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Professionalism

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“What do you want to be when you grow up?”

 

I think about that question a lot. It’s an odd question to think about, but during my time in medical school, I realized how important it is. In our world, it is actually a privilege for a child to even be able to answer the question at all. For too many children, life is more about surviving than thriving. “What profession do you want in 10 years?” Can be a difficult question to answer when posed to a child who doesn’t know where their next meal is coming from or where they are going to sleep next month. The truth is, not everyone gets to have a long term perspective on life, and that is where we are failing children.

 

When I was in undergrad, I took a philosophy class in which we discussed why people make the decisions they make. One of the ideas I was intrigued by was the Socratic concept that “to know the good is to do the good.” Basically, every decision a person makes is what we think is the best decision. When we order the salad instead of the pasta at dinner, it’s because we have prioritized what we believe is the “long term good”. We sacrifice the satisfaction of the better tasting pasta for the nutrition of the salad because we know that is “good”. But if we give in and order the pasta, we still made the decision we believe is best. The pasta is a pursuit of a shorter term “good”, but it is our own idea of “good” nonetheless.

I read this book during my undergrad years and it first introduced me to the concept of “knowing good and doing good”

If you view the world through this lens, it can provide some important perspective on why humans make the decisions we do. We are all out here just doing our best!

 

But like, what’s my point? How does this tie into “professionalism”?

 

The point: everyday I get to weigh decisions about what is “good” in both the short term, and the long term. That chance is not afforded to everyone. Opportunity is really just having more ways to know the “good” and to do it. This ties into professionalism because the “good” that I know is that kids need a chance to know a long term “good”. One of the kids I have tried to help achieve a long term perspective of what is “good” is my mentee through Franklin County Children Services, Daquan. More than anything else, I think our relationship speaks to some of my values that will help me maintain professionalism as a pediatrician.

 

The Simba program is a special subset of of FCCS in which black males mentor younger black males. I felt like I should be a part of this program because I would be able to relate well to a mentee who might share some of my own llife experiences. The truth is, Daquan and I grew up completely differently in a lot of ways, but we still had plenty of things in common.

 

The first time we met, I took Daquan to BW3s for some wings. He didn’t say anything. He sat at the table with his headphones on, eating silently, and only looking up from the game on his phone to answer my questions with one word. He was polite enough but I was worried we wouldn’t be able to develop a relationship at first. As we spent more time together, conversations got easier and easier and he wore his headphones less and less. I learned that he is such a nice kid but can get caught up in peer pressure. He tends to follow what his friends do. Luckily he has an awesome foster mother named Ms. Fawnda who is not afraid to keep him in check. Sometimes when I would come to pick him up, Ms. Fawnda would tell me he had been getting in some trouble at school or getting bad grades and ask me to talk to him about it. We would talk our way through those problems and he would always correct his behavior by the next time I saw him. In the roughly 3 years I have known Daquan, he went from being forced into high school because he was going to age out to not even requiring summer classes.

We solved a lot of the immediate problems together, but he still always had a short term perspective on life. He wasn’t getting good grades because in his mind, the only reason to get good grades was because people were telling him to. He hadn’t made the connection between the grades and his long term participation in society. So all of our best conversations came when I would ask him what he hoped for in life. I was thrilled when he told me he was interested in culinary school. Daquan and I had always bonded over food. We loved going to different restaurants to talk. For his birthday every year, we throw down on the grill for the whole neighborhood. Not too many kids want to make the ribs, burgers, hot dogs, baked beans, and corn for everyone else at their own birthday, but that’s how Daquan is and it makes me so happy that he always wants me to help.

I took Daquan to his first Ohio State football game! Go Bucks!

Grilling out on Daquan’s birthday!

I really get to know Daquan better when we talk about his hopes and dreams. Like everyone else, where we wants to be is tied closely to where he’s been. I’ve learned about his family and how it feels to have parents who take care of their other kids, but not him. I learned about how he felt when he learned that his grandma had gained custody of him, but days before he was supposed to move in, she suffered a debilitating stroke. I’ve even helped him navigate some relationships and talked to him about the birds and the bees.

