Career decisions - Clinical Research Physician

For years, I thought that my place in medicine would be working in the clinical trenches or a mix of academia and clinical medicine. However, after finishing my PhD, I’ve discovered that research with a smattering of clinical medicine on the side is my niche. I’ve gotten a LOT of positive feedback regarding my dissertation and my school has actively encouraged me to continue this line of inquiry throughout my medical school days. I’ve also been fortunate enough to continue working with Melva Thompson-Robinson on our existing COVID and HIV work.

Recently, I had a conversation with an African American research physician here in San Antonio about his career. He is an older physician who started medical school later in life, like me, and one of the things that he said about his career is that after residency and spending a few years in solo practice to gain adequate clinical experience, he said that the career is “Easy on the bones.” He typically works office hours, has clinical patient care responsibilities that don’t require the typical 60-hour work weeks of family medicine/internal medicine docs, and has a faculty appointment at UTSA in both the internal medicine program and the PhD in Translational Research. His career is sustainable & intellectually stimulating, and he said that he feels like he can easily work well into his 70s. He went on to say that its tough for Osteopathic Physicians to get into the field due to stigma and the perception that DO’s aren’t trained well in research methodology, but because I have an existing research-based doctorate along with a masters in pharmacology, I’d have an easier time getting into the field than most MD’s AND I would come in at a higher salary because of my existing research background.

After a LOT of research and more thinking about it, I’ve decided to pursue a career as a clinical research physician (CRP). What do CRPs do? A CRP conducts research and performs clinical studies to develop improved care options for local physicians and their patients. As a CRP, I will oversee clinical trials, perform safety medical reviews, and build relationships with professionals in the pharmaceutical field. CRPs also play a critical role in developing regulatory documents for the pharmaceutical industry. Depending on the position, I may also work closely with the sales and marketing team for medical marketing and product launches. CRP salaries range from 92k to 795k, depending on whether the work is part-time or full-time, credentials that the individual has, and whether the individual is working for a small startup, academic institution, or large pharmaceutical/medical device company.

So, to prepare myself, I’ll be seeking a clinical research project while I am in medical school (and eventually residency), and I’ll be finishing a master’s in clinical & translational research concurrently with my DO (Was admitted to the MS at Arizona State University today and was awarded a full scholarship, lightning does strike twice!). I’ve identified some mentors in the field and will be preparing to take the clinical research professional certification exam before I finish medical school. I doubt that I will leave academia fully; in fact, the VA has a large clinical trials arm and its possible that I could end up with a faculty appointment and a directorship with the VA. I’m feeling rejuvenated now that I see a way that I can use my doctoral research training AND medical training but not end up burnt out like so many of the physicians that I have recently met.

#careerdecisions #osteopathicmedicine

I feel no joy in the Ahmaud Arbrey verdict

Yesterday, the three men who killed Ahmaud Arbrey were found guilty. Its likely that they will all be sentenced to lengthy prison terms and the possibility exists that the three will spend the rest of their lives in prison.

Despite the outcome of the trial, I do not feel a sense of happiness or even relief. For starters, none of these men will be home with their families on this Thanksgiving Day. Ahmaud Arbrey's family and friends will forever have a missing chair at the table. Whaever hopes and dreams his family had for him, died the day that he was murdered.

The lives of the families of Arbrey's murderers will also forever be changed. While they will get to visit their loved ones in prison on Thanksgiving, there will no longer be those fun family get togethers. They will sit in prison as the lives of their families go on without them. Their families will have to forever deal with the noterity that comes with having their names attached to one of the darkest moments of 2020 history.

I so wish that we could go back to that February 23, 2020 day and have Ahmaud's three killers see the future and reflect on how their actions would change so many lives. Maybe, just maybe they would pursue a different course. Maybe they would show some humanity instead of racism and ego, and let Ahmaud be. Just a fantasy though... I won't feel like celebrating until a day comes when I and my brothers & sisters can just exist and do normal every day stuff without fear of being profiled, chased down, harrassed, and possibly murdered.

Starting board prep

The sheer volume of material one needs to study. To get through their medical school classes and the USMLE/COMLEX requires a very structured, and organized approach to covering the material. A strong schedule will allow the student to cover the material at an appropriate pace, give plenty of time to study, and make things more manageable as the student tries to fit in all of their other competing demands.

The other issue, for me, is that I find the curriculum at UIWSOM to be a little… disjointed. It feels like we are jumping around with little to tether topics to a solid basic medical sciences foundation. Some of my classmates might disagree with me, but this is how I feel. So, when I took my leave of absence, one of the things that I said that I would do in the six months away from school was do a thorough review of the basic medical sciences using my Kaplan On Demand and Boards & Beyond Videos along with the Kaplan Q-Bank and a few other resources that I have at the house. The first step was devising a schedule however, and I found a free schedule posted to Cram Fighter that I am modifying to my needs. I’m also designing a spreadsheet to catalog all the Kaplan questions that I get wrong; as I learned with the MCAT, part of preparing for the boards (and classes), is making sure that you understand WHY you are getting questions wrong, and you need to set aside time to analyze the wrong questions/answers. Thus, I am limiting myself to 10 Kaplan questions per night as I think that it will take about an hour to properly review/catalog/analyze those questions. Boards will be here before I know it; I want to get at least two passes through all of the Kaplan material before I start with UWorld questions during our dedicated board prep time. This summer, I plan to take an intensive review I don't want to be caught unawares. Plus, this prep will help me to have a more solid foundation when I return in July.

Keeping busy

Though I am on a leave of absence from school, I am not just sitting around. Today, I pulled up the 395 Kaplan USMLE/COMLEX questions that I’ve completed to this date, and I started to review them to understand why I got them right or wrong. I also started work on an executive summary that I owe to the Texas Nurses Association, and I’ll be using this time to work on a manuscript that covers the data that my research group gleaned from our COVID19 project last summer. I’m going to work on turning my dissertation into one or two manuscripts, and finally, I will be reviewing the anatomy, pharmacology, physiology, and biochemistry that we cover through the first three units so that when I return in July, this stuff will be old hat to me.

Sometimes, you have to take a step backwards to move forward

One of life’s truisms is that sometimes, to take a step forward, sometimes you have to take a step (or two or three) backwards. Unfortunately, I must take a six and a half month leave of absence from school to deal with a health issue. Oh no, it’s not a drastic health issue that would cost me my life or anything like that! That said, my issue is one that is compromising my ability to successfully get through my classes and if not dealt with now, would compromise my ability to successfully complete medical school and residency.

You see, I have a condition called “Keratoconus” and because of it, I am legally blind in both eyes. My vision in the left eye is 20/400 and, in my right, my vision is 20/200. I was first diagnosed with the condition in 2006 and in 2007, I started wearing polymethyl methacrylate contact lenses. Basically, these lenses are made of plexiglass and while. They gave me better than 20/20 vision in both eyes, they are not permeable to oxygen. My eyes ended up very dry and irritated after 6 to 8 hours of wear. Sometimes, the contacts would get so dry that they would fall out of my eyes; I lost more than one contact lens this way when I was in undergrad!

A few years later, in 2009 or ’10, I transitioned to a hybrid contact lens. This lens has a rigid, gas permeable center surrounded by a soft skirt. The lenses are MUCH more comfortable than the rigid lens and I can wear them up to 12 hours a day. Wearing them this long, I can get 10 to 12 months of use out of the lenses. Unfortunately, VSP (my eye insurance) no longer considers my lenses medically necessary and so they only cover $25 of the $405 cost. Correction, that is $405 for EACH lens. Being in medical school, I am wearing my lenses up to 20 hours in a day and I have worn out a set of lenses (I usually purchase two sets at a time). At this rate, this won’t be sustainable and I’m already experiencing vision issues from wearing these worn-out contacts.

