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What I Learned From My First Year As A Resident Doctor


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1. You’re only one…Google search away from coming up with a differential so long that even your staff is rolling their eyes.

2. Getting two pillows in your call-room is the universe throwing you a HUGE bone.

3. You’ll constantly be surprised by your ability to run on less and less sleep and more and more coffee.

4. You’ll start to understand why the enthusiasm of medical learners brightens up any ward.

5. Being part of a professional group is nice and so is having benefits – begin chanting – I have rights! I have rights!

6. Nothing cures the post-call blues like the comedic genius of Kevin Hart, John Mulaney, Amy Schumer, and Amy Poehler. Nothing.

7. One of the coolest moments will be being when you get called to a code and are able to manage it (#iknowstuff).

8. Be kinds to nurses.

9. Be kind to the person who hands out call room keys.

11. Drink lots of water and lots of coffee. But more water than coffee.

12. People can’t help you if you don’t let them know you’re struggling.

13. Rounds scheduled on days that end in ‘y’ typically have coffee at them.

14. Sometimes the quality of a rotation depends on the frequency of free coffees.

15. It goes faster than you think.

16. Patients love when you ask about their pets.

17. Ask how often the hospital keyboards get cleaned. I dare you.

18. Be kind to everyone…but especially the Timbit guy at Tim Horton’s.

 

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Diverting Distraction


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Hello everyone and welcome back! This next post is long overdue and for that I apologize. I’m trying to take a step back, re-calibrate my schedule, and refresh my goals. Moving forward, I’ve challenged myself to sit down and write once per week so you can look forward to more consistent content in the near future!

Lately I have been thinking about distraction…mostly because I’ve been feeling so distracted. With changing rotations, endless amounts of charting, research deadlines, financial stress, social engagements, and the Olympics (much love to you Team Canada), I have been finding it increasingly difficult to tune into the task at hand and tune out all the noise in the background. I’ve always prided myself on being a multi-tasker extraordinaire; however, lately juggling 5-10 different tasks hasn’t been working for me or for what I’m trying to get done. So what to do? I’ve been trialling out a few different strategies. Here’s a little bit of what I’ve learned:

  • Recognize when it’s time for a break – This point should be bolded, underlined, circled in red, and covered in glitter. I somehow got the idea that feeling distracted meant I was being lazy and that there’s no way it could possibly represent anything else. I couldn’t be more wrong. I took a day off (gasp) and did absolutely nothing on my to-do list. Instead I listened to some of my favourite albums, read some new (non-medicine) books, napped and went to Crossfit. Initially, I felt SO guilty; however, in the following days/weeks, I had a renewed sense of focus. It was not only easier to concentrate but I had more fun doing the projects I had set out for myself. Huh.
  • One thing at a time – There’s more and more research coming out to suggest that multi-tasking isn’t cognitively efficient. It puts our brain in overdrive. We’re pouring out valuable energy with multiple background thoughts that burns our tank dry sooner rather than later. Undoubtedly, there’s times where balancing tasks may be unavoidable; however, trying to start and finish one task at a time is actually more efficient in the long run.
  • Make a timeline and be reasonable – Rome wasn’t built in a day and my 16 page research abstract certainly won’t be either. Break down tasks into smaller steps and figure out an appropriate plan of action. Then, stick to the plan. If distractions start coming in, refer back to your plan, incorporate changes as necessary and return to the task at hand.
  • Know your strengths and capitalize on them – I’ve always admired people who can plug away on papers and studying well into the wee hours of the morning. I have never been one of them. The times I’ve tried I’ve woken up with impressions of my textbooks on my face – cute. What I do know is that I do some of my best work in the mornings. Just like a hockey player shoots with their preferred hand to increase their chance of scoring a goal, I’ve tried to play to my cognitive strengths and schedule some of my more demanding tasks when I’m at my sharpest.

What helps you stay on task? How do you block out distractions? Comment below!