 

All I’m really trying to say is that Daquan and kids like him really deserve a chance. I want them to be able to make decisions with the long term “good” in mind because they are truly just out here doing their best.

Always bonding over food

Systems Based Practice

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During the AMRCC portion of the curriculum during fourth year, I had the opportunity to rotate with Dr. Curt Daniels on adult congenital heart disease. I loved the experience because it gave me the chance to see personally some of the longer term outcomes of pediatric patients I will be taking care of. I had previously rotated on  the pediatric cardiology floor and seen quite a few kids with congenital heart defects that would have been fatal not too long ago. I saw babies with Tetralogy of Fallot and hypoplastic left heart who were going to live past infancy, which was so incredible to me. One of my favorite patients of all time was a little baby with HLHS who had spent the first few months of her life in the hospital. The first couple of days, nobody was there when we rounded and I wondered if she had a supportive family. One afternoon, I snuck back to the floor to hold her for a bit and her mother was there! Not only that, her father and three sisters came too. I would talk to her parents while her big sisters took turns holding her and it made my heart so full to know that she is loved so much. It was such a happy day when she got discharged for the first time. She has a long road ahead still, but 50 years ago, she never would have had a chance and I’m grateful she does now.

 

One of my best learning experiences on ACHD was the presentation I had to do. During morning conferences the end of my rotation, I had to present a patient and topic directly after a fellowship interviewer presented their research. It’s a pretty intimidating experience to spend a month on a service and then present a topic that your audience has studied for years, but it’s such an important part of learning medicine.

 

My presentation was about a woman who was considering pregnancy in the next few years. She was born with a unicuspid stenotic aortic valve. She had previously undergone a balloon valvuloplasty and she had progressed from mild to moderate regurgitation across the valve.

She was not in imminent danger, but a pregnancy would have been dangerous for her because of the increased cardiovascular output necessary to carry a pregnancy to term.

Above is a picture of the objective portion of her examination.

Her ECG was normal, but an echo showed enough regurgitation across the valve that indicates eventual repair will be necessary.

Above are some of the concerns for pregnancy. Anticoagulants are necessary with many types of repairs including mechanical valves. As shown above, oral anticoagulants can cross the placental barrier and cause congenital malformations. Heparin does not cross the placenta but it is less effective for prevention of thromboembolic events for the mother.

Ultimately, we decided to opt for the Ross procedure. This procedure involves taking out the diseased aortic valve and replacing it with the patient’s native pulmonic valve. By doing this, the patient can avoid anticoagulation that may endanger her life or a pregnancy.

The patient agreed to schedule the procedure later this year and in the meantime, she was referred to gynecology for birth control.

It was a very cool experience to talk to a patient who was around my own age who is going to be able to pursue motherhood because of so many new medical interventions. I also learned quite a bit by taking on the pressure of presenting her case to some of the leaders in the adult congenital heart disease field.

Below is the entire powerpoint that I presented:

AMRCC ACHD Aortic Stenosis Case

Interpersonal Communication

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I feel like the best example of my efforts to improve my personal communication is my global health experience in Argentina. Originally, I was supposed to go with a group of people to Thailand, but fears about COVID-19 curtailed that plan. At the last minute, our group was offered the chance to go to Argentina for a different global health experience. Ideally, we would have known this more than a couple of days before leaving, and we all would have been able to practice some Spanish before leaving. Unfortunately, this was not the case, and I showed up in Argentina having not taken a Spanish class in over 8 years. Luckily, as part of the program, we got to take a week of Spanish classes prior to starting our hospital experiences. It was extremely difficult communicating in the beginning. I think the most difficult aspect of traveling to a new country that speaks a different language is knowing the best way to learn is by speaking and being corrected. It really takes some level of courage to know you are about to do something incorrectly and still make the effort to do it in front of people.