So, I applied for a leave of absence yesterday and it was approved today. I hate to take the LOA but I’ve got to get my vision issues taken care of. Medical school isn’t going to get any easier and by the time I reach 3rd and 4th year rotations and eventually residency, I could be burning through contact lenses every three months. I spoke with my physician back home and on 14th of December, I’ll be seeing him in his office to discuss and weigh the pros/cons of having a double cornea transplant vs. being fitted with the latest in contact lens technology, the scleral lens.

I wrestled with taking the LOA over the last week. I’d already decided that I was going to continue with medical school but a couple of weeks ago, in gross anatomy lab, I misidentified something that was so egregious that my professor half joked that my vision must be going bad. I nervously laughed it off but inside, I knew that my contacts were worn out and I had been having difficulties recognizing images in histology for a few weeks. So, I decided to be proactive and take the LOA so that I can get ahead of this situation before it leads to failing something. The downside is that I’ll be missing the start of my next class, Unit 3 and will have to pick up my studies with the entering class of 2026. But, I have to take a step backwards to move forward. The upside is that once my vision issues are corrected, I won’t have to worry about worn out contacts or limitations on how many hours a day I can wear contacts. I’ll have crisp vision and will be able to successfully complete my classes and eventually, clinical rotations and my residency. I must take a step backwards to take a step forward.

What this is all teaching me is that when unexpected challenges arise, when things go wrong, the temptation is to tell ourselves that we have failed. Not only that, but the temptation to then quit and run back to what is comfortable grows within us. That is how many people have lost out on their dreams. Medical school is a long game and things may happen during that long game that will knock you down. Like me, you may have to take a step back to take the step forward into progress. Though I will be out of school until July 2022, I won’t just sit around. I worked with our curriculum guru to devise a study schedule using the Kaplan USMLE/COMLEX Board Prep materials that we have, and I will be downloading all of the PowerPoints and learning objectives for the first three units so that I can 1) stay in the know and 2) Be ready to start Unit 3 upon my return. I must take a step back to take a step forward. Not the worst thing in the world.

P.S. - For those of you who are interested in opthomology, check out my corneal topography and corneal thickness maps. The technology medicine is AWESOME.

Do not compare

One of the lessons that I learned in my PhD program that I should have had front and center when starting medical school is that we are all good at different things and we SHOULD NOT COMPARE OURSELVES TO OUR PEERS!!! When I was in my last semester of coursework in my doctorate, I had to take an advanced statistical methods class and my committee and methodologist suggested that hierarchical linear modelling (HLM) would be useful for my dissertation and future career goals. Math and statistics were never my strong suite and in undergraduate, I like to say that somehow, I screwed around and earned a B in the class. In graduate school, my biostatistics and epidemiology grades always hovered between B’s and B+’s. In contrast, I always felt at home discussing community & behavioral health theory, social determinants of health, and of course, I loved writing. Always earned A’s in those classes.

So anyway, I got to HLM and was soon in over my head. From where I sat, it looked like all of my classmates were getting it and I wasn’t. I thought that my professor, Dr. Deroche (God rest her soul) thought that I was the most incompetent student EVER in life! I was always submitting my work a little past the deadline and it seemed like there was always something that I was forgetting something in my regression models. Somehow, I messed around and earned a B in the class (and in retrospect, gained a ton of confidence in my abilities to be a quantitative researcher but that is a story for another day). Later, after my comp exams, I spoke with a classmate who’d taken the class with me and she mentioned that a number of folks struggled in the class and that there were only one or two students who really got it. I learned a VALUABLE lesson. Several actually. 1) We’re all good at different things but that doesn’t mean that you can’t be proficient at the thing that challenges you; 2) NEVER compare yourself to your peers; you never know what their struggles are (and as I am finding out, nearly everyone is struggling with something in medical school); 3) If you are determined enough, do what you need to do to succeed; though I struggled in HLM, I found some books that explained things in a better way and I went to Dr. Deroche for tutoring; and finally, 4) In graduate school, I discovered that its not usually the smartest who make it out. It’s those who work the hardest. Medical school is no different.

My Achilles tendon in medical school is gross anatomy. I don’t find it to be taught particularly well, at least for me, and I normally don’t do well in rote memorization type classes. And believe me, there is a LOT to memorize in gross anatomy. The course and my seeming inability to retain the information has been weighing on me (give me biochemistry and physiology all day! I LOVE spitting out pathways and talking about the conceptual nature of physiology) to the point where I was genuinely depressed. I decided to do something about it though and I went out and bought me a skeleton to help with learning all the muscle origin/insertions and actions. I dusted off my anatomy coloring book and Rohen’s atlas and I am re-watching Acland’s Anatomy. The biggest thing though, is that I am choosing a different attitude about gross anatomy.

Whatever you are struggling with in medical school (or grad school, pharmacy school, DNP, etc…) just know that you CAN master the material. It may take you a little longer and you may have to do something like buy a skeleton, but you can master whatever your weakest subject is. You got this!

Early NRMP / ERAS Application numbers

Just before bed last night, I read this article about the 2022 Match. The early data suggests that medical students are applying to more residency programs than ever because of how competitive things have become. US and Canadian MD students applied to an average of around 68 programs apiece while US DO students are applying to about 92 programs each. IMG MD students are applying to 139 programs each. There are around 28,000 MD applicants to this years Match, 8,000 DO applicants, and 15,000 IMG applicants. I haven’t seen a number that indicates how many positions there are in this years Match but every year, the numbers of unmatched students seems to be incrementally creeping up. Personally, I know of a fair number of friends who are IMGs who have gone unmatched over the last few years and I know two US graduates who have gone unmatched. Scary.

This all scares me because when I. think about the fact that I will be 54 when I finish medical school (assuming that I decide to stay in medical school, I’m still considering my options in this regard), I know that age discrimination will be something that I will face. On the one hand, I understand why a residency program director might say, “Why should we take a 50+ year old resident who may only work 10-20 years after completing training as compared to a late-20s or early-30s applicant who may work 30 or 40 years after training?” Residency training costs programs a significant amount of time and money to train the resident and it makes sense as to why they may have a desire to train applicants who they may think will work longer. There is a EM program director on Twitter that I follow and he has been very open and honest about the sorts of discrimination that occurs within his field when it comes to selecting residents. He and I spoke about the age discrimination that occurs and he gave me some tips as to what I can do to try to increase my odds of earning a residency in EM: Make sure that I cut my hair and beard so that my gray hair won’t be showing (i.e., appear younger), be very high energy in the interviews, and while I am in medical school, do things that demonstrate that I have the energy and vitality that a younger applicant would have (i.e., involvement in research and other campus activities). Then he proceded to tell me that doing all of that may still not be enough…

This whole thing sucks because age and my ethnicity are two things that will never change about me. I am busting my ass to make the grades and I’m still involved in research; I recently presented a poster at the 2021 AMA Research Challenge and I have two manuscripts that are in publication. I’m still teaching for A.T. Still and am part of the MPH curriculum and accreditation committees (i.e., leadership), and I plan to get involved with a couple of community service activities here on campus at UIWSOM. Despite that, I could still find myself in a situation, down the road, where I have no residency and thus, no job. That is scary. My best friend is 55 and has been forced to make a career transition; he’d taught at Northern Arizona University for almost 17 years before the school decided not to renew his contract. He’s been out of work for the last two years. He’s got TONS of relevant and recent experience in public health program evaluation and development in addition to teaching, but he has not had any calls for any of the jobs that he is applying for. I can see the depression starting to eat at him and it sometimes makes me wonder if this is a possible future that is in store for me. At the least, it makes me wish that I could go back in time and do some things differently; I feel like things would have been a LOT better for me had I started medical school 10 or 15 years ago…

Osteopatchic Manual Therapy practice

One of the things that you quickly learn as an osteopathic medical student is that there is never enough time in OMT lab to practice all of the techniques. In our DOCS lab, we typically have 80ish students (e.g., half the class) in lab and the two hours are broken up into four 25-minute stations with a 10 minute *lecture* at the outset (I use asterisks around the word ‘lecture’ because UIWSOM does not utilize lectures in the traditional sense of the word. We use a lot of flipped classroom modalities / Socratic delivery of material. Not good or bad, how you feel about this method of information delivery is really about personal preferences…)

Some of the OMT faculty are very good at demonstrating the techniques and others not so much. Further, as I have seen other DO students and graduates complain about, I am finding that there are not a lot of really good OMT resources out there. Finally, because there are so many students in class, the faculty can’t get around to everyone to answer questions or correct mistakes in our technique.