 

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AWESOME Moments as a Doctor


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Has anyone read ‘The Book of Awesome’ by Neil Pasricha? It is one of my absolute favourites for days that feel less than awesome. The concept of the book is brilliant and yet so simple – recognizing and celebrating life’s sweet little moments. After a tough shift, I challenged myself to come up with 16 ‘Awesome’ moments in Medicine. What a fun exercise this was! Some are a little sassy, some are sweet. But all helped me to come back to a more grounded, grateful head space. Here are my 16 ‘Awesome’ residency moments:

  1. When your last page comes at midnight and no other issues come up before handover.
  2. When whatever gentle soul was making up the call rooms left TWO pillows and TWO blankets instead of one – hello comfort!
  3. When you go to grab a coffee and there’s NO line.
  4. When you get the scrubs that tie up in front rather than the silly, sultry pair which show some scandalous side skin.
  5. When some generous soul buys a box of 80 Timbits for the department and there’s a healthy number of sour cream glazed remaining.
  6. When you walk outside into the crisp autumn air and feeling the sun on your skin after finishing a 26 hour call shift.
  7. When you thought you left your stethoscope on the 8th floor and you look into your call bag and it’s. right. there.
  8. When one of your staff kindly offers to buy dinner for the team.
  9. When you need to look up some blood work and there are several computers ready and waiting.
  10. When said computers load in a reasonable amount of time without any crashes, glitches, implosions, explosions…
  11. When your last patient ‘No Shows’ after a double-booked, ten hour clinic day and you have a quick moment to catch your breath (and document).
  12. When(ever) the therapy dogs come around to visit (!!!)
  13. When some grant money comes in that you weren’t expecting.
  14. When the surgeon has a bumping playlist going in the OR (and also when you no longer have to be in the OR #psychiatry).
  15. When you run into some of your friends in other services and are able to exchange quick hugs, smiles, eye rolls while desperately trying to keep up with your staff.
  16. When your call room has an en suite washroom and you get a taste of true luxury.

…Awesome, right?

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Procrastination Nation: How to Boost Your Productivity Without Burning Out


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Happy December everyone!

It has been a little (LONG) while since I’ve been back. I apologize for the radio silence – there’s no easy explanation; however, I would be lying if I pretended that I haven’t been dominated by my “to-do” list. You don’t have to be in medicine to have experienced the pure chaos of running from task to task to task. Between work, appointments, research, house work, and studying it can feel like a small miracle to have eaten lunch some days! When life gets busy, it can be hard to maintain a sustainable level of productivity and it becomes all too easy to put off tasks. Although procrastination may feel like a welcome break in the immediate period, usually that feeling doesn’t last long. This past weekend, I had a day where it felt so good to put off all responsibilities – gym? Maybe tomorrow. Emails? Not today’s problem. Grocery shopping? Peanut butter for dinner it is. The next day, I was kicking myself. So I started reflecting on ways I can (and sometimes have) boosted my productivity. Here’s some of my strategies:

Eat and eat well.

I feel like I talk about the importance of proper nutrition every blog and for good reason! You can’t expect to pour yourself into other tasks with any empty cup. In fact, when we’re undernourished, it’s harder to regulate our emotions, concentrate, and practice good decision-making. My go to snack? Right now I’m really loving mixing up some cottage cheese, blueberries, and cashews. Perfect mix to propel me through my to-do list!

Make a list.

It can be really easy to get lost in the chaos of every day life and forget what you actually need to do. Making a list can make your to-do tasks seem much more manageable and concrete. It can also help you subdivide different tasks into smaller steps which might make them appear less daunting. I also find that there’s significant satisfaction which comes with crossing off an item. Check! On to the next one please!

One thing at a time.

Science tells us that multi-tasking may not be as much of a gift as it was originally thought to be. It turns out, we’re more likely to complete tasks efficiently and effectively if we focus on one thing at a time. Furthermore, taking on tasks one by one seems so much more manageable that trying to balance five all at the same time.

Add in some fitness!