My partner Jacqueline and I stayed with a wonderful host named Mercedes, a 30-year-old woman in Cordoba, Argentina. Mercedes lives in a small apartment downtown and works for a non-profit collective that provides food stamps for mothers, natural sanitary products, and connects fair trade farmers to keep organic, natural food and product prices low. Her partner, Franco was around quite a bit. Franco is in school to become an occupational therapist and his parents own a farm, bed and breakfast, and a camp for adults with disabilities. Our interactions were definitely awkward at first because of the language barrier, but luckily, we had a host family that was willing to be patient. Gradually, we progressed from having no idea what was being said to making jokes with each other. We communicated exclusively in Spanish and did our best to avoid using google translate at all. On our second weekend, Franco invited us to his parents’ house in Candonga, Argentina. We basically drove on a dirt and gravel road up a mountain to a town that consisted of a church, a restaurant, some cabins, and Franco’s parents’ house. The views and the experience were absolutely incredible. The food we ate was incredible, and we even got to help prepare some of it. We drank mate in a river while horses grazed nearby. At night, we could see what seemed like every star in the universe. The best part was the chance to learn from Franco’s parents and speak with them in Spanish. Even as we were leaving, we were able to look down on the city lights of Cordoba.

Cooking with Franco in Candonga!

In the hospital, I learned a lot about what it must be like to be a patient in a country that does not speak your language. I worked in El Hospital del Niño Jesus, a pediatric hospital, but I was assigned to the dermatology service, which cares for both children and adults. It actually was a great experience because some of the gaps in my Spanish knowledge were filled by being in such a visual specialty. My role was not extremely hands on procedure wise, but simply learning how to greet patients was valuable. I was in a position where even if I had an idea of what the diagnosis or treatment was, I didn’t know quite everything that was being said. In a way, this put me in some of my patients’ shoes because not understanding a language completely is intimidating and even makes you feel unintelligent at times. That feeling is amplified in a medical setting, where patients may not understand everything going on already. I will take this lesson into my career by taking the time to make sure nonnative speaking patients have the opportunity to clarify any questions they might have. During our class curriculum, we learned about Argentinian culture, education, and healthcare. Some fun facts from each of these categories are: Malbec is a rough translation of “bad mouth” and the name comes from people not liking it; Argentina spends 5.1% of GDP on education compared to 3.6% in the US which allows a path to being a doctor for everyone, without cost; “Obra Social” is the national healthcare system and patients pay a little over $10/month for complete healthcare coverage at public hospitals and clinics.

Learning in Spanish about the Argentinian Health System

At the end of my experience, I wrote a little bit about it and presented it in Spanish and presented it in front of the class:

Muchas gracias por la oportunidad de compartir mis experiencias en este viaje. Primero, quiero agradecer a todas las personas del CFHI y mi familia Meme y Franco por todo. Hace un mes atrás, pensé que íbamos a Tailandia pero todo cambió con el coronavirus. Estuve emocionado cuando nuestra coordinadora de Salud Mundial nos dijo que nosotros podíamos ir a Argentina. Yo siempre he querido ir a un país de Latinoamérica porque quería practicar mi español y aprender sobre la cultura. Cuando era un niño, mi madre siempre ha leído y cantado a mis hermanos y a mi en español. También, estudié esta lengua por muchos años en la escuela. Desafortunadamente, no había estudiado español hacia muchos años y tuve que practicar para completar un examen de una aplicación para ir a un país latinoamericano, debido al problema por el coronavirus y ahora estamos acá.

With part of the crew in Mendoza

Cuando llegué a Córdoba, estuve nervioso porque no había vivido con una familia anfitriona antes. Meme es una señora muy agradable, pero aprendí español rápido porque ella no habla inglés. Hubo cambios que yo necesité hacer. Primero, practicar mi español en el aula, en el apartamento, y afuera. Segundo, ajustar el tiempo porque en los Estados Unidos, cenamos a 7:00 o 8:00 de la tarde y noche pero acá, la cena es 10:00 o 11:00. Cuando queremos ir a un boliche en los Estados Unidos, llegamos a 11:00 o 12:00 y los boliches cierran a 2:00. Pero acá, los boliches están abiertos hasta después de 2:00 cierran a las 6:00 o 7:00 a veces. Esta ciudad nunca duerme.