So, my wife surprised me with a massage bed (like the OMT tables in lab in most respects) so that I can practice at home. She has a few long-standing low back and gluteal somatic dysfunctions, so she’ll benefit from my practice and of course, I’ll benefit by being better prepared for the DOCS exams as well as my COMLEX exams in a few years. I’ll also get to practice my patient interviewing and examination skills.

So, what I did to prepare for the last DOCS exam was have my wife lay across the bed while I pulled up a video of say, diagnosing lumbar somatic dysfunction, and I performed the steps on my wife as I watched the video. I’d stop the video now and again to take notes; I got through all of the OMT videos and the Bates patient exam videos two nights before the exam and I actually felt prepared for those two finals (Other good sources for OMT and patient history and physical videos are Lecturio and Osmosis). This time, I’ve got almost two full weeks to go over all the OMT and patient history/physical & SOAP note material from this block, starting tonight. I’ll close by saying that its an AMAZING blessing to have a spouse/partner who is as vested in your success as you are.

P.S.- As you can see, Thor has claimed the table as his own. When I set it up, Loki decided that it was something to be scared of so he went and hid under the couch…

God is right...

I went to Walmart this morning after class; Eboni hasn't been feeling well so I wanted to surprise her by turning her home office into an oasis. While I was there, I ran across this sign that is now posted up on my book case. Sometimes, when God speaks to you, He speaks to you in a whisper. Other times, He beats you over the head with a sack of bricks. The last few days, I've gotten fairly conflicting messages that are, in retrospect, not from God, but seeing this today was like Him hitting me over the head with that proverbial sack of bricks. I know what I need to do so the question now is do I have the courage to stay the course? If I stay the course, I 100% need to revamp the way that I am taking care of myself, correction, not taking care of myself. Last week, when Eboni looked at me and told me that she could tell that I was not well, she was so right (to the fellas who are reading this, believe me when I say that when you've been with your wife for so long, they know EVERYTHING about you. You don't have to open your mouth for them to know if you are well or not, telling the truth or not...) At the rate that I am going, I won't make it to year three in a physically or mentally healthy frame of mind. I need to figure this out...

The etiquette of seeking a mentor

I was in the midst of studying limb embryology when my wife sent me a text message. She was amused and slightly annoyed at an email that she received from a student at our alma mater, who is seeking a mentor. I don’t want to sound like the old fuddy duddy or. A “boomer”, but there is a certain etiquette to these things and your success with establishing and maintaining your mentor-mentee relationship will depend in part, on professionalism.

First, pay attention to surroundings. When you send someone an email, you may not know if that person is a faculty member or whether that person has a doctorate. Thus, don’t feel entitled to use that persons first name in an email. Start with Mr./Mrs./Ms.Better yet, do some research before sending the email to see if you can find out something about that potential mentor. Do they have preferred pronouns? Do they have a doctorate? What department do they work in? If you get a response to your email, pay attention to the signature line of the email; if you see any indication that the person has a doctorate degree, and/or preferred pronouns, you refer to that person by their honorific (i.e., Dr. So-and-so) or preferred pronouns unless and until they grant you permission to refer to them by first name or some other way. One of my wife’s pet peeves (I understand given her status as one of the few African American female faculty at her medical school) is when students or prospective mentees refer to her as Eboni or Ms. Anderson despite her signature line clearly showing that she has earned her doctorate and her signing her name at the end of emails as “Dr. Anderson.”

Next, when you are reaching out to someone to ask for mentorship, be prepared. For starters, send a proper email of introduction. Spell check it and make sure that your grammar represents what you are trying to portray. Next, BRIEFLY tell your story (i.e., who, what, when, where, how, and why), make the ask, and thank them. What goes along with this, if you have a copy of your resume/CV, unofficial transcripts, personal statement, and/or standardized test results, include these in your email. These things will give us a clue as to how we might best help AND where to start.

If you develop the mentor-mentee relationship, don’t waste your mentor’s time. A young man reached out to me almost 16 months ago, requesting assistance with planning his undergraduate studies and preparing himself for medical school. When I take on a mentee, one of the things that I like to do is find out what they expect of me and how much of a time commitment they are willing to devote and what time they expect of me. This student asked to meet on a frequent basis but what ensued was strings of broken meetings. I get it, life happens. If you must break meetings, let your mentor know in advance. And if you are at a place in your life where you are not able to have a mentor, that is A-OK, acknowledge that and let your mentor know that it’s not a good time for mentorship. Believe me, most mentors will understand and not take it personally. What goes along with this, is an understanding that as your relationship develops and grows, you may find yourself in a position where you are considered a friend or family. My wife and I have two mentees, Destiney and Asia, who are no longer mentees but family. Asia is my little sister and Destiney is my daughter from another mother. Eboni and I have done a lot for Asia and Destiney and whenever the four of us are in the same state, we don’t miss a time to get together. We have a running chat on our iPhones, and we all chat almost daily. It took TIME for these bonds to grow, however. You’ve got to allow these relationships to grow organically. Its NEVER appropriate to ask your mentor for money if you’ve developed a pattern of continuously standing him up, being un prepared when you do meet, and being less than honest with him.

There is much more that I could say but I need to get back to the books. What I will say in closing is that few of us make it to medical school or a doctorate or even out of undergrad without some type of mentorship. Lord knows that I would not have gotten to where I am if not for the various mentors that I have had over the years, and I do not anticipate successfully getting to a family medicine residency without the guidance of mentors. Building relationships with people is an art and I wish that this was a skill that was taught in high school and in undergrad. There are books and journal articles that give advice on how to network, build relationships, and seek mentors. I highly suggest taking the time to look at some of these resources if developing relationships with. People or seeking mentors is a weakness. You can have a lot of doors opened for you with the right mentor0mentee relationship. Just make sure that you are ready to fully engage with your mentor when the time arises. Back to the books!

Can I work while in medical school?

As a rule, no. Medical school is a full-time job in and of itself. Even at my school where the curriculum is set up to be a *little* more student friendly, being a student is essentially an all-day job. That said, I do have some classmates who are doing things on the side. I myself am still an adjunct faculty at a school in Arizona.

If you have a master’s degree, it may be possible for you to teach an online class or two. When I started teaching online in 2009-’10, we were responsible for building our own classes, writing our own syllabi, finding our own teaching materials, etc. Essentially, we were building curriculum and teaching, and classes were a lot more labor intensive. Over the last ten years however, there has been a shift to standardization and what I find now is that schools that have a heavy online presence have departments that build the classes, write the syllabi, design the assignments and grading rubrics, etc. These days, I don’t teach as much as watch over the classes unless a student needs something and of course, assign grades at the end. My responsibilities generally include responding to student emails within 24 hours, grading assignments within 48 hours of the due date (sometimes, 72 hours), and interacting with students in the discussion boards (and few students ever interact back). Quizzes grade themselves and many classes no longer have exams. The most labor-intensive work that I have now is grading papers and these usually are no longer than three to four pages in length. I spend a bit of time teaching APA but other than that, teaching online is low stress and doesn’t take any time from my studies.

I have other friends who were nurses, firefighters, PA’s, paramedics, and consultants in their pre-medical school lives and some of them work. My buddy who is a firefighter-paramedic works one or two shifts per month, on weekends and I have another friend at USC SoM who does research consulting for $150/hr. Another friend of mine was a DNP before medical school and she does PRN shifts at urgent cares in and around San Francisco a few times each month. My point is that if you have the right skill set and education, its possible to make a little money while you are in medical school.