Feels like I’m adding another thing to your list right? Wrong! Yes engaging in physical activity is a time commitment, but it doesn’t have to be an hour on the elliptical at the gym. Many of us are aware that engaging in regular physical activity translates into improved mood and energy levels. There’s tons of “sneaky” ways to incorporate physical activity into your day without ever stepping foot into a gym. I like riding my bicycle to work and taking the stairs in the hospital. Youtube is also an awesome resource for a number of different workout videos. Free, accessible, and different lengths – what more could you want?

Practice mindfulness.

To-do lists can seem so tedious. Sometimes I find myself dreaming about the couch waiting for me at the end of it. I found myself thinking one day – how can I reframe my thinking so I’m not just trying to get through X activity and wishing away hours and/or days of my life? Can I take charge and be present in every moment? Living moment by moment makes it easier to find comfort, ease and peace in the present task. It’s not always easy and doesn’t always work. But with practice it becomes less effortful and more consistent.

Try to add some fun wherever you can.

Can you do the activity with a friend? Blast some music in the background? Bring a book while you’re waiting for that doctor who takes forever? Making our tasks a little more enjoyable will make them more tolerable and less likely that they’ll get pushed off until the day after tomorrow (after tomorrow, after tomorrow…).

 

What are your tips for keeping procrastination at bay? I’d love to hear them and share ideas! Comment below.

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Re-fueling the Tank: Tips for Preventing Burnout and Taking Self-Care to the Next Level


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Good evening everyone! Keeping with my recent post Physician Burnout: More Than Just an Old Battery (Part 1), I thought I would discuss some strategies for preventing burnout and promoting wellness. We last spoke about what burnout is and how to recognize it. In the coming days we will explore why burnout happens; but for now, I thought it would be important to identify a few strategies anyone can use to prevent burnout. During a yoga class not too long ago, one of my instructor’s said: “You need to fill your own cup before you can fill anyone else”. This really resonated with me. The next day at a resident training event, we were encouraged by a presenter to find one self-care activity before, during and after work and to watch, without expectation or judgment, the effects on our perceived sense of well-being. I remember thinking, “Who has time for that?”, but I decided to give it a shot anyway. Here are some of the ways I have been practicing self-care during my day to day. Not only have some of these strategies been useful to prevent burnout, I believe that they have made me a happier, more engaged, and effective resident.

Pre-Work

Let’s face it – mornings can be a little bit of a mad dash on the best of days. As someone who’s had a long-time love affair with the snooze button, I knew changing my routine was going to be challenging; however here are some changes which have worked for me:

  • Setting my alarm 15 minutes early (the mad rush becomes a little less mad)
  • Packing my lunch the night before
  • Listening to a playlist while getting ready (Despacito anyone??)
  • Taking five minutes to cuddle with my cat
  • Setting a 15 minute limit on how long I check emails
  • Getting rid of Instagram – starting my day as the primary focus rather than that of other people
  • Double checking where/when I am supposed to be the night before (rather than when I’m leaving the home)
  • Riding my bike to work

During Work

When the presenter first suggested that we practice self-care while at work, my eyes almost disappeared rolling into the back of my head. Again, with what time?! I went home and thought long and hard about how I could incorporate self-care into my work routine. I imagined telling my staff that I would be back in 30 minutes – just popping out for a pedi! Fortunately, I came up with some other ideas before sacrificing my professional identity:

  • Drink water
  • Eat the snacks you bring
  • Stop, take five deep breaths, feel the chair underneath you and the floor beneath your feet
  • Wash your face
  • Drink water
  • Stand outside for five minutes
  • Name one positive thing that has happened during your day and one person you are grateful for

Post-Work

This category felt pretty straight forward – good food, good wine, good friends – problem solved! But sometimes, our go-to feel good measures aren’t always available. I tried to think of mini self-care exercises which were time efficient but wouldn’t break the bank either!