 

Yo estuve asignado al servicio de dermatología en el hospital de niño Jesús. En este servicio, asisten niños y adultos también. Cuando llegué el primer día, todos los residentes me dieron la bienvenida. Una residente llamada Julia me dijo que yo podía ver pacientes con ella. En mi primer día, vi un paciente con un tumor de piel y Julia se lo sacó. Durante mi tiempo en dermatología aprendí sobre Xantofibromas. Los Niños pueden desarrollar estos a dos meses de nacidos hasta cinco años y se resuelven sin complicaciones o tratamientos. Es importante que el médico busque las manchas café con leche porque el Xantofibromas tiene una relación con la neurofibromatosis. También, aprendí sobre psoriasis y los síntomas y formalidades médicas que los pacientes necesitan hacer porque no tienen obra social.

 

Fuera del hospital, tuve una gran experiencia. Ya que un fin de semana, fuimos a Mendoza con mis amigos. Allí fuimos a viñedos y tomamos mucho vino luego dormimos por una hora y después fuimos a Grita Silencio para tomar muchos Fernet con Coca y bailar. Después, dormí por quince horas. Al día siguiente, comí un asado y como entrada probé chinchulines. EL fin de semana siguiente, Jacq, Franco, Meme, y yo fuimos a Candonga. Condujimos por las calles de tierra en las montanas a la granja de los padres de Franco. Candonga solo tiene una capilla, un restaurante, cabañas y la granja. Las vistas desde las montañas estuvieron muy lindas. En la noche, el cielo estuve muy claro y podíamos ver muchas estrellas. El sábado, cocinamos pollo fresco de la granja y hablamos con los padres de Franco. Después de un asado, hicimos una caminata por las montanas y tomamos mate en el río junto a los caballos.

 

Este viaje ha sido el mejor de mi vida.

300 year old chapel in Candonga

Check out the Asado!

With the crew

One of the beautiful vineyards

The Argentina Group!

At the open air market in Guemes

Cathedral in San Martin Plaza

Grand Rounds at El Hospital del Nino Jesus

Dinner in Candonga

Practice-Based and Lifelong Learning

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A month before starting school, I moved to Columbus because the previous tenant in my house had moved out and just paid the rent for the remainder of his lease. I wanted to explore Columbus, but quickly realized that I didn’t have the money to just do all of the fun stuff I wanted to everyday. So, I decided to decorate my room. My first thought was to buy some records I liked and attach the covers to the walls in my room. I decided against this idea because I don’t have a record player or records and I saw that turning into a very expensive project. Luckily, Blick had a very cheap paint set and I decided I could just try to paint the album covers myself. My mom is an artist and I had taken a semester of a drawing class in high school, but other than that, this was a completely new venture I was undertaking. I started with “808’s and Heartbreak” by Kanye West. The album cover features two gloved hands either holding together or pulling apart a broken heart. The hands each feature a large black X, the signature of the famous American artist Kaws. Throughout the process of painting the album, I listened to it on repeat. Kanye made the album shortly after his mother passed away following complications from plastic surgery and he split with his long-time fiancée. The next album cover I painted was “Man on the Moon” by Kid Cudi. These two albums are both haunting and emotional, and the process of creating art while listening to them tied the artistic process to a new way of processing emotion for me.

808’s and Heartbreak

Man on the Moon

Kaws has art prominently featured at The Joseph, an upscale hotel on High Street in the Short North. Seeing some of those works led me to visit the art museums throughout Columbus. The next thing I knew, I was an art enthusiast. I found myself visiting art museums in every city I travelled to throughout medical school. I watched YouTube videos and documentaries about art in my free time. I bought new brushes, canvases, and paint. I started creating art that didn’t have any paint at all. Of all the things I expected to learn in medical school, it certainly wasn’t this. But once I actually felt the connection between the ideas, emotions, and process of art, I was obsessed.