Working while you are in medical school is NOT optimal but I get it. Many of us have reasons why we have to continue working. For some, the loans are not enough, particularly if they have family and for others, they are not able to get loans for various reasons. If you find yourself in a situation where you have to work, just make sure that you choose something that is low stress and doesn’t keep you from your studies (or sleep). Best of luck to you.

A few points for non-traditional medical school applicants to consider

It’s been a minute since I last had time to blog. Since that time, I’ve completed three of the EMT skills day, including one day of NREMT Psychomotor Skills Testing, taken final exams & finished Unit 1, and started Unit 2 (today marks the start of week 3 of Unit 2). Things have picked up considerably and time is even less of a resource than it was in Unit 1. That said, I really wanted to share something that I want you to all think about, particularly if you are a non-traditional student with a spouse and/or children.

About a week ago, a headhunter reached out to me on LinkedIn and asked if I would be interested in applying to a Population Health Director role with United Health Group and an Academic Dean of Health Sciences role at a local, Phoenix, AZ-area community college. These roles pay $114K and over $130K respectively and the Dean’s role in particular, would suite me well because of m y academic background and the fact that I hold a doctorate. The role would also come with tenure so I would never have to worry about a job again. I could literally sit in the role until I retire or maybe seek to move up to something like President of one of the community colleges in the system or even a Provost within the system.

I have been praying about what course of action to take. On one hand, I fought so hard and for so long to get to medical school. Those of you who know me, know how long and how hard this fight was. It feels almost absurd to walk away. On the other hand, there is the reality that attending medical school as a non-traditional student, particularly when you are nearing 50 (I will be 50 in November) or have family, money issues hit differently than they do when you are in your 20s or 30s with no real financial responsibilities. One of the kids who I’ve gotten to know since being here sort of sums up the difference. He is 24 and lives at home with his parents. Though he is taking student loans, his parents are also paying for his car note (2021 Mercedes Benz SUV) and just dropped $2k on an Apple Macbook Pro four or five weeks ago. I don’t blame him, if I had those advantages, I won’t sit here and say that I wouldn’t take advantage of them. In truth, I don’t know how I would act if that advantage had ever been afforded to me. In my situation, however, Eboni is taking on 99% of the financial burden of me being in medical school. While she earns a comfortable six-figure salary, because of the increased cost of everything, me being in medical school is a financial burden. She’s never said anything to me about it and I still teach adjunct status with A.T. Still so that I can at least pay my truck note and take care of some small things around the house, but I see the lines of concern on her face each month when it’s time to pay rent, utilities, her car note, student loan, etc…

The other thing that I think about is that if I make the decision to stay in medical school, this means almost a decade of Eboni fronting the financial cost of this little adventure. I’ll be 56 when I finish residency so we’re looking at me being out of work for at least 6 ½ more years or so and that assumes that I am fortunate enough to secure a family or internal medicine residency right out of the gate. One of the other realities that does not get enough attention is that there is a fair amount of ageism in medical school admissions and residency selection. Now and again, you’ll see these stories in the media about an older residency applicant having to sue a residency program because of age discrimination. In any case, the other thing that is of concern for me is that these six, almost seven years, that I am not working is also time that I am missing out on saving for retirement. To be sure, once I am a physician, I’ll be able to make those years up financially and if I choose to continue my commitment with the VA, and work till I am in my mid-70s, I’ll have a decent retirement. That brings up a whole different question regarding how long I actually want to work but that is a subject for another day.

My point in mentioning all of this is that if you are planning on attending medical school as an older student with existing financial obligations, please carefully consider your financial plan. If you are married, consider what that will look like for you and your spouse, especially if you have young children and have to rely on one income. A few of us older students in my class do work on a part time or as-needed basis, but this little money that we bring in does not make up for the major loss of income that we incurred by starting medical school. I am fortunate that my wife is supportive of this but some of my classmates are facing issues and we are only 12 ½ weeks into a four year journey…

Something else that does not get enough attention is that when you come to medical school, no matter what age you are, you have to understand that for as much as medical school will give you, it cannot give you time. What I mean is that you are signing up to miss a lot of life events and you will have to be OK with that. You will have to be OK with family not understanding why you couldn’t be at your 96-year-old paternal grandmothers birthday party (And in this day and age of COVID, there is even less guarantee that I’ll be able to see her 97th birthday…). You’ll have to be OK with letting your spouse fly back home to tend to an ill uncle while you stay behind and study (Eboni’s uncle may be near death and once he is gone, she will not have many family ties to that side of the family. This has been so hard for her and I feel so bad that I haven’t been, can’t be there for her the way that a husband needs to be there for his wife…). You’ll have to be OK with missing out on fishing trips with your dad (Our last fishing trip together was my senior year of high school, in 1989). The list of the events, both happy and not so happy, that I have missed so far as lengthy and by the time I finish medical school, I feel like I will have missed enough events to fill a small book. Understand that once these events are gone, there is no going back to get them. You’ll have to be OK with that and you’ll have to be OK with family and friends who do not understand why you can’t be fully present.

I haven’t yet made a decision about what I am going to do (i.e., take one or both of these job interviews and possibly leave medical school). Right now, I am TIRED and there is so much on my plate with studying. Next week, I’ll need to transition to starting to prepare for the end of unit finals so to be honest, I don’t know when I will really have time to think about all of this. I think that I needed to vent this morning before class starts (15 minutes) and I wanted to let you, the reader think about these things before you hit that “submit” button on your applications. These are real-world issues that you have got to think about and plan for, hopefully BEFORE you start medical school.

How exams work at UIWSOM

I survived final exams at UIWSOM. This was a GRUELING week. The closest thing that I can compare it to was when I prepared for and took my written and oral comprehensives last year when I was finished with my PhD coursework. And to be honest, that still paled in comparison to what I just went through… What follows is a description of how exam week is for the OMS-1 year at UIWSOM. I’ll give as many details as I can, but I cannot discuss particular topics or questions that were on our exams.

So briefly, at UIWSOM, our classes are given in a block system and each block lasts between 3 to 10 weeks. This first block was Essentials of Biomedical Sciences and EMT. Within each block, we have Small Group (SIGS), Clinical Skills & OMT (DOCS), Large Group (LGS), and Gross Anatomy/Histology/Embryology (STRX). The grade for SIGS is based on your attendance and participation in the case studies. Essentially, you only have to have a pulse, be professional, make an intelligible comment now and again, and you’ll pass the course. The grades in the other three activities are based on exams. This is what I will. Now describe.

For LGS, we take an exam called the “CE” or Cumulative Evaluation. This exam covers anything that was said in LGS, SIGS, DOCS, and STRX. Where UIWSOM is different than most medical schools, maybe all U.S. medical schools, is that our exams are not multiple choice. Our exams are written exams, so you really must know your business on a deeper level. There is only so much bullshitting that you can do to pass the exams.

The CE was on Monday of this week. The class was broken up into smaller groups so that we could take the exam in different rooms in Building 2. Check in for the exam started at 0715 and was complete by 0755. If you arrived after that time, you likely would not get to take the exam. The exam was broken up into three blocks of 14 essay questions each. Block 1 went from 0800-0945; this was followed by a 15-minute break. The second block went from 1000-1145 and was followed by a 30-minute lunch. The final block was from 1215-1400. If you finished early, you could leave but we were not allowed to hang out in the building nor were we to discuss the exam with one another. The exam was taken on the ExamN lockdown browser.

The next day, Tuesday, we took the DOCS exam. The exam was divided into two parts. The first was the History & Physical exam and this was taken in the CIELO Patient Simulation Center with mock patients. The second part was taken in the OMT lab with one of the OMT professors as the rater. For this part of the exam, we were matched with a student and took turns being the patient.

