week I needed to ask some sensitive questions to a patient that I was seeing for the second time. I asked him if it was ok if I asked these questions and he responded with a huge smile and said, "Of course you can ask me that, you are my almost doctor person!" I is so amazing to me that someone considers me to be their "almost doctor." Wow, 3rd year is awesome! It is challenging, but by far, 10 times better than first and second year.

I will try to give up dates and stories as time and medical privacy laws allow.

I passed!!!!! board studying craziness

I just found out that I PASSED the USMLE step 1!!!!!! I took some pictures for this blog post before I found out my score, but I thought it might be sort-of depressing if I told you all about how much I had studied for Step 1, and it turned out that I had actually failed. I was a little bit disappointed in my score (I was secretly hoping to do better), but I passed which is what really matters!

My technique to studying is that if you are producing something or actively engaged somehow, it helps you learn so much better. I dedicated myself to taking volumes of notes from various sources and making study sheets which I plastered all over our house (I think my roommates are glad that I am done with Step 1 too). :)


This is my freak-out picture. I tried to capture some of my inner feelings about the whole studying for boards thing. The First Aid Step 1 book is sort-of the bread and butter of board studying and I supplemented it a lot with listening to some board review audio lectures, going through cases and practices questions and some other subject based board review books. All in all I think that I probably bought/tried to use too many books, but I think it is a common mistake.


The outside of my bedroom door and my bedroom walls were covered with study sheets. It is nice because you can review material when you are just brushing your hair or whatever.


Some more pictures of my bedroom wall.
After available wall space in my bedroom was expended I moved the the bathroom (with my roommates' permission, of course). Andrea said she enjoyed reviewing material while brushing her teeth, etc, but I think she may have just been saying that to be nice.

The pen/highlighter graveyard. This isn't even all of the pens and highlighters I used while studying for Step 1. I decided to start saving the pens/highlighters about a week and a half into my studying.
Now you can get the picture of how messy my room was while I was studying. I had a pile of books and note-taking supplies that I moved around with me as I studied in various locations throughout the house. good times. Now I am off doing my clinical rotations.

Birthday hike and other pictures

A lot has happened since the end of spring quarter. I decided to give the photographic tour of the last couple months.

Med school graduation for the 4th year class (it will be me in 2 years!): I know several people in the fourth year class so I decided to go and take pictures to be supportive. It was a nice ceremony, and inspiring that they all got to take the Hippocratic oath, but if any of you plan to come to my ceremony - bring pillows! The stadium chairs are something to be desired.

This is Andrea, or I guess as I should call her now, Dr. Andrea, one of my roommates for this year.



Melissa, my roommate from the previous 2 years, also graduated last month. Here she is with one of her sisters and her cousin Betsy. Although Melissa has left me, Betsy is still here and we get to hang out sometimes which is fun.
Here I am with Katja on her birthday. Katja is a friend that I know through my classmate and friend Sarah. Sarah and I organized a birthday picnic for her (but Sarah did most of the work - baking the cake and the main dish).

Katja holding her birthday cake.
At the end of second year we gave our ICM II mentor, Sam, gift at our end-of-the year breakfast. We gave him a pretty funny coffee mug.
Here is another picture of our ICM II group (I am sure my blog readers are tired of seeing them by now). ;) They are all such cool people.

The next big thing was that my older brother came up for a surprise visit for my mom's hip surgery. We have a couple pictures from surprising mom. She had no idea he was coming - it was great!
My little sister, Monica, during the surprise.

My brother, Aaron, with our mom. She was pretty happy.
This is me with one of my favorite elderly women at our church. She is so sweet - she sends birthday and anniversary cards to every one in the church every year. It is pretty incredible.

Me with my momma.

Me hanging out with my bro' waiting for mom to arrive for the surprise.


In June I turned 25! To celebrate the big birthday, I went on a hike with my good friend Sarah from med school. We hiked up Mount Bandera. It was beautiful as well as good exercise and a lot of fun!

Me at the pseudo peak of the mountain (the real peak was just a few feet away and blocked by a snow slide).
The view from the top of the mountain. It was pretty!
Even though it was a warm day, our path had snow towards the top. You have my permission to be impressed. ;)
More pictures of the view.
Me standing in front of a waterfall. The water was nice and cool.
Here is Sarah in front of the same waterfall. It was a really fun day!

Whooooo! Second year is OVER!

So as of this afternoon, at 5:30pm, it looks like second year is officially over and I passed everything. Now I just have a few things waiting for me before third year rotations start such as STUDYING FOR STEP 1 (AAAHHHHHHH!!!!), turning 25 years old, catching up with friends, oh yeah, and taking Step 1.