  • Changing out of my work clothes
  • Washing my face
  • Drinking water
  • Checking in – what do I really need to feel well right now? There are a number of things we feel we ought to do, but do have need to do them?
  • Lighting a candle
  • Go for a short walk or even just sit outside
  • Water a plant

Will all of these techniques work for everyone? Probably not. Is it possible to perform each of them every day? I find it challenging for me. The bottom line is – try to schedule in time to recognize your physical, emotional, and spiritual needs and nurture them in the ways you know how and maybe even try some new ways. What keeps you well? Do you think any of these strategies work for you? Any that you would like to try?

health, ideas, medicine

Physician Burnout: More Than Just an Old Battery (Part 1)


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Good evening everyone. I hope that you are all well. I’m sorry that it has been a little while since my last post. I have been having quite a time trying to balance my clinical duties with long, long hours at the hospital with my research interests with my interpersonal relationships with physical activity with the needs of my new (recently ill) kitten. Needless to say, there has been a lot on my plate. So much so, that I have been feeling like there’s not too much room left. I thought I would right about a topic which has felt a little closer to home than usual – burnout.

We use the term ‘burnout’ pretty regularly in everyday life when speaking about a variety of household objects – batteries, candles, light bulbs, etc. Typically, the word is used to describe the amount of an energy source or, rather, lack thereof. When used in the context of physician health, burnout also denotes a depletion of energy but this energy takes on a number of different forms including physical, mental, emotional, and spiritual. Different physicians may vary in how much each of the aforementioned domains is impacted; however, the outcome or end picture is fairly consistent. Physicians who are burnout are significantly less engaged and/or effective in their clinical duties. In some of the more extreme cases of burnout, physicians may feel totally disconnected from their personal and professional identities coupled with a sense of purposelessness. Now many people are at risk of experiencing burnout – it is not an affliction unique to physicians; however, I have chosen to speak from the physician perspective because of my personal experiences.

What does burnout look like? There are a few common symptoms which have been described in the literature; however, like many other illness states, burnout’looks different on different people. The rates of burnout vary between different specialties, genders, locations…you name it. The following are some commonalities which have been highlighted, although not all symptoms need to be present for one’s burnout to be clinically significant or, in non-medical jargon, “real”,

  • Exhaustion – Mentally, emotionally, physically, individuals feel that their current pace of life is not sustainable and that a “crash” is inevitable, however that crash may look.
  • Lack of purpose – You begin to question the usefulness of your work – “Why do I do this every day if people don’t listen to me?” Devoid of meaning, your work becomes something to get done, rather than something you enjoy doing. You go through the motions of your day-to-day without ever feeling like you are making a difference.
  • Depersonalization – You become mentally and emotionally disconnected from your work. You find it increasingly difficult to relate to others and the “real world” seems a lot less “real”. Deadlines – do they even matter? A complaint? It will probably just go away or maybe it won’t – it would not matter to you either way.

 

Have you ever experienced burnout? What was your experience like? What symptoms did you notice in yourself? How did you become aware of these symptoms? In future segments, I will be exploring the importance of identifying and addressing burnout as well as strategies individuals and organizations can employ to prevent its occurrence. Any other thoughts or questions? I would love to hear from you!

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Media-trician Moment: ‘Thirteen Reasons Why’


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On March 31 2017, Netflix released a drama web television series based on Jay Asher’s 2007 novel ‘Thirteen Reasons Why’. The web series, starring Katherine Langford and Dylan Minnette, explores the final, tumultuous weeks of a high school student, Hannah Baker, through a series of tapes she leaves behind after she has suicided. Hannah leaves detailed instructions for select individuals on where and when they should listen to the tapes. The individuals Hannah has selected are people she feels have been implicated in her psychological downturn including several peers and one teacher.

‘Thirteen Reasons Why’ became a hot and controversial series seemingly overnight. Some audiences praised the show for its coverage of sensitive subject matter such as sexual assault, bullying, suicide, and the use of social media in transmitting intimate photographs. Some health organizations condemned the show’s graphic portrayal of sexual assault and suicide and expressed concerned that these images would  be triggering for struggling adolescents and young adults.