 

I think my art started to transform when I learned about Kehinde Wiley. He is a famous African American artist who replaces prominent white figures in colonial era paintings with African Americans in modern dress. I love the concept because it is a rebuttal of imperialist concepts and commentary on the erasure of Black history worldwide. Wiley gave me the courage to evolve my process from simple mimicry of art I liked to exploring my own artistic process. I painted Drake’s “Nothing Was The Same” album except I replaced Drake’s profile with Barack Obama’s. I did a drawing in which I drew myself as a baby in place of DJ Khaled’s son Asahd on one of his albums. I even recreated Pablo Picasso’s Guernica, except I depicted the Ohio State vs. Michigan rivalry. In the midst of the fallout from Colin Kaepernick taking a knee during the National Anthem, I painted him into the album art for “My Beautiful Dark Twisted Fantasy” by Kanye West. The original painting was done by George Condo and depicts the severed head of Kanye West with a sword protruding from it, and blood drops on a barren landscape with a beautiful, yet stormy sky in the background. It is a decidedly disturbing picture. For my painting, I replaced the head of Kanye with that of Colin Kaepernick and changed the sword to an American flag. To me, it represented how Kaepernick had to weigh the importance of what he felt like he needed to say against the possibility that he would be sacrificing the career he worked so hard to attain. The flag represents the “patriotism” that was weaponized to justify the destruction of Kaepernick’s career. For too many people, “patriotism” is all about the flag waving, the clapping for troops at sporting events, and other rituals instead of the substance of improving the lives of your neighbors. For Kaepernick, these displays of patriotism were superficial because the rituals are devoid of any notion that we need to improve as a nation or a world. And the people suffering as a result happen to be disproportionately Black.

Nothing Was The Same
Drake x Obama

Ohio State vs Michigan Guernica (in progress)

In one of Kanye’s verses on the song, he says these lines:

 

Now I embody every characteristic of the egotistic
He knows, he so, f*****’ gifted
I just needed time alone, with my own thoughts
Got treasures in my mind but couldn’t open up my own vault
My childlike creativity, purity and honesty
Is honestly being crowded by these grown thoughts
Reality is catchin’ up with me
Takin’ my inner child, I’m fighting for custody
With these responsibilities that they entrusted me
As I look down at my diamond encrusted piece

 

No one man should have all that power

 

Kanye is struggling with the fact that he has so many ideas that he wants to express and the talent to do so, but now that he has gained an audience that will listen, he can’t be completely honest. He has the “diamond encrusted piece” (a necklace worth a lot of money) but worries that he will sacrifice that lifestyle if he says all the things he really believes. Now, I’m not suggesting that Kanye and Kaepernick are the same at all. I simply found that both of them had me asking myself the same questions: “What are you willing to sacrifice to stand up for what you believe in?”

I took a picture of my painting, put it on T-shirts, and sold them. I donated all of the profits to a charity Colin Kaepernick supports.

Eventually, I began exploring my own artistic process from start to finish. My painting, “Mindset” won the People’s Choice Award at the annual Medical School Art Show. It was my expression of how even if you feel broken on the inside, with determination, you can positively impact the people around you and that is what nurtures your soul. I showed “Mindset” alongside the Colin Kaepernick piece at the S.O.S. Social Justice Art Show in Cincinnati. Now, I constantly have an art project going on. Someday, I hope to show a series of paintings I have done that have the common link of a woman interacting with the sun and space in some way. They are my own personal rebuttal to the masculinity that has been assigned to God and an acknowledgement of the vastness of the universe.

Med School Art Show People’s Choice Award!

SOS Social Justice Art Show

So, what did I learn from art and Kanye West during my four years of medical school?

 

A lot.

 

First off, I learned an entirely new way to express myself. I learned that I need to constantly be looking for new ways to express myself. It helps me find balance in my own life, but it also helps me understand what patients are looking for in their own lives. I have learned a lot about what is important to me, and that I have a long way to go to understand how to express that to other people. Finally, I have learned that my art can just be art. It is important for me to do because I like to do it. I don’t always have to say something profound with it. I can do it just for the simple exercise of concentration. I can do it because it makes me feel in control of my own world. Or I can do it because it makes me feel like I’m not in control of anything. My art is what I want it to be and why I want it to be that way.

 

Art makes me ask myself the same question Kanye poses in the last line of “Power”

 

“You got the power to let power go?”