The History & Physical part of the OSCE started at 1230. The class was broken up into groups of 10 to 12 students and each group of students had to arrive at the CIELO, check in, and then the check in staff gave us a number that corresponded with our exam room. At the appointed time, we were escorted to the exam room, and we had a few minutes to read the prompt on the door. The prompt was a scenario that gave some basic information about the encounter and what we were to do. After reading the prompt, a buzzer went off and I knocked on the door. The mock patient said “Enter” and I entered and started what I was supposed to do. Once I’d finished gathering information and examining my patient (we were allotted 16 minutes), we had eight minutes to type up a SOAP (Subjective, Objective, Assessment, & Plan) note. After the SOAP note was completed, we waited until we were escorted to the OMT lab for the OMT portion of the exam.

The OMT station was a timed, 12-minute station. The instructor who was also the rater, gave us each a red folder that contained information regarding the type of OMT exam and/or treatment that we were to perform. Once a buzzer went off, if you were playing the role of the physician, you instructed your patient to disrobe and then you started the exam. As you were doing the exam, you had to verbalize what you were doing and why, verbalize key anatomical landmarks, state what you were looking for, name the somatic dysfunction if applicable, etc. At times, the rater would ask a clarifying question, but they did not otherwise communicate. It was really kind of an odd feeling because me and my partner were standing there in front of her as she sat at a computer typing notes on our performance of the exam. We were not to communicate in any way, as you might imagine. Once the exam was done, the rater would ask, “Is there anything else that you would like to add?” If nothing, we were done. We dressed and exited the OMT lab.

The final exam, arguably the most mentally taxing, was the anatomy or STRX exam. We had that today and again, the class was broken up into two groups for the exam. My exam time was at 1230. When I arrived at Building 4, I checked in and then our group was broken up into two groups. One group proceeded to the lab for the visual lab practical and the other group proceeded to the large group lecture room for the microscopic anatomy portion of the exam. Each portion of the exam consisted of 40 questions, and we had 90 seconds to write an answer for each question before a buzzer would sound for us to rotate to the next station.

The exam started at 12:45 and ended at 1510. When I got to the last six questions of the microscopic anatomy, I was mentally DRAINED. Few of the questions were straight up “identify this” questions. No, everything was a 3rd or a 4th order question. Like they would show a basophile and ask what does this cell type do and when is it activated? Or If I cut off this blood vessel, what collateral can supply this tissue? You had to really know your stuff.

UIWSOM does not give letter or numerical grades; the idea is to cut down on competition in the class. Everything is graded Pass, Pass with Recommendations, or Fail during the OMS-1 and 2 years. In the OMS-3 year, you can Pass with Honors, Pass, Pass with Recommendations, or Fail. I feel that I did well enough to pass everything, probably pass with recommendations, but at this point, that is all I care about. I need to make some modifications to my study strategies for this next block, Musculoskeletal & Integument, that starts on Monday. For example, I need to go back to making flashcards; I got away from them because they were time consuming but in retrospect, they really do help with my memory and retention. I am also NOT doing a study group. Study groups are good when you have a good group but sometimes, you just don’t mesh well with the people that you are studying with, or you find that the effort that you put out is not equal within the group. I found that my study group slowed me down. Finally, I now understand the depth that we are expected to go into so that will help when I answer the lecture objectives and make my flashcards. I’m going to rest tonight, and tomorrow, I’ll prepare my poster for the AMA Research Challenge. Saturday, I’ll start getting ready for the new block that starts on Monday. Seven weeks of MSK and Integument!

Lessons learned after completing the first block of medical school

I just wanted to share my thoughts after completing the first block of medical school. I’ve learned so many lessons and I hope this helps those who are beginning the journey, or even having second thoughts regarding their commitment to the journey. Hope this helps💙

REFLECTIONS: Lessons learned over the first block in medical school:

1. Self-doubt will set in. Comparison to others will set in. Imposter syndrome lurks around every corner.

2. Medical school is a mind game, and you have to learn to wear blinders comfortably. Horses run with blinders for a reason. If you compare your race or judge your race according to others standards, you will always feel inadequate. Run your own race!

3. A great support system is necessary and essential to your success. If you have people around you who are undercover jealous or are not working towards their goals, what you do may “offend” them. If you keep people like this in your life, it is a recipe for YOUR disaster. I understand why a kitchen strainer is vitally important. The kitchen strainer sifts food particles from the water and like the kitchen strainer, you must sift through the people in your life. Once you do, you can see clearer and not be weighed down by other people’s burdens.

4. Those who respect what you are doing, are genuinely concerned, and are cheering you on will respect your needed boundaries. They will not be “offended” when you must tend to your business. Your relationships will pick up where you left off and you’ll talk in between AND there will be no “injury” to the relationship. You will find out who only cares about their emergencies and demands being your issue and they make an issue when you do not respond. They will never understand, especially depending on their motives and level of selfishness, why you are grinding so hard. Don’t try to make them understand. Sift them from your life.

5. Medical school challenges you to control what you can control and not feel guilty or obligated for those things you cannot control or is not yours TO control or fix. You start analyzing, “What is mine?”, “What have I taken on?”, and “What do I need to give back to the person who it belongs to?” It challenges you to also make arrangements for those things that temporarily require your necessity to ask for help.

6. Even Superman needed help. You cannot be all things to you and everyone else AND it is ok. You must believe that. And know it’s ok. It does not make you weak. It makes you strong and human. GET HELP with daily tasks and obligations and those who have signed up to do and more importantly being paid to do, INSIST THEY DO what they are supposed to do or find others who will. It also hits you in the face that winning overworked, over stressed, overextended award of the year is overrated.

7. No is a complete sentence. I cannot is too. No explanation do you have to give others and if they are for you they will understand.

8. Let your light shine. Not for bragging rights because you should understand, all things come from God. It’s not for those who are members of the National Negative Association. But you are letting your light shine freeing others to know that they can let their light shine to. If you can do it they can.

9. It’s not your obligation to continue to drag people across their destiny finish line. Somewhere, they must do what you did. Be inspired. Do the work. If they don’t, count it as a seed being planted and pray for the harvest to yield. If it doesn’t, it’s not your farm to tend to.

10. Self-care and congratulations, including celebrating small and large accomplishments are necessary. Even if you must do it by yourself. Do not wait or depend on likes or comments because after a while, most of the likes and comments will stop after you continue accomplishing your goals. Be ok with that if the why you do it is out of the right motive.

11. This is a weeding out period. The school is not weeding you out, but you will see that people will weed themselves out. Read that again. Read it one more time. Your responsibility lies with what you must complete. Not with how what you complete makes people feel. Trust the process and what the Lord allows. Do not get distracted.

12. Everything that can happen, will happen. It’s a distraction. Recognize it, step over it, and continue the race.

13. You cannot do any of this without prayer and God (or whatever you believe in as the higher power). Do not even try to. And when you depend on God, give it to God, and just be accountable for YOU doing the right thing, 1-13 are easier.

14. Get rest when you are tired. You do not have to feel bad or justify. You are not a robot.

15. Open your mouth to your professors. They are people too and life happens to them as well. When you can advocate for yourself, it makes them respect you and give you a chance. Accountability and responsibility is vital. Do what you can do as much as you can in advance to prepare for classes because they are coming. Your stress level will thank you.

16. Time management is crucial. Boundaries are vital. You have to make You Important and paramount. Your support system is very important. #16 will help guide you through your process to accomplish 1-15.

17. Whoever is left after the process were meant to be part of your life. They’ve stood with you. Be thankful, but know, there will only be a handful of people.

BONUS: you will recognize how much people stay operating out of feelings and not facts. Don’t get caught up. That’s not your cross to carry.