I originally heard about the series from one of my colleagues who felt a strong, personal connection to Hannah’s narrative. Initially, I was extremely hesitant to watch the show. What I understood from my colleague’s description, was that the protagonist was utilizing the tapes as a form of retribution against those she felt victimized by. Throughout the series, each of the individuals identified by Hannah, slowly begins to realize their misdoings and expresses remorse for their actions. I was skeptical – how would this message be interpreted by different age groups, specifically those with developing insight? Initially, I felt that the message of the series was problematic and over-simplified the psychological and emotional impact of suicide; however, after hearing more and more media buzz, I decided to give the show a go. One post-call day, I suited up in my favourite track pants, grabbed some snacks, made a cup of tea, and settled onto my couch. The following are my thoughts on the series as a psychiatrist-in-training and person with lived experience with mental illness:

Suicide: I still feel that the series may romanticize suicide in the way that it portrays the reactions of characters implicated in Hannah’s psychological downfall. I’m cautious as to how the responses of these characters may be perceived and understood by individuals who are struggling with their own feelings of hopelessness, trauma, and self-harm. Suicide is not a conflict resolution tool and should never be conceptualized as such. Undoubtedly, a completed suicide is a high impact event. The person who has suicided has no further opportunities to engage in conflict resolution and/or to receive emotional and psychological support. Furthermore, the individuals who loved and cared for the person who has suicided are irrevocably changed by their passing; however, no one can truly anticipate or expect that their suicide will elicit a particular emotional response in their “wrongdoers”. The only people who can reasonably be expected to suffer from such an event are the individual who has suicided and their loved ones.

Normalization of Mental Illness: I commend the series for the amount of discussion it has generated around suicide, trauma, and mental illness. In Canada, we have made some progress in reducing stigma and recognizing mental illness as a legitimate health problem; however, there is still a long way to go. As a psychiatry resident, I get jibbed by other physicians on a fairly regular basis that I don’t want to practice “real medicine”. I think it is really important to recognize the platform the show has created to explore different facets of mental health, specifically within adolescents who may be less willing to discuss emotional struggles. Regardless of whether you agree with how the series has addressed suicide and/or trauma, ‘Thirteen Reasons Why’ has become so ubiquitous in popular culture that everyone (okay maybe not everyone, but a lot of us) are talking about it. Talking leads to exchanging ideas which leads to increased understanding which leads to change in societal perception leads to…I think you see where I’m going with this.

Support Systems: Hannah does make a few efforts to reach out for help; unfortunately, she does not find solace or support from any of the individuals she contacted. In fact, her feelings of abandonment and isolation are reinforced by these interactions. As the viewer, I felt hopeless and helpless watching Hannah’s missed opportunities for therapeutic intervention. I recognize that these “near misses” were juxtaposed with Clay’s identification of an isolated peer and his eventual decision to check in. That being said, I feel that this positive interpersonal interaction paled in comparison to Hannah’s missed interventions. I wonder if younger audiences were able to appreciate these subtle nuances. I feel that the ending may have felt different if a more resounding intervention was modelled to demonstrate that help is available and that it can be useful, especially in crisis situations.

Consent: I think the show is incredibly strong in its exploration of sexual assault and consent. Undoubtedly, the sexual trauma depicted in the show is difficult and disturbing; however, some really powerful modelling behaviours are demonstrated. The differences between Bryce’s and Clay’s verbal and physical behaviours towards Hannah and they ways in which they did (or didn’t) ask for consent are profoundly stark. I am glad that the show demonstrated positive consensual behaviours through Clay otherwise the sexual violence in other scenes would have felt gratuitous.

Final thoughts: Do I think ‘Thirteen Reasons Why’ is appropriate for all audiences? Absolutely not. It is undoubtedly chock full of mature themes. Regardless of their age and maturity level, young people would benefit from some guidance and support with some of the triggering themes presented. Do I think that the series should be banned from schools? Not necessarily.  ‘Thirteen Reasons Why’ has significant potential to be a powerful discussion and learning tool. I feel that the series can provide a platform for teachers, parents, healthcare professionals, and adolescents to engage in safe and therapeutics discussions around mental health, mental illness, and suicide. I look forward to exploring the upcoming season and hope that the show continues to address such sensitive topics in a mindful and compassionate fashion.