White coat ceremony pictures

This last Friday we had our clinical transition ceremony. It was really fun to get our white coats and look ahead to working in the hospital wards next year.

I put the best picture at the top. This is me getting my white coat from my ICM II mentor, Sam. (See previous blog posts about ICM II mentoring system). Thanks to Jo, one of my classmates' husband, for taking this picture!


This is me with Raye Maestas, my underserved pathway mentor and inspiring person (see previous blog posts). It was really nice to be able to introduce my family to some of my teachers/mentors at school

Our mentor, Sam, is super healthy and bikes everywhere. Here he is duded up in his biking gear and meeting some of my family including my mom and my Aunt Deborah.
Here is me with my white coat on.
This is me and my friend Sarah (and our white coats!) with mentor, Sam. It was a fun evening!
Here is another shot of me walking across the stage. contrary to the look of the picture, I was not striking a random action pose. There was someone just out of the picture that I was about to shake hands with.



So, apparently I waddle when I walk. Who knew? I think it is one of those things that you are surprised when you hear a recording of your voice or see a video of yourself, because it is not usually how you see yourself. I did not imagine myself waddling, but now I know the truth.

The USMLE step 1 (*JAWS THEME MUSIC PLAYS*)

In less than two weeks, the second year of medical school will be over and studying for the USMLE step 1 board exam will begin. Technically you are supposed to be studying for it all throughout your second year, but medical school keeps you so busy you can guess how much that happens. Step 1 is an 8 hour computer-based test over pretty much everything you should have learned over the first two years of medical school.

According to the USMLE website:

"Step 1 assesses whether you understand and can apply important concepts of the sciences basic to the practice of medicine, with special emphasis on principles and mechanisms underlying health, disease, and modes of therapy. Step 1 ensures mastery of not only the sciences that provide a foundation for the safe and competent practice of medicine in the present, but also the scientific principles required for maintenance of competence through lifelong learning."

'The content areas of the USMLE step 1 include:

• anatomy,
• behavioral sciences,
• biochemistry,
• microbiology,
• pathology,
• pharmacology,
• physiology,
• interdisciplinary topics, such as nutrition, genetics, and aging.

The specific systems covered include:

• hematopoietic/lymphoreticular
• nervous/special senses
• skin/connective tissue
• musculoskeletal
• respiratory
• cardiovascular
• gastrointestinal
• renal/urinary
• reproductive
• endocrine'

http://www.usmle.org/General_Information/bulletin/2009/content.html
------------------------------------------

The USMLE step 1 is sort-of scary for three reasons. First, it is really hard. Second, you have to pass it to continue on in medical school. Third, your score is important for applying to residencies and you should really try to do well on the test if you want to be competitive for residencies.


One of the review books for the USMLE step 1 is called "First Aid for USMLE Step 1." It is sort-of a funny pun, but I started thinking about it today. I don't need "First Aid for Step 1," I need, "Emergency Trauma Care with Defibrillator for the USMLE Step 1." I am serious, it is going to be several weeks of not so pretty studying in preparation for this thing.

I decided to give an artistic representation of how I felt about Step 1 right now. Yeah, that is pretty much it, except I probably don't have that good of form when I swim.


Although I might be scared out of my mind by the Step 1 exam, I am going to take a card out of Braveheart's book and give it my best (and yell 'Freedom!' a lot). Well, in the very least I think I might put some blue war paint on my face on the day of the exam so I will feel like Braveheart even if Step 1 does kick my ______.

Here is a chart that they keep showing us medical students about the average USMLE step 1 scores and the specialties you can match in. A score of 185 is usually the minimum passing score for step 1. Here I have circled the specialties that would be most likely for be to end up in at this point (generally not the most competitive, which is nice). Still, it is a very SCARY chart!

Roommates for next year. I am going to be living with my friend Andrea!

To my extreme sadness, my fourth year roommate, Melissa is leaving at the beginning of June. She matched to a Med/Peds residency in Michigan where she will be moving in just a few weeks with her boyfriend. In addition to the sadness of having to deal with Melissa leaving, this left me with another issue: I had to find two new roommates for the next school year. I really wanted to live with some girls who are nice.

With stealth and precision, I picked out my first roommate target several months ago. Andrea, one of my good friends from undergrad is also graduating this year. She told me earlier in the year that she was hoping to match in medicine in Seattle for her residency. I started immediately with the nagging, telling her that if she ended up matching in Seattle, she just HAD to live with me. I continued to remind her for several months what a wonderful house I lived in and would drop several not-so-subtle hints about how much I thought she would enjoy living there next year with me. She kept saying that she was going to look at other places, and that maybe she wanted to live in a different area, but we both knew they were heartless excuses.