Week 7

Today ended my week 7. We had an eight-hour medical skills training day on campus today from 0800-1600 as part of the EMT component of the curriculum. Can’t say that I was too happy about this given that our final exam is the week after next; today was VALUABLE study real estate. Oh, AND there will be new material that is being introduced for the exam next week…

This week was hard emotionally. Seeing all of the 9/11 20th year anniversary stuff in the media and my COVID fatigue really got to me. On Monday of this week, I’d gone to HEB to buy ingredients for chicken gnocchi soup, and I saw two idiots fighting in the store; one was wearing a mask and the other was anti-mask and was following the mask wearer around, needling him. Next thing you know, they were fighting. Seeing this made me angry and sad as I remembered what the immediate aftermath of 9/11 was like. For about two months, everyone just got along. It’s a shame that it took this national tragedy to make people put aside political and religious differences to come together (albeit, for a short time) but it felt good. Flash forward to the COVID pandemic and I am seeing people go out of their way to be assholes to one another as opposed to unifying to do something that is in the best interest of the nation.

I’m also seriously COVID-fatigued. Last year, Eboni and I were locked inside for the entire year. Don’t get me wrong, we were glad to do it for the sake of the nation and for the safety of the healthcare workers and everyone else who kept the country going through all of that. Its just that here we are a year later and we’re essentially back where we started. I’m tired of wearing an N95 to class every day. Tired of the constant COVID testing. Tired of being a medical student who can’t do rotations or volunteer activities, because of the fear that the school has of liability. Tired of having to meet with classmates over Zoom to study or meeting with campus organizations over Zoom for meetings. Tired of not being able to go to church. Again, I get it, every American needs to do their part so that we can get back to some kind of normal, but there are so many who refuse to do the simplest things and instead, they make this all about politics and individual rights as opposed to doing what is best for the local and national community.

So anyway, I had a good cry in small group on Wednesday; my classmates were all there for me and I told Eboni that I want to find a therapist. I didn’t think that I had anything to unload regarding this last year, but as Eboni and I talked, our frustrations (not with each other! If we hadn’t been on lock down with each other, things would have been so much worse!) with family, friends, the government, COVID, 9/11, and our jobs boiled over. We both decided that we need to see a therapist individually, so she is working to find some options for us. I’m thankful that I have a wife that understands and encourages the use of therapy… In any case, when finals are over, hopefully I will have found someone to speak to.

2020 AACOMAS Profile Applicant and Matriculant Report - Selected data

A total of 30,308 students applied and 8,280 matriculated into the nations 37 DO. schools. Applicants submitted 203,118 individual school applications and the matriculants submitted 92,119 individual school applications.

• The mean number of individual school applications per applicant was 6.70 and per matriculant was 11.14.
• Women represented more than half of the applicant pool (53.4%) and matriculant pool (51.9%).
• The mean age was 23 for both applicants and matriculants in 2020.
• For the single race/ethnicity category, the percentage of under-represented minorities is 15.4 percent for applicants and 11.1 percent for matriculants.
• Age range for matriculants was from 18 to 62. Eight students aged 45 and up were admitted; I am one of the oldest D.O. students in the nation.
• I am one of the 262 military veterans admitted to the class of 2025.
• 1,822 Black or African-American students applied and 273 matriculated. 95 of the 273 Black or African-American matriculants are male. 1.1%. Sobering.
• Applicants mean MCAT score was 503.19 while matriculants mean MCAT score was 504.29.
• Matriculant MCAT score ranged from less than 482 (one student) to 519 or higher (54 students).

• Applicants undergraduate GPAs are as follows:
• − Non-Science: 3.62;
• − Science: 3.37;
• − Total: 3.49.

• Matriculants undergraduate GPAs are as follows:
• − Non-Science: 3.67;
• − Science: 3.46;
• − Total: 3.56.

You can review the entire report here

My diploma arrived!!!!

After receiving my booster dose of Moderna, I checked the mailbox. My doctorate & graduate certificate arrived today! This was a LONG week of classes and I’ve got a lot of anatomy, immunology, and microbiology with a little pharmacology to review over this Labor Day weekend, but these two things bought a smile to my face and put some pep in my step!

#PhinisheD #doctorofosteopathicmedicineloading

Week 6 in the books

Tonight closes another long week. I was supposed to spend five or six hours studying after class today, but Eboni and I went for our booster dose of Moderna today. The dose has done a number on me; I started feeling chills and fever around 5 PM and I slept on and off until 8. SO, I didn’t do anything. Just means that I have a 12-hour day ahead of me on Saturday and Sunday. It’s all good…

I’ve written about this before, how to deal with people who aren’t on your team. It always hurts when the people who are standing against you are family though. Last week, my sister drove down to visit and last Sunday night, she and Eboni had some girl time to chat. Shawna was incredulous that Eboni would “let” me attend medical school at my age and she went on to give unsolicited advice (as she frequently does) and then ended the conversation by saying, “I am praying that Daryl does not make it through medical school.” Wow. Eboni was incensed and wanted to get in Shawna’s shit but I just told her that it’s better that we know where she stands so that we can put her in the category that she should be in regarding her place in our lives. It always hurts when family and friends stand against you, but I always say that what God has set in motion, no one can stop unless you let them. To those of you reading this, do not let ANYONE keep you from your dreams, even if they are family. Please, keep walking the path that God has for you.

Last week, we dove into the topics of lifestyle medicine, immunology, and microbiology. My plan is to spend 12 hours tomorrow catching up on the last two weeks work and on Sunday, I want to spend half a day reviewing anatomy and the other half reviewing. Previous materials. I have about a week and a half to two weeks to get everything locked down for final exams.

2021 AMA Research Challenge

I need to get to work but about an hour ago, I was notified that my abstract was accepted for the American Medical Association's 2021 Research Challenge! There is a $10,000 grand prize and while that would be AWESOME to win, I am more excited that I get to place my dissertation research in the open, front and center, on a national stage. The issue of HIV PrEP prescribing is such an important one and this represents a unique opportunity to let the medical community know about this important topic.

Suicide Prevention Month at UIWSOM

I am fortunate to attend a medical school that takes the behavioral health of its students seriously. Events happening around campus during Suicide Prevention Month.

Week 5 - Thank God its over...

This was an incredibly long week. My buddy/mentee decided to take a one year leave of absence from his medical school. He didn't know what he wanted to do, so he spent the week calling me and Eboni almost EVERY DAY to get advice. The whole business ended up leaving me feeling very emotionally spent. As a result, I did not do much studying and what studying I did do was not effective studying. So, that means that instead of really moving forward this weekend, I have to go backwards and make sure that I consolidate several days worth of material.

My sister also drove down; I didn't want to tell her "no" as I know that she is lonely now that her daughter has moved out, but Eboni and I really don't have time to play host. I would have felt bad if she had come and I didn't spent any time with her, so I spent time with her this afternoon. As a result, the only thing that I have done is take my WFA quiz. I did grill ribeye stakes, made some cream spinach, and baked some potatoes for dinner; it was nice for the three of us to eat together and catch up, but Eboni and I are going to be up late. Eboni started medical school interviews this week and she needs to put in review notes for the applicants that she interviewed. She also has a couple of school assignments of her own to do. I marvel at how she is able to get up early with me everyday to prepare breakfast and lunch for me before I head to school. She then starts work so her days are actually FAR longer than mine. And now that the interview season has started, it won't be uncommon for her to have 13-14 hour days, five days a week. Yet, she still makes time to make sure that I don't have to do too much so that I can focus on being a medical student...

One thing for you guys to note is that in medical school, you have new stuff building on old stuff everyday. Its important to NOT fall behind and at the same time, you have to make time to go back and review old material as the more times you review it, the more likely it is to stick to memory. Try to establish a study schedule that allows you to do this early on. My plan going forward, until our final exam this semester, is to spend two hours each day reviewing old material in preparation for the exam. The class that we take next semester, Musculoskeletal, is going to be a lot more dense and we won't have the benefit of being eased into things for two weeks. We'll have to hit the ground running from day one so I need to make sure to make alterations to my study schedule early on...

Praying that next week will be a better week...

UIWSOM Chapel

I spent 30-40 minutes at the campus chapel today. Its really very nice and is like a little oasis that students, faculty, and staff can go to in order to rest and recharge. I'm so happy that we have this resource on campus and I will be using it again.