What did you think of ‘Thirteen Reasons Why’? Did you have any reservations about the show? Do you think any viewing restrictions should be placed on the show? Why or why not? Will you watch the upcoming season? I look forward to hearing your thoughts.

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7 Things I Wish I Had Known Before Applying to Medical School


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Good afternoon everyone and welcome back! I have a few friends who are writing the MCAT over the next week. It has been a blast cheering them on from the sidelines as they wade through the med school application process and seek admission to any of Canada’s medical schools. Understandably, they’ve had a few (okay, a lot) of questions as to what to expect with the MCAT, the application process, and medical school in general. So I decided to sit down and reflect on what I wish I had known before starting my own journey. I don’t believe knowing these things would have changed my desire to go into medicine, I just feel that it would have been helpful to have a little more insight into the application, admission, and academic process (especially since I am the first person in my family to ever go into medicine).

1. It costs a lot of money. Even more than you think.

Sure, you’ve done your reading online and probably had to scrape your jaw off the floor after seeing how much tuition would cost. The schools provide lofty estimates of how much you’ll spend on books, medical equipment, and other learning resources. What’s not listed online are some of the miscellaneous costs – for example, the amount you will spend booking and attending electives. Electives are your opportunity to network and explore programs outside of your home school. If your electives go well, they can help your residency applications. Electives typically last from 2-4 weeks. Once you begin to factor in flights, (maybe) car rentals, accommodation, food…it adds up pretty quick. Then there is the cost of applying to residency programs. In Canada, you pay a baseline rate to register with CaRMs and then an additional amount for every program you apply to. The list goes on and on and on. I won’t belabour the point – medical school is very expensive.

2. You might not get the residency spot you want where you want.

You have finally been accepted into medical school – Huzah! You’ve made it, the competition  is over…ish. In most parts of the world (although I can only speak to my experience in Canada), there are a finite number of residency spots with regards to discipline and location. Historically, some disciplines (ex. family, internal medicine, psychiatry) have significantly more spots than others (ex. dermatology, vascular surgery). There are a number of factors considered in the determination and allocation of residency spots including population demands, market trends, and funding availability. For example, if you are interested in providing primary care in rural areas, you’re chances of securing a spot are pretty good because there is an incredible need for more rural primary care physicians. On the other hand, if you want to be a neurosurgeon in downtown Vancouver, it might be more challenging to secure a residency spot. Why? Because there is a finite amount of OR time with a sufficient amount of neurosurgeons already battling for it. The government wants to train doctors to work in fields and regions where they are needed. Overloading the market when there is already an adequate number of specialists is not the best return on their investment. Does this mean you should give up on your “dream specialty” in your perfect location? Absolutely not. If you were born to be a cardiac surgeon in Toronto, go for it! What I’m suggesting is that you familiarize yourself with the current healthcare system trends and understand your professional goals in the context of what opportunities are available. Depending on your preferences, you might need to make some sacrifices along the way.

3. You are not expected to know everything. Actually, you are expected to know very little at all.

After writing the MCAT and fighting for your spot in the class, there can feel like a lot of pressure to measure up against your peers – but there’s really no need. Sure, you will be applying with your cohort in a few years for residency spots; however, residency programs are looking for people who are skilled learners, not individuals who feel they know it all. The reason why we complete residency training is to grow and mature our knowledge. If you knew everything going into residency there would be no point! So, how can you be a skilled learner? Try maintaining a sense of humility when identifying and addressing gaps in your knowledge base. You may have read all of Harrison’s, that does not mean you understand all the embodied concepts and are ready to incorporate them into practice. Recognize your limitations and honour them. Furthermore, understand the value in working with others and take advantage of how many learning opportunities are embedded in team-based environments. Most members of the team have been practicing for a lot longer than you have – be open to their perspective and ask their advice. Challenge yourself to test your knowledge. If you sit back and let others answer all the questions, how can you be sure that you know the answers? Take a stab at solving clinical problems, it may be more challenging than you think!

