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!

Hump day...

The school decided to modify our schedule. Our DOCS and STRX labs are on campus while SIGS and LGS are work-from-home. They are supposed to fit test all faculty, staff, and students for N95s but I don't know when that will happen. To be honest, I rather like working from home on some days. The classrooms where we meet for SIGS and LGS are PACKED, crowded, and hot. Besides, the more time I spend out of the house, the lower my chances of catching COVID and bringing it home to my wife...

I'll be glad when this week is over with though. We hit it much harder than last week and I anticipate the entire weekend being devoted to revising and review.

Week 2 is in the books

Week 2: DONE. This was another successful week for me and I’m finding my study groove. I decided to use a study group and we’re going to be meeting for 2 ½ hours every Wednesday and Saturday. We may meet more than that, depending on how the workload is starting next week (see the attached schedule). Next week, we dive into the basic medical sciences, and we’ll be medical students in the truest sense of the words! We also started the EMT-Basic course. It’s not hard but it’s a LOT. We have six to seven quizzes that must be completed each week by Friday, so I’m trying to do two of them each night. My goal is to finish the entire course early so that I can spend more time focusing on my medical school coursework however.

We have had students test positive for COVID so we moved to online learning today and this will continue into Monday. We received a mandate for all students, faculty, and staff to get a COVID test, irrespective of vaccine status, so that the Dean and her leadership team can determine how widespread COVID is on the campus. This will allow her to decide regarding whether to extend the online learning period. My gut tells me that this will be extended for probably two more weeks, maybe longer, irrespective of the extent of COVID in the class. San Antonio is being hit HARD by the Delta variant and worryingly, the Lambda variant has established itself in Louisiana and it is potentially more deadly than Delta in that early research shows that it can evade vaccine-produced antibodies and the antisera of recovered patients. More studies need to be conducted, but this is the data that is coming out of Peru and Japan. As much as I hate to say this, I think that out of an abundance of caution, we should go 100% online, and the nation needs to adopt a public health posture that more closely resembles February 2020. I know that many reading this would not agree but the alternative is an increasing number of filled body bags. In any case, I never thought that I would be a medical student during a global pandemic. It’s an odd feeling…

Case Based learning at UIWSOM

So, at UIWSOM, the centerpiece of the curriculum is ‘Case Based Learning’ (CBL). Case Based Learning is an off-shoot of Problem Based Learning (PBL). As originally conceptualized, PBL is an adult learning modality that poses contextualized questions that are based on real clinical/non-clinical problems. Where CBL differs from PBL is that CBL allows for some advanced preparation, and the general content of the topic is known by the student. Like PBL, in CBL, the facilitator is NOT the driver of the discovery process. CBL allows the student to engage in the search for and application of knowledge, it promotes collaboration, and allows the student an easy means to assess their knowledge. When I taught undergraduate community health and pathophysiology at Arizona State University-Downtown, I used CBL and my students loved the method as I wasn’t spoon feeding them by reading from a PowerPoint. They were more engaged with the subject matter of the class and their retention of the material was much greater.

At UIWSOM, the process works as such:

On Monday, we receive two cases and as a group, we have about an hour and a half to develop what we call “session objectives” (SO) that are related to the case. While developing the case, we take turns reading each paragraph and then we pause for 30 seconds after the paragraph. Then we discuss what we think are the important points to research from that paragraph and if there is group consensus, that becomes a SO and then we move on. And so it goes until we have completed the two cases. On Wednesday, we meet to review one of the cases and we meet on Friday to discuss the second case. Again, we discuss in a collaborative way and everyone must share. Later on Friday, after 5 PM, the faculty releases the case study and the SO’s that they came up with so that we can compare ours to theirs. The SO’s become the basis of our exams.

Each week, we choose someone to lead the discussion, a scribe, and a timekeeper and we have very strict rules regarding the timing of things. We also have rules regarding the use of technology in the class; essentially, no one is allowed to bring out a computer or iPad. That’s taken me some time to get used to because I hate killing trees. For the last few years, I’ve taken all my notes on my iPad but now, I’ve got to get used to paper and pen. At the conclusion of every week, we get a quiz that tests us on concepts that we should have covered during the case; the quizzes are ungraded and are meant to be a study aid to us. I also forgot to mention that all our quizzes and exams are written, meaning, we get a question, and we write. None of the questions are board-style. To prepare for boards, the school has purchased access to the Kaplan USMLE/COMLEX prep course, and we are to work a minimum of 200 board style questions per course (this is part of the overall course grade). The school has also provided a suggested schedule to help incorporate these board questions into the curriculum. I digress; I’ll talk about this stuff later. Anyway, that is the CBL process. I’m probably leaving out some details and unfortunately, I cannot share any of our cases as they are copywritten by UIWSOM but you get the gist.

I know a lot of medical students who hate CBP/PBL but I personally enjoy it. I am an independent learner and like the ability to learn and study in a way that is best for me. I don’t do well in the rote PowerPoint environment, nor do I do well in a situation where I have to be in class all day long. One thing that may be different with the way that UIWSOM conducts CBL as compared to some schools is that we do have what is called “Large Group Sessions” where, using Socratic methods, we get exactly two hours of lecture/problem solving that is used to assist us with developing a framework of knowledge from which to draw while we work on our cases. DOCS and STRX also support SIGS (the CBL class) with their learning activities so if anything, all aspects of the curriculum across every class supports and reinforces each other.

UIWSOM Class Picture

My class picture. It looks like we have 15-18 Black students so we make up around 11% of the class. Impressive. The school has been VERY purposeful about talking AND walking the diversity talk. I have a trans classmate who is the coolest person and we have a good balance of older students and younger students. Very happy to be here.