Medical Knowledge and Skills

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I failed my first exam of medical school. What I felt when I found out was surprising to me. More than disappointment, more than frustration, more than anger, I felt… lonely. I genuinely think everyone who enters into medical school should understand how isolating failure feels. I was more nervous for my next exam because I hadn’t technically proven that I could cut it academically in medical school, but I still felt like if I put in some extra work, I could do it. I knew I could get to the point everyone else was at, but I felt like I had to get there by myself. Did I ask for a tutor? No. Not only did I not request one, I declined one who was offered to me. Did I ask my friends what their strategies for studying were? Nope. Didn’t do that either. I didn’t even tell my parents. I was surrounded by the most concentrated group of intelligent people I had ever experienced in my life and as far as I knew, I was the only one who hadn’t succeeded. I want future students to know that if they fail an exam, they should lean on their support group and I want the people who don’t fail to simply offer friendship and support to those that do.

 

 

The weeks leading up to step 1 were some of the most difficult I ever had in medical school. I was fresh off passing my host defense exam and excited to see where I stood with the baseline NBME. It was only a week or so after the host exam, so I decided to take a bit of a mental break and not prepare too much for the initial NBME. Part of the reasoning for this was also that I had seen the statistics based on block exams and they showed that it would be unlikely for me to pass on the first attempt anyway.

 

The test felt low pressure while I was taking it. I remember looking at the questions and thinking to myself, “oh, I remember this stuff then looking at the answer choices and thinking… uh, like 3 of these sound right to me.” Even still, I was not pressed leaving the exam because the topics felt familiar to me. Unfortunately, when the scores came out, I received a projected 147 which is essentially off the charts bad.

 

So I buckled down. I was in the library every single day for a minimum of 12 hours. I had bought Doctors in Training and was using it in conjunction with First Aid most of the time. I felt like because my baseline was so poor, I was missing a lot of the medical knowledge my peers had acquired over the first couple years of school. After two weeks, I took another NBME and had improved to a 188. It’s not where I wanted to be, but I felt like I was moving in the right direction.

NBME 3 results

I was tired, though. The next couple of weeks came with the same amount of studying, but fewer and fewer cooked meals and less and less exercise. After two more practice exams, I had accumulated scores of 147, 188, 190, and 188. On the final practice NBME available to me, I received a 192, which I thought was a passing score and would enable me to take Step 1 the next week. Unfortunately, the passing score had increased by 1 point from the previous year and I was not going to be allowed to sit for the exam.

 

I called my parents extremely worried because I thought I was going to be stuck with an extended period of not having financial aid in which I also would need to be studying for Step 1. I was so fed up with the process already and I just wanted to be finished. So I typed out a plan for success, confirmed with my portfolio coach that it was a good idea, and went into my academic committee meeting prepared to beg for a week’s extension and to still be allowed to take the test.

Step 1 plan

The committee agreed that I could take the exam provided I passed two consecutive UWorld exams with a score of at least 210. In hindsight, maybe I should have been more concerned, but I was so thankful to have any opportunity to take the exam that I left excited and ready to buckle down again. I studied so hard the next couple of days and took the tests, receiving a 217 and a 231! I was going to get to take the exam!

UWorld Form 1 Score Report UWSA 2 Exam results

Okay, the real exam kicked my butt. I put so much effort into that time that the last week after I took the UWorld tests, I had so much trouble keeping my edge. I am proud of myself for pushing and pushing and pushing through that, but now I know that what I actually needed was more balance.

 

Post Exam Fake Smile

I studied for Step 2 CK for about half the number of days and for about half the time each day. I focused on eating well, exercising, and finding time to enjoy myself. I also switched my focus to answering questions and understanding learning objectives. I also found that my time in clinic and the hospital had accelerated my learning. When my Step 2 result came back, I was pleased to find I had gotten a 230. Sure, I felt like I could have done even better, but it was a moment of validation for me anyway.

Patient Care

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The beginning of fourth year was somewhat of a transformative time for me. I had decided to take a month off to study for the Step 2 CK board exam in the first month, followed by my mini-I experience because I needed to improve my board exam score from Step 1 and wanted to be at my peak clinical knowledge for my audition rotation. My mini-I rotation was at Nationwide Children’s Hospital on the hospital pediatrics team and I anticipated it being the most important month of my medical school experience. In my mind, it was my chance to prove to myself and others that I was capable of doing the job I wanted to be hired to do in exactly one year. I was ready for the extra responsibility of being the acting intern and prepared to step up to this next, biggest challenge.