4. It can be hard to predict what time your clinical duties will finish at.

If you are someone who likes to know that they will be done at a certain time so they can be home for dinner, children, significant other, sports activities, hockey games – kudos for having a good level of insight into what is important for you. You will not always have that luxury in medicine. As a trainee, you are expected to stay until you are dismissed by your staff or they go home. As an attending, you are responsible for the care of your patients. If someone’s blood pressure starts tanking or one of your patient’s is in significant psychological distress, you don’t have the luxury of clocking out and dealing with it the next morning. This can make scheduling appointments, social engagements, child care, etc. challenging and, at times, pretty frustrating.

5. “Pimping” is not something that happens on the streets or in hip-hop songs.

Throughout the first few weeks of medical school, I heard several students discussing how much they were being “pimped”. I was confused and frankly a little disturbed by the thought until one of my roommates clarified what was going on. “Pimping” is a rapid series of questioning posed by one of your seniors to reinforce the traditional medical hierarchy. There is some debate as to how the term originated – one of my colleagues referred to it as the act of being “Put IMPlace”. Some physicians will debate and defend the educational merits of “pimping” suggesting that their questioning facilitates clinical reasoning. In my mind, questioning and “pimping” are two separate entities. I believe that questioning can be an effective teaching tool when it is used in a goal-oriented, supportive manner. Many of my favourite physician-teachers regularly use questioning to determine the knowledge level of the learner so they can use whatever foundation they have to learn new concepts. Questioning can help create a respectful dialogue between learner and teacher that builds on student’s strengths while addressing knowledge deficits. “Pimping” on the other hand feels as dirty and demeaning as it sounds. Instead of empowering and supporting the learner, it leaves students feeling demoralized, incompetent, and isolated. Still not sure what “pimping” looks like? Watch an episode of ‘Scrubs’ and pay close attention to how Dr. Cox asks his interns questions.

6. Short, case-based review sessions are more helpful than hours spent memorizing arbitrary facts.

During my undergraduate degree, I prided myself on my comprehensive note taking and ability to memorize slides prior to mid-terms and exams. This study strategy lasted for my first week of medical school before I quickly abandoned it. It felt impossible to read and retain all the information I was sifting through. My Harrison’s text was quickly relegated as a makeshift TV stand. I was feeling overwhelmed so I decided to ask for guidance from one of my early mentors, a rheumatologist. He smiled in a kind, understanding way and gently suggested reading for 30-60 minutes each day around clinical cases. He explained that the added context would add meaning to I was skeptical – how the heck would that amount of reading get me to the MD?? I decided to trust my mentor and give his suggestion a shot. Not surprisingly, he was right and I continue to use this strategy to this day. My studying has become significantly more efficient, meaningful, and relevant.

7. You won’t enjoy Grey’s Anatomy as much as you did before.

You’ll cringe every time Meredith puts her stethoscope on backwards and roll your eyes when a gown’d and glove’d surgeon pulls off their face mask and then resumes operating (Has anyone heard of sterile technique? Surgical site infection?). You’ll be pretty confused as to why the surgical department at Seattle Grace seems to operate every other department. You’ll feel irrationally angry watching all the top-notch surgeons let McDreamy die with his ETT 7cm at the lip (I would have saved you Derek, even as an MS2). Actually, who am I kidding. You will love it all the same. Maybe even a little more now that you’re able to pick out some of the medical flubs and that you can answer your mom when she asks if that’s what it’s like “in real life”.

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A Commentary on My Career as a Woman in Medicine


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The following are excerpts of conversations I have had with friends, colleagues, teachers,  and strangers about my role as a female medical student, and now, as a female physician. I have held onto these comments for a long time, resentful of their implications. I am choosing to re-state them here so that I can acknowledge them and move forward. I have intentionally chosen not to provide my own commentary to let the noise of these words become reverberate and become silent on their own.