In the end, Andrea match in medicine at UW in the Boise track. This means she will do her first year of residency in Seattle, her second year in Boise, ID, and her third year back in Seattle. She looked at some other apartments, but in the end she decided that she does want to live with me for the next school year! I think we are going to have loads of fun together (that is when we are both not crazy busy in the hospital, which probably won't be too often).

This is a picture of Andrea and Me taken last year. Andrea rocks.

But wait! The story is not over, because the search was still on for a third roommate. We finally found her in the form of an unsuspecting incoming first year med student named Liz. I have only met her once, but she was really nice and I think she is going to make a really fun third roommate for the next year. It will be fun to hear her experiences of first year as I am going through my thrid.

Beat the Bridge!

On Saturday I ran into one of my classmates who had just registered for the Beat the Bridge to Beat Diabetes event. She told me it was an 8k (5 mile) run and that she was was going to run/jog (slowly) with another classmate of ours. I thought it sounded like fun so I stopped by the Husky Stadium and registered. I met up with my classmates in the morning who were part of a larger fundraising team. There were thousands of people there and they closed off the streets to traffic for the race. It was sort of like a big fair. During the race my classmates and I stuck together which made it more fun than just running with a group of strangers.

This is the course map. We went across the Montlake bridge and the University Bridge. The University bridge is the bridge you have to beat because they raise it up 20 minutes after they release the third wave of runners and it is at the 2 mile mark.

Here is a picture of the finish line/area at Husky Stadium. There were tables of water, sports drinks, and fruit for you at the finish line. It was a warm day and I was pretty thirsty at the end of the race. They had these water stations along the race course where you could get a cup of water and drink it while you were running, it is a cool concept, but I wasn't very good at it.
Here was their little logo thing that I downloaded off the internet. The event was sponsored by Nordstrom and raised over a million dollars for type 1 diabetes research.

Here are some pictures of me all sweaty after I walked home. I got my "results" back today and did better than I thought. Our group of med students averaged about 9 minutes per mile (we took around 45 minutes to run the 5 miles) which is pretty good, I think. I never would have run that fast if my classmates weren't running with me and encouraging me. Peer pressure/team spirit is the keep to motivation!

Another sweaty post event picture. It was a lot of fun.

Whoo, only 4 more days of class and 2 weeks of finals until the end of second year!

During our (delightful) 5 hours of class every afternoon, we get brief 10 minute breaks between (enthralling) lectures. During these breaks the small number of us who are actually still coming to class at this time of year have started standing outside in the sun during our breaks if it happens to be sunny outside. Today while standing outside for our typical 8 and a half minutes, we realized that we only have four days of class and two weeks of finals between us and the end of the second year of medical school! Exciting times! Of course, after that we have to immediately start studying for step 1, and after step 1 we almost immediately start our clinical rotations. However, despite the negativity, in a mere 2 weeks and 3 days the joy that is the dreary first and second year medical school classrooms is no longer to be ours!


To celebrate our final (tearful) goodbyes to the medical school classrooms. One of my classmates, Olga, took some pictures of our typical classroom scene. Good memories.

People chatting and setting up their computers before class starts.

Our row. This is Jessica, me, and Sarah.

The mac laptop rainbow seen during class. black, pink, white. I think there might even be a green one somewhere.

Here are more people setting up their laptops and checking their email before class starts. Daniel from my mentoring group is on the left and Ryan is on the right.

This is one of my classmates illustrating the typical medical school library study toolkit: 1) big desk 2) not so comfy chair, 3) coffee, 4) laptop with a power source, 5) a book/syllabus, 6) highlighters, 7) pencils/pens, 8) food or something of an edible nature that resembles food.

Clerkship Schedules!

Yesterday we got our clerkship schedules for 3rd year. It is really nice because it gives us something beyond the end of second year and boards to look forward to. In general I am really pleased with my schedule and got a lot of my first and second choice clerkship locations.

After I take boards, I will be spending 12 weeks doing adult medicine in Seattle at some combination of Haborview, the UW med center, or the VA. Then I do 6 weeks of family medicine i the Country doc clinic in Seattle (I am very excited about this because this clinic serves a lot of underserved populations and it was my first choice for family medicine). Then I do 6 weeks of obstetrics and gynecology in Anchorage, Alaska (should be cold, but fun!). Six weeks of psychiatry in Seattle and then 6 weeks of pediatrics in Pocatello, Idaho. I have an elective period and then I finish it off with 6 weeks of Surgery in Tacoma.

I think third year is going to be so much fun!!!