 

 

It went… poorly.

 

I was on a team with two medical students from a different university. We had actually all started school at the same time, but they had a different schedule, so they had been labeled 3rd year students and I was the 4th year/acting intern but it felt like I was doing comparatively awful. I didn’t get through a single presentation my first week. Seriously. I would start my presentation, my attending would interrupt to ask a question, I would lose my place and skip to a different part of the presentation or go back to an old part, he would call me disorganized, say his plan and go into the room. A few times he even slid down the wall in exasperation when I switched the order of my physical exam and vitals. The residents and other students on the team would all offer me advice and practice opportunities and suggestions, which I appreciated, but I was still struggling. This was supposed to be when I stepped up and assumed more responsibilities, but instead of doing that, I spent afternoons practicing writing a presentation word for word quickly so I wouldn’t get knocked out of place when I was inevitably interrupted during my presentations.

 

The most frustrated I ever got was when we had a patient for whom nobody could figure out a diagnosis. After work, I went home and spent hours researching causes for what essentially appeared to be intractable hiccups accompanied by respiratory distress. On pulse O2, no desaturations were noted, but many were found on overnight sleep studies. When I came to work the next day, I was armed with multiple case studies and suggestions to augment my assessment and plan. Unfortunately, I had a miscommunication with the nurse about the exact time the patient had been made NPO and said the wrong time during my presentation at which point she corrected me. My attending just walked into the room, declining the opportunity to hear the rest of my presentation. When we left the room, the resident on the team said, “I think you need to put more effort into the thought process and show that you have critically thought about the assessment and come up with your own plans even if you’re wrong.”

 

Here is a picture of my evaluation from my attending after the first two weeks of my mini-I:

Here is some of the feedback I received after my first two weeks. It seemed at times to be more harsh in person.

 

I think a little context on who I am personally is necessary here. I subscribe to many of the ideas Malcolm Gladwell talks about in his book David and Goliath. He goes into incredible detail about what humans perceive as advantages and disadvantages and how we all respond to them. If I could condense the book into one idea, it’s this: When we find success, it is as much a product of the bad things that shaped us as good and the same can be said in the opposite way for failure. So yes, I generally feel it’s disrespectful to walk out on a student doing a presentation, but I guess I didn’t feel personally disrespected. Sure, I was frustrated, but as a student, the point is to learn and be better whether the feedback is good or bad. I took three things from this particular experience: 1. I won’t run my service this way when I am in that position. 2. I can take the criticism and respond. 3. I will pay more attention to how people are treated, make time to ask how they feel about, and stand up for them if necessary.

 

Here is Malcolm Gladwell’s Ted talk about the David and Goliath story:

So… the first two weeks were rough. I ended up lettering this rotation and my attending for the last two weeks of this rotation ended up writing a Letter of Recommendation on my behalf for my residency application.

 

When week 3 started, I had implemented the strategy of writing my entire presentation word for word and reading it as fast as I could to avoid interruption. (That sounds so silly writing it today, but it was the strategy one of the other students had implemented first and she was consistently receiving positive feedback.) That Wednesday, my new attending declared, “Okay guys, tomorrow we are doing presentations without paper!” I almost laughed at how much of a disaster it was going to be. But what I perceived as a disadvantage was actually exactly what I needed. See, when you aren’t spending the time to write down absolutely everything, you are paying attention to what is important. Suddenly, my mornings consisted of having more time to hear more detailed patient histories. I knew the patients better. I had more time to chart review. I was trending pertinent lab values in my head. I had more time to research an assessment and formulate my plans. The feedback I got was increasingly more positive, but just as importantly, I knew that I was really improving.

 

At the end of the day, I’m thankful for the entire experience. I needed that sense of urgency. I needed the negative feedback to focus on improvement. But most importantly, I learned that sometimes an unconventional approach to a solving a problem is the best approach.

 

Here is some more of the feedback I received from my rotation:

This is some of the feedback I received after my last two weeks of my mini-I