 

“What does your partner think of you being in medicine?”

“Is your boyfriend a doctor? Wait, an occupational therapist? Well, that’s kind of backwards isn’t it?”

“Well I guess we know who wears the pants in your relationship.”

“He hit the jackpot!”

“So how are you going to manage having a family?”

“I would avoid any surgical specialties – they’re near impossible to have a family.”

“There is nothing worse than being a female medical student because all the men at the bar are too intimidated by you so you can’t get a date.”

“When do you think you will start a family?”

“I’m guessing that Andrew will go into internal medicine because he’s very intellectual. You’re very nurturing and I’m betting good with kids – maybe paediatrics?”

“Women don’t belong in medicine.”

“All you female doctors just have something to prove.”

“Seems like a lot of work when you’ll probably just stay home once you have kids.”

“I bet you are a good doctor because you’re pretty.”

“You’re too pretty to be a doctor.”

“Guys must hate finding out what you do.”

“Thought you were too good for nursing huh?”

“Wait, you’re the doctor?”

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Goal-Setting 101


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September has finally arrived! For some of us, the arrival of September means returning to school; For others, maybe diving back into work after a restful vacation (hopefully out in the sun). But for all of us, the start of a new month, if we choose to recognize it, can represent a fresh, new beginning. I thought this would be a great chance to talk about goal-setting.

I will be perfectly honest, I really enjoy the process of setting goals, but tend to have a challenging time following through with many of them – especially since becoming a resident. I was first introduced to the idea of setting regular goals in my pre-adolescent years when I began competing as a national-level synchronized swimmer. We were fortunate to have coaches who were exceptionally skilled in designing appropriate training goals and breaking them down into manageable steps.

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Setting and following goals for athletic performance is one thing, but professional and life goals feel like a totally different game – but do they have to be? Are all goals created equal? What strategies can you use to ease the implementation of your goals? I am by no means an expert, but experience has been one of the best (and brutal) teachers and here is what I’ve learned:

First, I am more likely to keep to my goals if I have them written down. So, over the last six months, I have been maintaining a ‘Goal Book’. The book itself is nothing extravagant or overly exciting, but I like to think that the ideas inside are. Throughout the pages, I’ve written (or even drawn) outcomes I’d like to see happen over the next month, six months, and five years. There is something about having a visual, tangible reminder of my goals that increases my motivation and accountability.

The next strategy I’ve learned is to break down the goals into reasonable steps. One of my longer term goals is to complete a fellowship in Addiction’s Medicine. On paper (and in real life), this can seem like a tall order and pretty overwhelming; however, when I start to think about what exactly I need to do to achieve the fellowship in smaller steps, I felt much more at ease and in control. Writing the USMLE? Not a problem, when should I write and how should I study? Completing additional elective time in Addiction Psychiatry? I’d be thrilled. What setting would be the highest yield? What programs am I particularly interested in? I write down these steps as well to keep me focused and grounded. I feel in control and ready to leap over the next hurdle.

I like to make a variety of goals outside of my professional development. Not surprisingly, I spend a considerable amount of time focusing on how I can become the best physician and psychiatrist I can be. I love this journey and I would not trade it for anything in the world; however, balance is important. Making goals outside of medicine helps keep me centred and well-rounded. It also helps to reinforce some healthy boundaries between my professional and personal lives.

Finally, I check-in regularly. I like to do both mental and written check-ins and I try to keep them as time efficient as possible. At the beginning of each month, I open up my book and consider how my goals for the previous month went – did I reach them? What behaviours were particularly effective? Which behaviours could use some modification? Throughout the month, I’ll try to jot down quick notes to track my progress. At the end of month, I’ll do more of a structured check in, using a compassionate lens, and really try to reflect on how on what went well and what I can change. Keeping these check-in short (and sweet) keeps this process fun and engaging.

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How do you plan to make the most out of your September? What are your goals? Do you have any good goal-setting quotes? I’d love to hear them!