Protect your energy

Last night, I spoke with one of my friends who has decided, six weeks into his studies, to either quite medical school or take a leave of absence. Things at his school haven’t been the best and the school is not doing anything to protect their student’s mental health. Despite this, my buddy is doing well and has passed his three exams. Still, he has been very negative since moving from his home state to start school and the last three or four days has seen him at his most negative. By the time I got off the phone with him, I started questioning the wisdom of me being a medical student at almost 49 years old. I started wondering if turning down that $93,450/yearly epidemiology job a few weeks ago was a smart bet. I started asking myself if I should apply to the tenure track assistant professor job that is currently open in my department at ATSU-CGHS where I adjunct in the MPH program. I started questioning the wisdom of delaying making real money for the next seven years to attend medical school.

I didn’t sleep well last night and when I woke up this morning, Eboni could tell that my energy was off. Instead of the guy who wakes up happy to be living his dream as a medical student every day, I was just sort of “blah” through breakfast today. When I got to school today, Eboni and I talked before I went to class, and I told her that I was going to keep my friend/mentee at arm’s length because his energy has gotten too toxic and was infecting me with that negativity. After class this morning, I visited the chapel on campus and spent some time in prayer and asked God to fortify me. I also spent time reflecting on my “Why medicine” so that I do not lose sight of why I am here.

Medical school is going to be incredibly tough so you must protect your energy for the long days and nights that you will have. That may mean cutting some people out of your life, temporarily or permanently. At the least, you may have to take a step back from some people. My buddy is not doing anything to fix his situation, beyond griping to me, Eboni, and another mentee of ours so we must take a step back from hom. Other things that you can do to protect your energy is to not lose sight of your “why.” For whatever it is that you are doing, whether it be medical or graduate school, training for a powerlifting competition, learning to cook a new dish, just remember your “why.” It will keep you going when the days get hard. Practice saying “no.” It’s hard for me to say “no” at times and as a result, I have tended to spend too much time listening to people’s issues or taking on another mentee (I actually had to turn someone down this week; that hurt. BUT I did provide the student with an alternative.) What goes along with this is remove toxicity from your life, Anything that is harmful will take a toll on you and is not worth having in your presence.

These are just a few things you can do to protect your energy. I am sure that you can think of other strategies that you can use to protect your energy. Whatever you do, just make sure that you watch out for negativity and when it finds you, do what you must to protect yourself.

Environmental racism

I had to drive in to campus on Friday for small group and to take my COVID-19 rapid test. On the way, I stopped at this petrochemical plant that is a few blocks away from the school, The San Antonio Refinery LLC, to take a couple of snapshots and see what was close to the refinery. The facility produces coal and petroleum products and has earnings estimated to be $36.5 million as of 2021. The San Antonio River is a few blocks away from the river and there are several apartment complexes and schools, including the medical school, in close proximity to the refinery. What drew my attention was the flare stack that constantly burns day and night. Whenever Eboni and I drive near the area, there is a heavy stench of sulfur in the air and depending on the direction of the wind, some days, the air will have your eyes and nose watering/running.

These flares probably release all sorts of benzene, methane, sulfur dioxide, particulate matter, nitrogen oxide, heavy metals, carbon monoxide, and God knows what else. Many of these chemicals (and others) are correlated with preterm births, low birth weight, and some birth defects. These chemicals are also associated with asthma and other respiratory ailments in children and older adults. I can’t help but notice that the vast majority of the people who live, work, play, eat, sleep, and eventually die in this part of San Antonio, are Latinx.

This refinery being placed in the midst of what should be a thriving community is the very definition of environmental racism. I’m talking about the disproportionate burden of environmental hazards being placed in communities predominately made up of people of color and poor Whites. Frequently, this form of oppression is achieved by using the tools of systematic racism (i.e., policy and economic tools) that place low-income and brown communities near refineries, highways, lack of green spaces (which can bring down temperatures in the microenvironment), and landfills that contribute to the poor environmental health in these communities. These features also drive down property values and thus, keep these people from experiencing wealth generation/accumulation via home ownership.

Living under such conditions guarantees that poor and Brown people will experience a greater burden of disease. South San Antonio is also a food and healthcare desert, so these folks are already trying to live in a situation where the deck is stacked against them. Since I’ve had the chance to spend time with the people in the community these last four weeks, I’ve found myself paying close attention to the community health needs of S. San Antonio and I’ve been spending a lot of time thinking about how I as a medical student, might use my voice to do something to bring about change. I don’t imagine that I would be able to force a multi-million dollar petroleum company to go out of business but I feel like I need to do SOMETHING. I wish that I could explain what I feel. But I’ve just had this growing need to do something to use m y voice to take action regarding environmental racism, the health of the environment, and climate change.

Resillience

My first year in college I earned a 1.678 GPA.

I started my studies at Texas Southern University in the fall of 1989. In this time before the dawn of the 90s, rap & hip hop were coming into their own and TSU hosted several concerts: Heavy D, The Geto Boys, Queen Latifah, and Biz Markie just to name a few. I spent almost every night partying, going to football practice, seldom studying, and I was dealing with some heavy trauma from my parents separation and eventual bitter divorce. I ended up having to leave TSU as I lost my football scholarship, and I enlisted in the Army. Over the years, I matured and I ended up doing relatively well in college after I returned to finish my undergraduate studies in 2005. I even landed on the Dean's List six straight semesters.

I was finally accepted to medical school last year (just wrapped up week number 4) and at this stage of my life, I know exactly who I am, what I want, and I am undeterred. As I have grown in age and wisdom, I am much better equipped to handle life’s stressors. As a result, I am performing well in my classes to this point, despite having to attend school during a global pandemic.

I say all of that to say this: keep going. When life comes at you hard, when you feel like a failure, when you want to give up, don't stop. And if you are someone who didn't quite chase your dreams early on, it's never too late start chasing them. With age comes wisdom and a determination that most rarely grasp onto in our youth. So go back to school. Apply to medical school. Apply for the job. Do the damn thing. I will be here cheering you on!

#osteopathicmedicine #medicalstudent #resilience

Is lecture attendance in medical school necessary?

One of the tasks that you rapidly have to master in medical school is figuring out HOW you will absorb and retain material. For some students, that means attending every organized class activity and for others, it means skipping certain activities. Personally, I have chosen to skip those non-mandatory activities, particularly our Large Group lectures. I attended through the first two weeks of the term but quickly discovered that the Socratic method of teaching was not giving me enough to sink my teeth into. This is not to say that the Socratic method is a bad one; I think that you need very skilled faculty to deliver content in this way and not all of our faculty have this skill-set.

If you make the decision to skip lectures, you need to be 100% sure that you have the appropriate resources to learn from. I have a variety of videos such as Conrad Fischer, Kaplan USMLE, Pathoma and Boards and Beyond. I also have a large variety of textbooks covering the different subjects that we learn in LGS. I download EVERY PowerPoint from LGS; these serve as my roadmap to what I need to learn for that particular lecture. I will choose resources that help me to learn what I need to learn for that lecture and then I test myself using practice board-style questions and of course, the weekly quizzes that we get.

There are advantages to skipping lecture. You get to learn in your own way and in your own time. You also get to stay engaged in a way that best fits you; I tend to rapidly get bored in lecture so they just don’t do me any good. You also get more opportunities to review the material. That said, it is nerve-wracking at times to miss lecture as sometimes, things are covered that aren’t in the PowerPoints. Obviously, if you have issues, you don’t have that chance to ask questions of the faculty the day of lecture, and you have to be a very independent, motivated learner to take this on.

Ultimately, lecture attendance isn’t necessary to get a good grade in your basic medical sciences class. If you choose to skip lectures, just make sure that you have the right resources at hand to assist you with your learning.

Glad that Week 4 is over...

Week four is over, thankfully. This has been a BUSY week and STRX hit HARD. I think that the majority of the class was in shell shock regarding how hard we got slammed in STRX, but Large Group also caught a lot of students unawares. My plan for this weekend is to get caught up with all of that anatomy, consolidate my histology and neuroscience, and then start working on next week’s anatomy. I also have Labor Day circled on my calendar as that is going to be a good day to do some catch up. Our course exams are in exactly four weeks…

White board for medical school

When I was in undergrad, I used to be able to read something, take an exam a few days or weeks later, and recall everything that I read. Then, I got to graduate school. While in my first master’s program, pharmacology & toxicology at Michigan State University (GoGreen!), I discovered that there was just TOO MUCH to read while trying to effectively study. I mean, sometimes, we’d be assigned 60-80 pages in a week in the Intro to Toxicology class and that was on top of 100+ PowerPoint slides. I had to rapidly learn to extract the “high yield” stuff from the readings/PowerPoints and figure out a way to make it stick.

I went back to something that I used to love to do as a child: Draw. I don’t know what it is about drawing that helps with my memory retention and recall but even now, to this day, 40 years later, I can draw that P-51D Mustang or 1970 Chevelle SS from muscle memory as if it were a Saturday afternoon in the fall of 1981. When I started drawing during my master’s degree, I started remembering and retaining more, especially when I would draw things multiple times. I still have notebooks full of receptor pharmacology drawings and I can draw any of them to this day AND explain what is going on.

So, pro tip: Get a white board and some dry erase markers. If you have an iPad with an iPencil, that will work just as well. Using the whiteboard will promote:

1. Active recall
2. Help to remind you that you need to study
3. Enable group collaboration
4. Help to do quick cramming before an exam, sort of like a cheat sheet. Before an exam, try to write down everything that you remember.
5. And if you can’t afford an iPad or other tablet, they are cheap and easy to install.

Not all international medical schools are created equally

I just got off the phone with a friend of mine whom I haven't spoken to in probably five years. He was at one time, a student at St. George's University and was doing well. However, after an illness, some shadiness on SGUs part, and a threatened lawsuit by my buddy, he withdrew and enrolled in another international medical school, Oceania University of Medicine. The school has an online basic medical sciences curriculum but most disturbingly, the school does not have any affiliated hospitals in the United States. North American students who pursue a degree from this school only have access to outpatient rotations at private doctors’ offices and affiliated outpatient surgical centers. Elective rotations are very limited, and students must pass an insanely difficult in-house exam at the end of their basic science years, to sit for the USMLE Step 1. Students also have to complete one rotation at a hospital in Samoa.

My buddy wants to apply to match this year, so he asked me to proofread his personal statement for ERAS. He shared some of the hardships that led him to Oceania, and he didn't sound at all certain that matching is going to be in his cards. In fact, he is very fortunate that he had a career as a family nurse practitioner before starting medical school; if he doesn't match, he still has a career that he can lean into.

I won't comment on the online aspect of the education but any medical school that does not have hospital affiliations should be a no-go in your book. My buddy had 15-20 year’s experience as an FNP and home health nurse so I'm sure that he was able to translate that experience to many of the outpatient clinics that he rotated in, but I can't help thinking about everything that he missed by not being able to rotate in a hospital. Further, from a financial standpoint, since the school is not able to give U.S. Federal loans, they *urge* students to enroll in online masters or doctorate programs to get the financial aid. The idea is that they take out the max loans that they are eligible for and then use the financial aid refund to pay for their medical school. That in and of itself sounds sketchy.

I told my friend that I will keep him in my prayers in the hopes that he can get a residency and I told him that I would assist him with getting on as a research RA with my lab; Oceania does not have any sort of research experiences or student leadership activities that a student may take advantage of to build their CV in preparation to apply to the Match. I'm no clairvoyant but I know that my friend faces a steep climb to earn a residency spot. Is it even possible to earn a residency if you have not done any hospital rotations?

Why am I telling this story? Not all international programs are created equally. For U.S. pre-meds, there are some good programs in Australia, Europe, and Israel and there are some that, while not great, will give you a fighting chance at earning a residency in the Caribbean and Central/South America and Mexico. And then... there are the rest that will take your money and leave you holding an empty bag. I believe that every student can make it to medical school, preferably in the U.S. or Canada, but if you must go abroad, PLEASE DO YOUR HOMEWORK! Not all international schools are created equally, and most will take anyone with a pulse. What I have seen is that the students who do get out of the international schools and successfully match, they tend to be very strong students who could have gotten into a U.S. program but for some blip in their application or a lower test score on the MCAT or something. These are students who are very tough minded, have good study skills/habits, and are determined to get what they came for. They tend not to spend a lot of time playing around. The students who tend not to make it out of these programs aren't bad students, but they could stand time in a post bacc or SMP program working on their skills. Or maybe they were impatient regarding the MCAT. Some were trying to avoid the MCAT altogether and viewed going abroad as a shortcut to their goals. Whatever the case, these students tend not to graduate or if they do, they frequently do not earn a residency. So, if you are going to attend an international school, before you go, research the school(s) and make sure to give an honest assessment of yourself as a student. My buddy isn't as old as I am, but he does have a son who is entering college and I know that his wife is starting to get tired of the constant international adventure. Time does not sit still, and I would hate for him not to match as that is going to impact his family as well. Don't let this be your story. If you are going to head abroad, do your homework.

Week 3

Week three is over. This was a more tiring week than the first two. We dove into the science this week; that wasn’t too bad actually. What made the week tiring was all of the COVID news. COVID fatigue is real and right now, Texas is more or less back where we were last year at this time during the shutdown. The zip code that UIWSOM is the most heavily impacted by COVID, so the school sent us home for the latter half of last week and for Monday of this week. They bought us back on campus, but we’ve all got to wear N95s indoors and outdoors (if we’re in groups of three or more) and we have to get COVID testing every week, irrespective of vaccine status, on Thursday or Friday. I understand the precautions and I am SOOOO appreciative that our Dean, Dr. Robyn Phillips-Madson, has a public health background and is a strong administrator (And personally speaking, after working in academia for so many years, I am THRILLED that there is a strong woman in charge!) but honestly, I am so over COVID right now. Earlier this week, one of my mentees who attends another osteopathic medical school that I won’t name because they are NOT taking any real public health measures to protect students, staff and faculty, told me that she contracted COVID from most likely, unvaccinated faculty or staff. So, on top of dealing with the changes here, Eboni and I were worried about our mentee. Despite that, I was able to mostly stay caught up with work and this weekend, I will be catching up on anything that remains undone over these two weeks as well as meeting with two study groups.

In terms of what was covered this week, in DOCS, we spent more time learning about the Osteopathic Structural Exam (OSE) and palpating to look for asymmetries in patients. We also started learning how to properly use our medical instruments and take vital signs during a patient encounter. In SIGS, we did two case studies, one covering a patient with Turner Syndrome and the other, Cystic Fibrosis. The cases were really interesting, and I loved working with the group as we worked our way through the cases. STRX saw us continue with histology/make up of cells and we started working on the cadavers for the first time as we continued our understanding of the skeleton, its joints, and got an introduction to the integumentary system. Large group saw us dive into biomolecules and basic enzymology. Of course, the EMT course continues; that also contributed to my tiredness; we have five to six quizzes to do each week in that program and while it is online, the quizzes are time consuming. I’m fortunate that I’ve been an EMT and have taken the NREMT exam in the past so none of this is new to me, but it’s still time consuming.

Other than that, my chair and ottoman arrived today. My office is almost complete. I want to get a filing cabinet or small decorative table and a lamp for my office. I thought about getting a TV for the office but I think that will be a distraction, especially during football season so I’ll likely not get one. The chair is comfortable and will make a nice spot to read when I’m. not on the computer. It also makes for a nice sleeping spot (Yeah, I napped today) when I doze off… I want to do something super nice for Eboni; she bought me the chair and ottoman because she wanted my office to be comfy as I don’t like studying on campus. She’ll be returning to school on the 19th for PhD number two so I want to do something nice for her to make sure that she starts off with a nice, comfortable, and inviting study space. Time to go take some EMT quizzes!